Call Me By My Name

“Roger?”

The bubbly twenty-something medical assistant poked her head out into the clinic waiting room into a sea of vulnerable faces.

Silence.

“Roger?” she repeated louder, certain that repeating the name at heightened volume would facilitate improved understanding from her intended audience.

More silence.

I turned to my father, Dr. Roger Malebranche, who sat stone-faced in his wheelchair next to me, scowling as if someone was waving rotten eggs directly under his nose.

“Dad?” I queried.

He didn’t move. He didn’t speak.

“Roger?” she repeated a third time, now utilizing a sing-song quality used when beckoning a cuddly pet animal. She even ventured into the waiting room to scan the entire area.

I waved at her, pointing to my father as I rose to get behind his wheelchair and push him into the clinic. As she held the door open so we could pass through, he broke his silence.

“It’s Dr. Malebranche,” he snapped, never once looking at her.

From the moment she used his first name, the visit was over.

In that sterile examining room, he stared at the ceiling, the walls, any object to demonstrate his willful disregard for her. He sighed and rolled his eyes as she took his vitals and asked him questions. He never uttered another word. I just sat and watched the show. We had reached the point of no return.

She got the not so subtle hint, ceasing the small talk.

“The doctor will be in to see you in a moment,” she declared before exiting the room.

“I do not want that idiot to ever speak or touch me again,” he quipped before the door fully closed, ensuring she would hear him.

“I think she got that message loud and clear Dad,” I responded.

In my 20 years of practicing medicine, I have noticed a shift in greeting formalities between staff and patients within medical spaces. My mentors taught me to begin with a proper title of “Mr., Ms., or Mrs.” when addressing a patient for the first time. It was a matter of respect. If they were a doctor and wanted to be acknowledged as such, a patient could then correct you. If they were comfortable with you using their first name, they would grant you permission to do so. But you always started with the formal title. That was non-negotiable.

Yet something has changed over time. Medical staff, everyone from the receptionist through to the clinicians, have started calling patients by their first names instead of using proper names. The reason? Perhaps a generational relaxing of stoic physician decorum over time. Some have suggested that concerns over confidentiality and privacy have sparked changes in institutional policies. Others have expressed fear of mispronouncing patients’ last names.

Additional explanations have been forwarded, all of them plausible, though I’ve often seen dynamics of age, gender, and race all play a role in the use of official titles when healthcare workers address patients. A clinician will greet an elder white woman by calling her “Mrs. Jones,” yet the same Mrs. Jones blessed with more melanin will be addressed as “Sally.” A middle-aged man will be acknowledged as “Dr. Johnson,” while the same physician adorned with more estrogen will be referred to as “Deborah.” Patterns like this and their individual level bias can be as harmful as they are arbitrary, negatively impacting patient care as the microaggressions they are experienced to be. The etiquette of welcoming patients in healthcare settings is as varied as the colors of a peacock’s feathers, sometimes with deleterious consequences.

When working with adolescents and young adults in student health, the shift to first name introductions may also reflect a generational concern about misgendering a patient during our medical greeting rituals. This can happen if you assume a gender based on someone’s perceived external appearance or gender performance. I remember a 23-year-old transgender man who used to see me for management of his hormones. His partner, sitting outside in the waiting room, would be classified as a woman by many based on anatomy and presentation, but identified as gender non-binary. I made the mistake of referring to his partner as “she” during the visit.

“They,” he politely rebuffed.

I apologized. Moments later in the visit, I referred to his partner as “she” again.

“They,” he repeated, rolling his eyes this time to emphasize his exhaustion with my lack of cultural humility. I apologized once more, and never made that mistake again. He never had to remind me again.

So what’s in a name?

For an 87-year-old Haitian immigrant physician, it’s a matter of respect. An acknowledgement of him having to work twice as hard to get half as far in a country steeped in white supremacy and racism. A recognition of the gauntlet of micro- and macroaggressions he went through that his white colleagues never did. An understanding that he came from a country where blackness is exalted and elders are respected, so first name familiarity may not be appropriate to assume during a first meeting.

For a 23-year-old transgender or gender non-binary person, it’s also a matter of respect. A confirmation that a medical clinic may be the only safe space in which no physical or verbal harm will be done to them. An appreciation that this provider-patient interaction may be the only encounter of the day where they can truly feel like themselves and be affirmed as such. A realization that it can be traumatic when a clinician assumes and verbalizes a gendered title that is incongruous with one’s gender identity, serving as incentive never to seek healthcare again.

My approach when greeting patients is simple: Lean into the more formal introductions with elders and use either titles or first names with youth and young adults, depending on my feel of the situation. Could I offend someone in the process? Sure. Will I get it wrong sometimes? Hell yeah. Could I rip off the scab of a historical wound of which I wasn’t aware? Absolutely. My technique is not perfect, and I allow myself room for the occasional blunder and create space to be corrected if I get it wrong. If I do misstep, I work with my patient on getting it right so we can have a mutually loving, respectful and affirming health partnership moving forward. I remind myself daily that if I struggle with a greeting or don’t know how to refer that the human being sitting in front of me, there’s a simple solution.

Don’t assume. Just ask.

David Malebranche, MD, MPH, is an internal medicine physician, public health official, activist, and educator who lives in Atlanta, Georgia. He appears in the YouTube series “Revolutionary Health” as part of The Counter Narrative Project and also on the #AskTheHIVDoc video series. His writings and research have been published in JAMA, the Annals of Internal Medicine, and Lancet. Dr. Malebranche also penned a memoir entitled “Standing on His Shoulders,” about his relationship with his father, which is available on Amazon.