Ashley Graham Kennedy: Do medical titles harm the physician patient relationship?

ashley_graham_kennedyIt was 4 am in the emergency department (ER). An 83 year old woman had come into the ER after experiencing an episode of disorientation and shortness of breath earlier in the evening. The resident physician and I entered her room and he introduced himself to the patient. “Hello Ms Stanley, I’m Dr James.* I will be taking care of you this evening.” “Well isn’t that nice? I’m Dr Stanley.” “What kind of doctor are you?” the resident asked. “I’m a social psychologist,” she replied.

This elderly woman’s message to her physician was clear: “Treat me with respect. I am your equal.” However, this is exactly what the use of the title “Dr” does not do—it does not foster respect of the patient on the part of the physician. When a physician introduces himself to a patient as “Dr” he, whether knowingly or not, sends a message to the patient that she is not his equal.

Titles carry the power to shape relationships. Most of us learn this at a young age. Many of us were taught, as children, to address authority figures—such as our teachers—by their titles, and never by their first names. Think back for a moment and you will probably realise that using those titles shaped the relationships you had with the individuals to whom you afforded them. And this, no doubt, was often a good thing. Addressing an individual by a title can be a way of showing respect to that person. Introducing oneself with a title can also be a way for a person to set himself apart from others.

The practice of medicine has changed radically in the past fifty years or so, and doctors no longer “call the shots,” in the way that they used to. With the rise of patient centered practice, and the widespread recognition and acceptance of patient rights and autonomy, the physician-patient relationship, thankfully, looks less and less like the one that the title “Dr” suggests. The physician-patient relationship is no longer that of a paternalistic provider to a patient. It is time that we, as a society, drop the “Dr” title, as a sign of recognition that the physician-patient relationship has changed.

More than one physician has suggested to me that the title “Dr” is required for identification purposes, especially in busy clinics, where there are many people—nurses, techs, physician assistants, security guards, administrators, and janitors—running around. Some have argued that without the use of a title, that patients might not be able to identify their physicians. But I doubt that’s the case. Introductions, surely, could do the job just fine.

The more time I spend with physicians the deeper my respect grows for their profession. The work of a physician demands that she be at once hard-working, compassionate, brilliant, and kind. It isn’t easy work, by any means. And although I object to the title of “Dr,” this is not in any way an attack on physicians, among whom I count family members, mentors, colleagues, and friends.

An introduction is the beginning of a relationship, and it’s important to start out on the right foot. No doubt this patient would likely have appreciated a simple, “Hello, I’m Tom James. I am an ER physician and I will be taking care of you this evening.” She likely would have responded, “Well, isn’t that nice? I’m Ella Stanley. I’m a social psychologist,” knowing that she had been addressed as an equal.

* The names in this blog have been changed.

I declare that I have read and understood the BMJ Group policy on declaration of interests and I have no relevant interests to declare.

Ashley Graham Kennedy, PhD is a philosopher at the University of South Carolina and a visiting researcher at Columbia University Medical Center. She conducts research on clinical reasoning and diagnostic methods and teaches courses in medical ethics to pre-medical and medical students.