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Independents' Day

Why I’m happy being ‘Heather’ to my colleagues

Dr Heather Ryan

Dr Heather Ryan

Most GPs would rather do a PR without gloves on than admit that Jeremy Hunt was right about something.

But in the past few weeks, he has managed to be right on two occasions: firstly, by calling for a review of medical manslaughter cases in the wake of Hadiza Bawa-Garba’s ordeal at the hands of the GMC; and, secondly, when he suggested that nurses should be able to call senior doctors by their first names.

A quick sweep of medical social media shows that his latter comment was widely misunderstood as referring to the doctor-patient relationship, and most GPs consequently ridiculed or ignored the suggestion.

I would certainly feel uncomfortable if patients routinely addressed me by my first name – the formality of being known as Dr Ryan creates a much-needed distance that helps maintain appropriate boundaries with my patients.

How will we ever have a true patient safety culture if junior doctors and nurses are routinely shouted at, belittled or ignored?

However, that’s not what Hunt was talking about. I too am vehemently in favour of flattening the hierarchy that still plagues the medical profession.

New entrants to medical school learn fast that they are at the bottom of the food chain, and in my experience, young doctors are treated little better even after they have qualified. Sadly, teaching by humiliation is still commonplace. In any other profession, would it be considered normal for a boss to pick apart a junior’s work in front of the whole team, or shout at them if a piece of work was not completed to their satisfaction?

But how will we ever have a true patient safety culture if junior doctors and nurses are routinely shouted at, belittled or ignored when they ask their seniors for help?

I have experienced first-hand the difference that a first-name culture makes. When I was an SHO on a medical rotation, I found it demoralising that, on ward rounds, the consultants would introduce themselves to patients as Dr Surname, and then would introduce me by my first name.

One day I was doing the ward round with one of the more approachable consultants, who I will call Derek Smith. As he said, ‘Hello, I’m Dr Smith’, I interjected, ‘And I’m Dr Ryan’. He paused for a second, nodded, and continued the consultation. From that moment onwards, Dr Smith not only introduced me to patients by my title, but also referred to himself by his first name when speaking to me.

It felt like an important barrier had been broken down, and there was a palpable feeling of mutual respect between us. Our working relationship was more effective as a result, and one of the other consultants in the department started to use his first name with juniors as well.

When health professionals feel unable to raise safety concerns, or if their voices are not listened to, patient care suffers. The most famous example of this is the death of Elaine Bromiley, who experienced hypoxic brain damage after anaesthetic problems during routine surgery.

The investigation into her death found that two separate nurses tried to make suggestions about how the emergency should be managed, but they were ignored. On a wider scale, the first inquiry into the Mid Staffs scandal found that a culture of bullying, in which nurses felt they could not raise concerns with senior members of the nursing team, contributed to poor care.

In this context, Hunt’s suggestion that nurses should be allowed to call doctors by their first names makes a lot of sense. The medical profession is anachronistic in this regard; you rarely hear of staff in law firms or schools being forced to call their bosses by their title and surname.

To an extent, this is a problem which affects hospitals more than general practice: many GP partnerships, including my own, encourage all members of the team to call each other by their first names.

Indeed, one of the things that most impressed me about my medical school and F2 GP rotations was that first-name culture and the sense of mutual respect it engendered. Yet there are still surgeries in which this does not happen; if this applies to your workplace, I would challenge you to ask yourself why, and what this hierarchy achieves.

It is important that seniority and experience are respected, but all members of the team make a valuable contribution to patient care. Allowing your practice team to call you by your first name won’t eliminate that hierarchy overnight, but it is an important step towards making staff feel valued and helping to keep our patients safe.

Dr Heather Ryan is a GP partner in Derbyshire


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Readers' comments (4)

  • This is far less of an issue than teaching doctors how to introduce themselves to people outside their team.


    'Hello I'm Dr BigandSmall, a GP. Who am I speaking to'

    'Urology on call'

    'Hello. I'd like to refer a patient. Can I ask who I'm speaking to?'


    'Hello Rajveer. Can I ask what your role is?'

    'SHO on call.'

    'Many thanks... continue with referral (as I can't be bothered to find out surname at that point)'

    It's not hard to train yourself to pick up a phone and say 'Dr BigandSmall, paeds SHO' or whatever your title is that day. But it is professional and important.

    When meeting patients one should introduce yourself by name, using the title Dr, so they know who you are.

    Some doctors are offended if a patient subsequently thinks they were a nurse. Isn't that a failure of the doctor by not saying 'I am Dr X, Registrar for the cardiology team' on meeting them?

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  • Curiously, I remember as a medical student at Leeds being called a mixture of FirstName in the lab/tutorial ( especially in first 2 years) but in hospitals, and in lectures after having been met in the hospital, as 'Dr Surname', even by staff who called us 'Firstname' in earlier years. This is of course not strictly correct, as students were not qualified doctors, and nowadays it is rare for us to have proper 'doctorate' degrees. But I think it gave us a sense of responsibility as well as keeping the doctor-(student)-patient relationship more formal.
    I have worked in a variety of hospitals and teams, and with medical students and PRHOs, where I generally was referred to as 'Dr Surname' with patients, but 'Firstname' amongst staff (doctors, nurses and support staff), although when referring to third parties, staff of most grades tended to use 'Dr Surname' to other staff too. There were, and still are, always exceptions, and sometimes individuals are inconsistent, but usually use 'Dr' with patients - a big exception was in paediatrics, and I have continued to use this useage since: we were often referred to as 'Dr firstname'. It just ocasionally caused confusion, as to staff outside the team, it sometimes looked like Paeds wards had excess doctors as some could be counted twice!
    Now, as a GP, many patients call me 'Dr Surname' at work, but 'firstname' outside work, which is nice - I feel they are openly acknowledging the work/home boundary. But I still always introduce myself as 'Dr Firstname' if children are present.
    Some staff have unfortunate names. They just have to be referred to by the one least likely to cause offence or fear. (yes I know a few, but should not mention without consent!)

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  • End of the line?

    As a locum..
    like Clint Eatwood (westerns)
    I am quite happy being the man with no name
    (the Locums here etc)
    quite happy to be referred to as "doc"

    My name is only important when someone wants it spelled out over the phone to cover themselves..
    In which case I ask them to spell theirs aswell
    (just to annoy them.. )

    LOL those guys at the hospital who start stringing titles
    and get pissed off if you dont use them all
    Professor Sir Sir MR ....
    (ffs get a life)

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  • Common courtesy should always prevail, the rest just doesn’t matter. Mr Hunt should perhaps refocus his endeavours to supporting an NHS that is f****d IMHO

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