Friday, August 04, 2006

What's in a Name?

Second day in a row that I'm stealing ideas from Dr. Crippen over at NHS blog. I hope he doesn't mind.

Today, in Making Friends with the Doctor, Dr. Crippen writes about his preference for addressing patients by their last names (surnames) and he comments about physicians who address their patients by their first names:

I think it is presumptuous and impertinent. It is done to give the feeling of a deep and meaningful personal relationship with the patient. It is bogus.

It's okay if I say that Dr. Crippen has a way with words?

He goes on to take a survey of his readers, asking their opinions. Actually, Blog polls seem to be the thing to do these days, Dr. A has his readers dressing him and telling him how to deal with his comments.

So back to the question of what should a doctor call a patient. In psychiatry, where relationships are so intimate and boundaries are so essential, this stuff has meaning.

To start with, I'm a fairly formal person. Well, sometimes, but definitely at work. It feels strange enough in blog-o-land to address physicians I've never met as "Foofoo" and especially "Fat Doctor." Even "Shiny Happy Person" is a bit of a stretch for me, but okay, it's a blog, it's what you want to be called and I'm not your psychiatrist. At work, with very few exceptions I introduce myself to patients as Dr. Shrinkrap (no, not really, but you get the picture) and I call folks by their last names. So, it's taken me this long to say that my blog post today is not about what I call my patients.

My blog post, instead, is about what my patients call me. Psychiatry, being a bit more intimate, and being in many ways similar to friendship, inspires patient to want to be my friend (even ClinkShrink wants to be my friend). As such, some people, even people much younger than I, will not infrequently address me by my first name, sometimes over the phone before they've met me, and sometimes after a few sessions. I have to tell you, it doesn't sit right. To quote Dr. Crippen, it feels presumptuous and impertinent. And I feel like I should confront this, but the truth is it remains a bit uncomfortable for me. Mostly, I've opted out. It's usually a thing that comes up on the phone where people are most apt to use names, and what I've done so far is to simply ignore it, and to return phone calls with "Hello, Mr. X, this is Dr. Shrinkrap, I'm returning your call." I'd say that mostly works, except that it ALWAYS works. People get the message, and probably I'm missing some great psychotherapeutic opportunity to discuss boundaries and presumption and all sorts of other things, but it feels just so stiff to ask someone why they think it's okay to call their doctor by their first name, and often I imagine it's about wanting a friendship and maybe that doesn't always need to be dissected. My favorite, by the way, were the series of calls I received from a patient's physician spouse where the messages were left for me as "Dinah, this is Dr. Smith and I want to speak with you about my husband." If Dr. Smith were say 85 maybe it would feel okay, but let's just say she's not that old.

I lied. I am going to talk a little about what I call patients. Because I want to be called Dr. Shrinkrap, and I don't like what Dr. Crippen refers to as an adult-child gradient ....or what I would call an imbalance of power and respect...I'm most comfortable calling patients by their last names. People often ask that I address them by their first names, and this feels very awkward to me, especially if the patient is my age or older. For a while, I dealt with this by simply not using the patient's name. This actually isn't as difficult as it might sound, there's not a whole lot of need for names in a one-on-one psychotherapy session where no one else is in the room. When it comes up though, it does remain awkward: on the one hand it feels disrespectful to address an adult patient by a first name, on the other hand it feels disrespectful to ignore a patient's request to be addressed in a specific way. I have, after many years and probably way too much thought, figured it out only recently. When a patient asks that I use their first name, I now say, "Psychotherapy is very intimate work and because of that it's important to have some boundaries. Using last names is one type of boundary. Having said that, it's your name and I'll call you anything you'd like."

And so, Dr. Crippen, what are we writing about tomorrow?