Medical students calling doctors by their first name

Earlier this week, I stopped by the Academic Building to drop off thank you letters to the two doctors who helped me with my Spring break clinical interlude. I was planning on just leaving the letters with their respective secretaries, but I turned the corner and Dr. S. was standing right there. "Hi Josh!" I said, reflexively. I was immediately mortified that I had called him by his first name.

Dr. S. is young for a neurosurgeon, has a very laid-back personality, and looks a lot like a friend of mine back home, all of which contributed to my mistakenly calling him by his first name. He didn't notice - or, at least, he didn't appear to care much about the informality. A quick mental calculation, and I decided that it would be more awkward apologizing for my slip-up than to mask my embarrassment and carry on. (Aside: He ended up showing me angiogram images of a patient with a very large aneurysm coming off the anterior cerebral artery and invited me to the surgery the next day. It would have been fascinating, but I regretfully declined because I had class.)

This incident brought up the issue of how medical students should address doctors. I grew up around doctors - none in my family, but many of my close family-friends are doctors, and I obviously call them by their first name. When I was doing research at UCSD, the doctors who I worked with regarded me as a colleague, and I also called them by their first name. As a medical student, though, I have entered a long-established pecking order in which seniority is given its due respect. With this in mind, I've developed the following guidelines for addressing doctors (to be taken with a grain of salt):

1. ALWAYS address an attending physician as "Doctor." If he/she invites me to be more familiar, I still address him/her as "Doctor" in the professional setting. Usually, I just try to dodge the situation entirely by avoiding the use of pronouns when possible.

2. ALWAYS address an established or older physician as "Doctor" at first. If interaction with this doctor is out of the clinical setting and he/she invites you to be more familiar, then I usually feel comfortable using his/her first name. Roles can change, though, and I would definitely switch back to "Doctor" if we were later interacting in a clinical setting.

3. ALWAYS address an intern/resident as "Doctor" at first, but it's likely that he/she will be much less formal with you and expect the same in return. I've found that younger doctors in general aren't quite used to their title yet and still remember clearly what it felt like to be a medical student. During my Spring break clinical interlude, every single resident introduced themselves to me by their first name and expected that I address them as such, even in the clinical setting.

These guidelines (which I've instinctively understood but never before spelled out as I did in this post) have helped me avoid most embarrassing breaches in etiquette - when I'm sensible enough to follow them.