On first name terms

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My first proper job was as a computer salesman at a big chain of electrical shops. During my induction the general manager introduced himself as John Clark.

I had just left school, and my only retail experience was from watching reruns of the 1970s British sitcoms Are You Being Served and Open All Hours, so I had no idea whether I should call him John or Mr Clark. I spent the next week addressing him as “Excuse me” and desperately listening out for cues from my colleagues.

Seven months into my first job as a doctor, and after six years of medical school, I still feel a bit uncomfortable about how to address my seniors—especially consultants. To my ear, calling doctors by their surnames has a whiff of Are You Being Served. But calling consultants by their first name, without first being explicitly invited to, would be unthinkable.

I’ve recently been experimenting with “Boss.” It does make me sound a bit like a doomed henchman in a 1980s action movie but has the advantage of having just one syllable and being a bit less stuffy.

The world has become a less formal place. Politicians don’t wear ties, gardeners don’t doff their caps, and people use first names.

What patients and doctors call each other is a different matter. Many patients prefer to use surnames. You could probably argue that it is a matter of clinical indication: that keeping a bit of gravitas with some patients can improve the therapeutic relationship.

But when patients aren’t in the room, why can’t our interactions catch up with the rest of the world?

As a medical student I was once given a comprehensive telling off for the way I was standing. “When you present a patient, stand up straight, feet a shoulder width apart, hands behind your back,” I was told. Stand at ease, in other words, which was odd, because I had no memory of ever joining the army.

Doctors are increasingly recognised not to be gods. So many scandals and screw ups could have been averted if juniors had had the courage to challenge what they were being told. Perhaps more commonly, being able to question your senior’s clinical reasoning helps you to learn why they are doing what they are doing. Getting rid of the rigid interpersonal hierarchy can only help this to happen.

Of course, the boss still makes the final call. But your seniors derive their authority from their experience and knowledge, not from outdated etiquette. The few consultants I have known who preferred to be called by their first names still had the full respect of their juniors.

So let’s be on first name terms. It’ll make work a nicer place, and it might make medicine better.