Much of the time I’m called Ian, and at others I’m called Dr Wacogne.  I do get called some other things, but I can’t write them here.

We’ve just greeted a new group of foundation (intern) doctors, and I have, as ever, entirely befuddled on them by emphasising that I am Ian, at all times unless I’m in front of a patient.  There is light hearted fun to be had from this – the refusal to hear them if they address a question to “Dr Wacogne”, for example.  (I call it fun, I guess they probably find it downright irritating.)  I should emphasise that this is a team rule, not one of my own invention.

They find this very difficult.  This is most evident when they’ve come from a particularly rigidly structured area of medicine – and is also resurgent when they’re about to return to a similar sort of area.

I’ve asked this group to try and work out why we, as a team, insist on it.  Of course, if they read about here, then they could win an extra prize.  These are some of my reasons.

The first and most obvious answer is that we’re a bunch of fluffy paediatricians, who all hug trees and ride bicycles with signs saying “my other car is a Prius”.   OK, well, that’s about 10% of the answer.

The second is a little deeper.  It’s to do with what I’d call asymmetry of address.  What I mean by this is an environment where one group consistently accords another a higher level of formality of address.  I was trying to think of a range of examples of this; the trouble is, there aren’t actually that many.  I might be hopelessly unworldy, but I can’t call to mind that many environments where in an exchange, person A would address person B by their given name, while expecting person B to reply using their title and surname.  I ran through a few examples in my mind, and none of them work that well.

• the relationship between Jeeves and Wooster in PG Wodehouse’s  stories.  But this doesn’t work; Jeeves is his surname, and Wooster is always referred to as “sir”.  They both use a formal form of address.  (and of course, the actual power lines in this relationship are most of the fun)
• the relationship between Sir Lancelot Spratt and Simon Sparrow in Doctor in the House.  But that’s “Sir Lancelot” and “Sparrow”.
• The relationship between a judge and a witness.  But then he or she is “My Lord” or “My Lady” and you are your title and your surname.
• The temptation to discuss one-time “Sir Alan” now “Lord Sugar” is large, but that one is so obviously aimed at demonstration of superiority it’s almost too easy
• The relationship between a teacher and the pupils.

Well, that’s it, isn’t it?  And isn’t that an odd link to make?  Because how did your teachers make you feel?  My foundation doctors are in their mid twenties; they’re adults, who can make decisions, vote, have families and so on.  And yet we still use the same form of address as a teacher would use to a schoolchild.

The third is deeper still, and goes back to my previous post.  For me it is about ensuring that the environment I’m working has the combination of a clear hierarchy  but also a shallow enough authority gradient – meaning I minimise the effort it takes other people to interrupt me in the middle of a mistake – so that I can be kept as safe as possible.  Certainly air crews have learned this lesson the hard way; the safest crews address now each other by their given names as a matter of policy.

There’s one last minor reason.  I’ve been a doctor for a couple of decades, and I’ve got a pretty big ego.  I don’t need to be reminded of my qualification all of the time; it’s lodged pretty deep into who I am now…