Sticks and Stones…

BY KIM BELLARD

According to the old saying, sticks and stones may break your bones, but names can never hurt you.  I’m not sure that still applies in a social media environment that can have real impacts on mental health of both teenagers and adults, but I have to note that healthcare seems to be pretty sensitive about who calls whom what.  

I’ll start with a new study from The Mayo Clinic about whether patients addressed their physicians by their first name.  It’s a tricky thing to get a gauge on; one could do surveys of both populations, or implant observers in exam rooms, but these researchers had the clever idea of examining how patients addressed their physician when using portal messaging.  They looked at over 90,000 messages from nearly 15,000 patients, with about 30,000 messages from 15,000 patients including a physician’s name (first or last).

The researchers don’t seem to have provided an overall percent of patients using the doctors’ first name, but they did report:

Female doctors were twice as likely as male doctors to be called by their first name;DOs were similarly almost twice as likely as MDs to have their first name used;Primary care doctors were 50% more likely than specialists;Female patients were 40% less likely to use first names when addressing their physician.

The authors noted that they don’t know if physicians had expressed preferences about how they should be addressed, but warned:

The pattern of addressing physicians with different titles based on gender, degree, and specialty may be forms of bias…Whether being informally addressed by other medical professionals or patients, untitling (not using a person’s proper title) may have a negative impact on physicians, demonstrate lack of respect, and can lead to reduction in formality of the physician-patient relationship or workplace.

In a New York Times article about the study, Debra Roter, an emeritus professor of health, behavior and society at Johns Hopkins’ Bloomberg School of Public Health, said: “Doctors might find it [patients using first names] is undermining their authority.  There’s a familiarity that first names gives people.”  However, doctors calling patients by their first name also carries risks, she acknowledged: “It could infantilize the patient or establish the paternalism of the doctor.”

Similarly, in an accompanying commentary, two female physicians (who were not involved in the research) state: “Use of formal titles in medicine and many other professions is a linguistic signal of respect and professionalism,” although they also add: “Such respect in professional communication should be bidirectional, as medical students learn early in training to ask patients how they prefer to be called during medical encounters.”

Most of my physicians must have missed those classes.

I’ll note that pharmacists these days have PharmD’s, and physical therapists have DPTs, but few of us have qualms about addressing them by their first name. Lawyers have a JD, but don’t usually insist on being addressed by the title. University professors and judges are the only two other professions I can think of with expectations about being called by their title instead of their name. Make of that what you will.

I don’t know what most physicians prefer to be called, but I know what they hate to be called: providers. I don’t know how many op-ed pieces, tweets, LinkedIn posts, etc. I’ve seen over the years in which physicians complain about the practice.  It’s been associated with how the Nazis minimalized Jewish physicians in 1930’s Germany, called “a powerful tool to confuse and dehumanize a physician,” and led to warnings that “the adaptation of this terminology led to medicine being thought of only as a business, a commoditization of care.”  

Using “provider” to describe physicians, physicians say, disrespects them, understates their years of training, confuses patients, causes “moral injury” to physicians, and may lead, or at least contribute to, physician burnout. A rose by any other name might still smell as sweet, but a doctor by that term is, apparently, catastrophic.

I have a pretty good guess as to how physicians who object to being referred to as a provider probably feel about being called by their first name.

While we’re being sensitive, some of us have an issue with being referred to as a patient.  I’ve written before that use of the term is a design problem.  It’s an implicit expectation that we should literally be patient (think of all that time we are expected to just wait), and trust in the greater expertise of physicians; as Dr. Roter noted, it infantilizes the patient and perpetuates the paternalism in the physician/patient relationship.  Moreover, it ignores our existence outside the healthcare system, failing to acknowledge that we have lives outside of it and how those lives impact our health.

As Matthew Zachery recently wrote about the practice, “We are no longer people.”  He goes on to elaborate:

We are products on a shelf, numbers on a page, ink stains on a fax transmission, and zeroes and ones existing only in data centers polluting the earth with their carbon footprints. Patients today are loss-leading, actuary-derived, health-economic meat on a stick.

And to think that some physicians believe that it is using “provider” which led to the commercialization of health care.

Mr. Zachery prefers the term “consumer,” as does my friend Jane Sarasohn-Kahn, but I have to admit that I don’t like that term much better.  We don’t do much intelligent shopping in health care: we don’t really have the right tools, not much in the system is oriented towards encouraging us to try, and there are too many health episodes when we have neither the time nor inclination to consume wisely.  

The bigger problem, as I’ve also written about before, is that, forget healthcare: we’re not really very good consumers of anything.  The concept of a “rational consumer” is a “myth,” says psychologist Peter Noel Murray.  We’re swayed by too many superficial factors that often bear little relevance to quality or value, whether that is healthcare, mobile phones, or automobiles.    

So here’s where I come down: to all the people working in healthcare, or those using healthcare services, who have issues with what they are called: get over it. If that’s the problem in healthcare you are focused on, you are focusing on the wrong problem. Healthcare has much bigger problems, that need more immediate solutions, and I hate that anyone is spending any extra time or emotional energy on this particular issue.

Treat people with respect; treat them as individuals, whether they are doctors, people receiving services, the person cleaning up, or anyone else.

Kim is a former emarketing exec at a major Blues plan, editor of the late & lamented Tincture.io, and now regular THCB contributor.