Editor’s note: The opinions expressed by the author do not necessarily reflect the opinions of the AAMC or its members.
When I was a medical student, I was assigned to work with one of the toughest doctors I have ever met.
She was a family physician who taught me about colposcopy, and her standards were exacting. She was not happy when her students were unprepared, and she’d quiz us extensively on how to check for signs of cervical cancer while patients listened. I’d carefully adjust the colposcope under her watchful eye, making tiny changes for what felt like hours.
And every time I called her Dr. Reed, she’d correct me. “Call me Elaine,” she’d say.
I didn’t believe her at first. How could my professor possibly want me to call her by her first name? I’d ignore what she said and continue to call her Dr. Reed, and each time she’d gently set me right: “Please, call me Elaine.”
Her request for title equality was totally out of sync with the complex hierarchies I had experienced prior to that point in my training. By the time I met Elaine, I had been through enough clinical rotations to realize that many of the doctors I worked with seemed to really enjoy the hospital pecking order.
We medical students had our uniform of short white coats, while more senior doctors wore long ones studded with lapel pins. Faculty sat at the table during lunchtime teaching sessions, while students ate their lunches standing at the back of the room. During rounds, trainees would scramble to be the lucky first to hand the senior resident the right piece of tape or gauze for a dressing change. Everyone seemed to know their place on the hospital totem pole. And I am certain that my experience was not unique: I’ve had many conversations with friends who went to medical schools all over the country, and they have all reported similar stories.
When I was a medical student, I was assigned to work with one of the toughest doctors I have ever met. … And every time I called her Dr. Reed, she’d correct me. “Call me Elaine,” she’d say.
This social order was unlike anything I had experienced before. I was shocked when I learned that everyone called nurses, nursing assistants, janitors — even residents — by their first names, but “Doctor” was reserved for the attendings. In my nonprofit jobs before medical school, it never crossed my mind to call my boss “Ms.” or “Mr.” I probably would have been considered a workplace oddity if I did.
We medical students may have known comparatively little about medicine, but we were undoubtedly adults, many of us with previous careers under our belts. I had worked on public health projects in East Africa before I started medical school. My classmates had been teachers, management consultants, military personnel — and yet the custom of calling our educators by their titles, just like we had done as kids, continued.
By the time I met Elaine during my clerkship year, I was used to the hierarchy, and I did my best to participate. That’s why her polite insistence that a medical student like me call her by her first name seemed unnerving at first. I worried that another student might overhear me and think that I considered myself special, somehow exempt from the expectations of my rank. I also thought her request might be a test or a trick, something that would show up on my evaluations later: “Mara had a good bedside manner, but she came across as arrogant.”
I can’t remember when I finally started to call her Elaine, but I did, and when I matched into the residency program where she was on the faculty, I continued to call her that throughout my training. And now that I am a new faculty member myself, I often think of her when I ask the students, residents, and staff I work with to do the same: “Please, call me Mara.”
It’s surprisingly hard to get them to do it. Most students I work with ignore my request, like I did when I was in training, and continue to call me Dr. Gordon. They sometimes seem flustered, like they don’t trust that I mean it.
Elaine’s gesture had a profound impact on me. She treated me like a junior colleague, welcoming me into the field of medicine. She set a tone of professionalism and mutual respect I now try to replicate.
But I do, because I want my workplace to reflect a sense of teamwork and collegiality. In retrospect, Elaine’s gesture had a profound impact on me. She treated me like a junior colleague, welcoming me into the field of medicine. She set a tone of professionalism and mutual respect I now try to replicate with my own students.
When I tell other physicians that I ask students and office staff to call me by my first name, they sometimes worry that I’ll diminish myself and my accomplishments. Yet when I worked as a trainee with Elaine, I never once forgot that she was the boss. Her request that I call her by her first name only made her appear more confident. I never confused the collaborative workplace tone she set with my own level of medical knowledge: I had a lot to learn, and Elaine was going to teach me.
I worry more that the tradition of using titles only for some in our ranks perpetuates an environment that too often belittles trainees. Medical education can be infantilizing, and faculty can forget that most students are highly motivated adults who want to become excellent doctors. Many colleagues from a variety of institutions tell me they fear that if students call them by their first names, the classroom and clinic will become too casual, and students will try to weasel their way out of the hard work of becoming a doctor.
I fear that the tradition of using titles in academic medicine is a symptom of a deeply hierarchical culture that harms us all.
But Elaine’s request to use her first name had the opposite effect on me. It made me feel like part of the team, and I wanted to rise to the occasion. She seemed to be saying, “I’m going to treat you like a colleague, and I expect you to act like one.”
I’ve heard from many fellow women physicians and physicians of color about how undermining the absence of a title can be. It is certainly not acceptable when all the men at a meeting are called “Doctor” and the sole woman is addressed by her first name. Even now, as a new faculty member, I am occasionally mistaken for a student or a nurse. Such instances can be offensive and evidence of systemic racism and sexism. So when many of my colleagues prefer to be called by their title because it confers respect, I understand. I believe that it’s important to call people what they want to be called and that when in doubt it’s smart to err on the side of formality.
But I fear that the tradition of using titles in academic medicine is a symptom of a deeply hierarchical culture that harms us all. Personally, I prefer to be called by my first name, because I think it helps every member of the team feel like they have a vital role to play. When I correct my students and say, “Please, call me Mara,” I really do mean it.