The doctor is in: Calling yourself a Dr.

What does it mean when a patient addresses you by your first name? Even when offering psychiatric help for the low price of five cents, Lucy (from the Peanuts comic strip) referred to herself as “doctor.”

In an article published in JAMA Open Network in October 2022, researchers analyzed the electronic messages delivered to more than 1,000 physicians and found that female physicians were more than twice as likely to be addressed by first name, a practice the authors referred to as “untitling.” Unsurprisingly (to me at least), male patients were more likely to refer to their physician by first name than female patients.

Many psychologists keep with the convention of introducing themselves as Dr. (last name) to patients. I’m not aware of studies that address the topic, but it seems that a minority of healthcare professionals refer to their patients as Mr., Mrs. or Ms. or routinely ask for permission to call patients by their first name.

I started in a traditional psychiatric hospital setting in the early 1990s, where psychologists were treated as having lessor status compared to their psychiatrist colleagues. The MD degree was a prerequisite for operating at the highest levels in that meritocracy. In that context, it is hard to fault psychologists for wanting to be called doctor to establish an atmosphere of interdisciplinary mutual respect. Medicine is nothing if not hierarchical and no one wants to be on the lower rungs of a hierarchy.

My earliest impressions about what it means to be called “doctor” were formed by observing my stepmother. She was a pediatrician who worked in a community health center in one of Hartford’s poorest neighborhoods. Frequently on call, she always answered the telephone (which had a rotary dial and was still attached to the wall back in the 1970’s) with a warm tone, “This is Dr. Troja, how may I help you?”

She appeared to be both completely confident in her role and wholly respectful of her patients. She had no difficulty with the fact that my sister and I called her by her first name, even from young ages. Her example demonstrated to me at a young age that being addressed as “Dr.” or by first name made little difference in how she thought of herself.

Very early on in my career, my one attempt to leverage the “doctor” title backfired in a memorable way. I had tried for weeks on end to reach a local high school principal with the goal of persuading him to allow my team to conduct a survey in the school. His secretary had fended me off multiple times and after a couple of weeks with no phone call returned, I tried one last time. I used my Dr. title and told her that I was following up on my prior call. She however, only heard the word “doctor” and put me through directly, assuming that I was, in fact, his doctor, calling for an important medical reason. Unsurprisingly, this only served to irritate him and access to conduct the survey was denied!

Doctor is from the Latin word, “docere” meaning, “to teach. People with doctorates have achieved the highest level of education in their field and from this perspective, are more than entitled to use the title.

But in clinical practice, how important is it that our clientele use this level of formality? Most patients arrive at the psychologist’s office in a vulnerable state and establishing a hierarchical relationship may be counterproductive. Clients follow the clinician’s lead and call the psychologist doctor or by first name, if that is how they refer to themselves.

I am comfortable with using the Dr title, but I don’t use it to introduce myself to patients. Some of my clients always call me Dr. Anderson, while others always call me Ellen. I have not observed that there was any difference in the degree of respect accorded.

It is not uncommon that women and people from under-represented groups are not accorded the same level of recognition as that given to their white male counterparts in the workplace. For this reason, it may be important to adopt a more formal stance in some professional settings.

Similarly, there are settings and contexts in which being on a first name basis is inappropriate. Not long ago, my uncle, who is in his 80s, wrote to tell me that he was recovering from lung cancer surgery. Not content to simply express his appreciation at the excellent care provided from his medical team, he told me that a team of “lady doctors” had cured him! I refrained from commenting that using “lady” as modifier to any profession, is both antiquated and covertly disparaging and instead, sincerely wished him well.

Despite my belief in the importance of parity in the professional setting, I don’t see it as necessary to refer to myself as Dr. Anderson with my patients I feel comfortable with introducing myself by first and last name. Some patients call me Dr. Anderson or ask what I prefer to be called. Others follow my lead and call me by my first name. So, going back to the original question, what does it mean when a patient calls me by my first name? From my perspective, not a thing.