What's in a name?

Many older people, in particular, don’t like to be called by their first name; nor do they like to be called ‘love’, ‘sweetheart’, ‘darling’, or any other so-called term of endearment, yet some people do it all the time.

When I worked in the hospital, on admission nurses would usually ask their patients whether they would prefer to be addressed by their first name or as Mr, Mrs, Miss or Ms. It could be argued that this is a loaded question which perhaps implies that nurses want to be on first-name terms, especially if the nurse has already introduced him/herself using their first name, and many patients will feel pressurised to comply with this expectation. Obviously some won’t mind, others will prefer to use their second name.

Years ago nurses were always expected to address patients formally - Mr, Mrs, Miss, Ms; and the nurses themselves would be known as Nurse and then their last name. With such rigid social conventions no longer the norm, walking the line between formality and informality is a difficult one.

I remember one relative commenting to me: “My father’s name was Samuel James Johnson*. He preferred to be addressed by his last name – Mr. Johnson. To close family only he had a preference to be known by his second name James, as he intensely disliked his first name. But, after being admitted to hospital, despite my mentioning this to the staff on several occasions they persisted to call him by his first name, Samuel. He felt it was demeaning and responded by withdrawing from them.” Clearly, an attempt to break down barriers through informality had only created yet a bigger one.

Doctors still generally prefer to be known as ‘Doctor’, but nurses now are usually more informal and using their first names. But is this a good thing? It is argued that doctors ought not to use a patient's first name unless the patient also uses the doctor's first name. In short, patients should always be addressed with the same level of formality. This is so even when patients invite doctors to address them informally. Doctors identifying themselves by title and last name while calling patients by their first name can be seen as offensive and condescending. But what happens with the nurses who are known by their first name, but have patients who wish to be addressed more formally by their surname? Does this demean the nurse? Would nurses get more respect if they introduced themselves as, for example, Nurse Jones? Would the clarity of the title also mean less confusion for the patient between who were nurses and who were the HCAs etc? Having been introduced formally, if the patient was unable to remember the nurse’s name they could simply call him/her ‘Nurse’ in the same way as doctors are often simply referred to as ‘Doctor’.

These problems are acutest when a doctor addresses his patients informally while expecting or encouraging formality in return. Does this also create a bigger barrier between a nurse and doctor if one is addressed formally and the other not? Friendly peers on first-name terms are seen as equals, someone who sees themselves as socially superior expects to be addressed formally and are apt to refer to subordinates on first name terms.

If you think of the service industries, it is considered acceptable for the customer, Mr or Ms Superior, to call the server by their first name, indicating that the customer is superior. This doesn’t work well in healthcare when nurses want to be seen as professionals to be listened to. It can also be argued that the nurse permitting the use of her first name is undermining his/her professionalism and autonomy.

If informally addressing patients is seen as disrespectful, one reason for that may be the effect it has of identifying the patient as in some way inferior to the doctor; an identification with potentially wide-ranging ramifications. Nurses, on the other hand, have the predicament of putting themselves in a more servile role by using their first name and addressing a patient formally, and they may not be respected as much as they should be. This also applies in the nurse/doctor relationship and the nurse using her first name could make patients see him/her as inferior not only to the doctors, but also the patients.

If informally addressing patients tends to emphasise their status as inferiors, that is a powerful moral reason to stop doing it. If a patient's perception of him or herself as an inferior works to inhibit him from asserting his right to participate in treatment decisions, in a morally objectionable way, it can compromise the care and treatment he receives.

At times informality permits useful power. Given that good care includes the persuading of lifestyle changes, it may be in the best interest of some patients. If someone eats, drinks, and smokes too much, the health care professionals perceived superior power increases the likelihood that the patient will comply.

Sometimes a patient will invite informality towards himself because he covertly wishes to establish his dependency and servility towards the health care professional. But imagine another person needlessly addressing you by your first name, while wishing you to use his/her last name. How could you not resent it? Are nurses unwittingly making themselves appear inferior by using their first names? Would a more formal approach engender more respect for the nursing profession? What about in business? Should we go back to adopting the same level of formality in address people used to have in the good old days?

*Names have been changed.

#Nursing #Respect #Authority

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