Editor’s note: The opinions expressed by the author do not necessarily reflect the opinions of the AAMC or its members.
Recently, I was selected as a panelist at a prestigious national medical conference in Phoenix, a huge honor for someone so early in their academic medical career. My co-panelists were outstanding physicians who had accomplished a great deal, and I felt blessed to be among them. I was also delighted to be discussing a topic I value deeply: promoting diversity, equity, and inclusion in medicine. But something was making me anxious.
As is customary, participants were expected to be professional throughout, including by introducing one another to the audience as Dr. “So-and-So.” As someone with an ethnically distinct name, I knew the struggles people like me face during introductions. As a researcher and national speaker on name-based microaggressions, I also knew I had to address my anxiety and try to ensure a smooth introduction.
So, I proceeded to teach my co-panelists how to say my name. “It’s O-HA-BUN-WA.” Some of them practiced, and I breathed a sigh of relief. Maybe this panel would be different. I had extra pep in my step — I felt ready to knock my presentation out of the ballpark.
Soon it became my turn to speak. The panelist before me said, “Next I will invite … ” He paused for a moment and looked at the note card I’d provided with the phonetic spelling of my name. Then he looked up, shook his head, and said, “Manny, please come up.” My head went straight down, with multiple thoughts running through it. Should I correct him? Should I have given colleagues more time to learn my name? Why did my parents give me such a difficult name? I quickly gathered myself, went up, and managed to present well despite the thoughts that raced through my brain like shooting stars in the sky.
My last name, “Ohuabunwa,” means “a child is not a slave.” I deeply appreciate the history behind this name. I appreciate my ancestors fighting against being sold into slavery decades ago. I appreciate their determination to do everything they could to protect and ensure the success of their offspring.
Name-based microaggressions, which are a subset of microaggressions, reflect bias against people with ethnically distinct names. Such name-related offenses are pervasive in our society. They include the experiences of many students throughout their school lives, during roll calls, gatherings, and graduations. They span the gamut of snide remarks, name avoidance, constant teasing, purposeful mispronunciations, racialized renaming, and daily questioning as to why one's name is “so difficult.”
Name-based microaggressions can be much less obvious than outright name-related discrimination, which includes such disturbing behaviors as selecting job applicants with racialized names less frequently than white counterparts, or offering mental health services to such people less often. But name-based microaggressions can still be deeply disturbing to those who experience them.
Why is that? Names are important, a crucial part of one’s identity.
One parent’s response when asked about their daughters’ ethnicity-based names captures some of the meaning behind names. “We wanted to give them something that they could carry with them, something they could use as strength, as home, in a world that might not always nurture them as we would want it to,” they said. They went on to acknowledge that their children’s names might be a challenge at times — and perhaps even a burden when the children just wanted to blend in. But, they went on to say, “we needed them to know that they come from somewhere, that this is their strength, their power, and the representation of our own hope for their futures.”
My last name, “Ohuabunwa,” means “a child is not a slave” in Igbo, the language spoken by my ancestors in southeastern Nigeria. I deeply appreciate the history behind this name. I appreciate my ancestors fighting against being sold into slavery decades ago. I appreciate their determination to do everything they could to protect and ensure the success of their offspring. And I appreciate that my name is a reminder to do the same for my future children — as well as for my mentees and students.
I also look with pride at my middle name, “Chibuikem,” which means “God is my strength.” It is a constant reminder to my parents that even though I was born prematurely in Nigeria, spent months in an intensive care unit, and almost died on multiple occasions, they needed to stay strong and believe I would survive. It’s a reminder to myself that I need to live a life of purpose: to take advantage of my second chance at life and do everything I can to benefit others. During my medical training, I wrote my middle name at the top of every exam I took. Like a compass, it has oriented me to my North Star. And I know that many other providers have such stories about their names.
We should care about names because of how mispronouncing or ignoring them makes others feel. In a 2021 University of California, Davis, survey of students with ethnically distinct names, 75% rated accurate name pronunciation as moderately to extremely important. In fact, name-based microaggressions can cause a range of troubling effects, such as anxiety during introductions, a negative perception of one’s culture, feeling like a burden or inconvenience, and decreased self-esteem. Microaggressions can also lead to behaviors such as code-switching, in which people who feel judged because of their name, appearance, or communication style shift how they present themselves in ways that stress and deplete them. If we truly pride ourselves on our diversity, on respecting people’s backgrounds, then learning names is an easy first step.
We should also care about names because the chances of working with colleagues with ethnically distinct names are high. A 2021 study of health care workers found that 29% of physicians, 22% of nursing assistants, and 16% of registered nurses were foreign born. Considering that “lack of respect from administrators, colleagues, or staff” is one of the highest causes of burnout, respecting names contributes not only to staff members’ well-being but to institutions’ bottom lines as well.
So, what can you do to promote respect for individuals with ethnically distinct names?
You can start by learning the accurate pronunciation of the names of such people around you. One approach for doing so is the Ask Learn Practice (ALP) model I developed in 2021. My goal was to create an easy-to-remember mnemonic to help people get past their fear of mispronouncing names. Employing the ALP model — asking for the correct pronunciation, learning it, and practicing it for future interactions — shows one’s colleagues they are cared for and respected as important members of the workplace. It can also lead to rich conversations about a colleague’s culture and heritage.
Flexibility and humility are important attributes in this endeavor. For those who do not have ethnically distinct names, that means having the humility to ask how a name is pronounced and take correction when one fails. For those with ethnically distinct names, it means having the flexibility to accept that not everyone has the capacity to pronounce one’s name accurately, even though they may try.
The ALP model extends beyond direct interactions with people who have ethnically distinct names. During a recent emergency department shift, I supervised two residents: a senior resident I had worked with several times and a junior resident on his first shift. As I was returning from a patient’s room, I overheard the junior resident asking the senior resident how to say my name. The senior resident smiled and shared how to say it. The junior one practiced a few times — and proceeded to use the correct pronunciation throughout the shift. It was heartwarming to see the effort both residents showed, and this experience highlights the importance of bystanders in combating name-based microaggressions.
Name-based microaggressions can cause a range of troubling emotions such as anxiety during introductions, a negative perception of one’s culture, feeling like a burden or inconvenience, and decreased self-esteem.
Institutions also play an important role in encouraging and celebrating name diversity. One way they can do this is by embedding name-pronunciation software into email signatures and official websites, allowing people to hear accurate pronunciations of names as many times as they want. (Companies such as Namecoach have a free version that offers a link to a person’s pronunciation name badge as well as paid versions that offer seamless integration into Outlook, Canvas, Microsoft Teams, and other systems.) Plus, they can print QR codes on name badges, instantly linking users to recordings of correct name pronunciations.
Institutions can also host grand rounds on name-based microaggressions, as I did recently, offering actionable tips such as increasing awareness of ethnic names by using them in standard educational patient simulations. In addition, interactive, Zoom-based workshops such as those developed at Stanford University have been shown to effectively encourage accurate name pronunciation among medical staff and trainees.
Finally, institutional leaders can model inclusion by learning accurate pronunciation of staff members’ names. Imagine the impact if my department chair refers to me as "Manny” instead of “Dr. Ohuabunwa” during a faculty meeting while using the “doctor” title with other team members. Such differential use of formality can be a subtle but significant sign of disrespect.
Consider this study of internal medicine grand rounds, in which researchers found that men introduced other men by using professional titles 72% of the time but introduced women that way just 49% of the time. To clarify, the use of professional titles is not the problem since some people prefer informal introductions. The problem is when people use titles in a differential manner, especially when such behaviors are directed toward marginalized groups.
Flexibility and humility are important attributes in this endeavor. For those who do not have ethnically distinct names, that means having the humility to ask how a name is pronounced. For those with ethnically distinct names, it means having the flexibility to accept that not everyone has the capacity to pronounce one’s name accurately.
I certainly experienced — and was hurt by — the differential use of formality during my recent conference appearance. Among other negative effects, the jarring contrast of the mismatched use of the “Dr.” title unearthed old feelings of impostor syndrome, which I had worked so hard to overcome.
Still, I quickly reflected on the psychological notion that impact does not equal intent. Certainly, well-intentioned people can exhibit behaviors that have inadvertent yet devastating impacts on marginalized groups. This notion allowed me to give my colleague the benefit of the doubt and to respond in a productive manner.
When I eventually made it to the podium, I took a deep breath, smiled, and began my remarks by saying, “Hello, all. My name is Dr. Ohuabunwa. It is a pleasure to speak to you all today.” Later, I approached my colleague in a gentle manner, using this phrasing: “I don’t think you meant this, but when you called me ‘Manny’ instead of ‘Dr. Ohuabunwa,’ I felt marginalized, like I wasn’t part of the team.” Such a gentle approach helps ensure that people are more receptive to correction. He apologized, and we shook hands.
Of course, I look forward to a day when I and my fellow physicians with ethnically distinct names no longer bear this burden of having our names repeatedly ignored, mocked, or garbled. Meanwhile, I will continue to advocate for awareness of how names matter deeply — and I hope you will join me on this mission to promote name-based respect for all providers.
