I have never liked the idea of showing respect for people simply because of their social standing. I am in favour of treating people with respect in a general sort of way, so being polite and considerate. I respect nature or property, so protecting or nurturing rather than damaging or destroying. I respect people for their ideas or achievements. I respect someone’s office, such as that of a judge in court or a chair at a meeting, but this certainly does not equate with respecting them personally.

What I don’t go for is respect for “grandees” simply because they are grand, and where the respect expresses itself as anything from unquestioning deference to florid knee-bending, hat-doffing obsequiousness.

How we actually show respect depends very much on our culture and in many ways is negotiated through language, in particular through the words we use to address one another. In French, as in many other languages, a declaration of respect is shown by addressing the person using the formal form of the word “you” ie “vous.” Indeed, in French culture it would be unthinkable (indeed insulting) to address anybody senior to oneself using the more familiar form – “tu.” In English, the “vous” and “tu”’ equivalents (ye, thou, thee, thine etc) have long gone, and for making the distinction we have relied heavily on titles, so addressing people either by their full title (echoing the “vous”) or by their first names (the “tu”). So in medicine when, not so long ago the “vous”- type respect was the norm, medical students and young doctors would always address their “grandees” as, say, Professor This, Sir Peter That, or Mr/Doctor The-Other etc.

But things are changing. In Australia, hospital consultants usually go by their first names, and this approach is being increasingly adopted in the UK. In many universities in the USA, students have long addressed academics by their first names, and at least in some institutions here first names are now de rigueur (when I walk down the corridor at my own medical school a large proportion of the medical students greet me with “hi Joe” or “hi Prof Joe”, and the same holds when I teach).

So does it matter if traditional indicators of this form of respect have gone? The problem is that the old order does not, and never did, simply reflect respect. Hidden in this vous-type relationship are issues of hierarchy, power, and privilege, and these inevitably make for very unequal partnerships in which the parties are divided and communication ultimately compromised. Dialogue on first name terms, on the other hand, helps greatly in removing the artificial barriers of formality, introduces a notion of equality in which the information is shared and in which all sides are open to questioning and criticism, seems to avoid what might be distortions where people say what they believe the “grandee” might want to hear rather than speaking honestly, and in a group as a whole engenders a feeling of oneness and “solidarity.”

Is there anything lost by this greater intimacy? Turning to the French again, when people go from the “vous”-form to the “tu”-form, which they will do as they get to know each other, the two parties are actually inviting one another to share their personal space. Accordingly, for a teaching environment where everyone is on first-name terms and so where all sides share more of their personal space, could the new familiarity itself lead to problems. Could it be that discipline is compromised, legitimate respect undermined, limits of friendship blurred, and differences or disagreement more difficult to voice. In my experience this is not the case. In reality there are different types of personal space to be shared, so for instance, actual physical space, emotional space, intimate space and intellectual space, and provided that the new “friendship” in medicine is based primarily on sharing intellectual space, then problems are actually rare. Importantly, legitimate respect persists but now it is earned and mutual (me for them and them for me), and when push comes to shove I can always revert to my “office” position, but this is unusual. Clearly it works because all sides understand the “rules,” find ways to detect and indicate when problems arise, and when they do occur, develop systems for their resolution.

In my view the core purpose of any academic institution is to provide a centre for learning, discovery and the sharing of understanding. It is my contention that communication on first name terms helps enhance these goals, while the old-fashioned and rigid respect systems using titles etc introduces unnecessary and damaging barriers. But students themselves still have a choice, so sometimes even now, and despite working together in small groups for weeks or months, some students persist in calling me “Professor” or even “Sir.” Interestingly, such formality perturbs the teaching environment – it certainly makes me feel very awkward.

Joe Collier is emeritus professor of medicines policy at St George’s, University of London