Cases - Etiquette of How to Address Someone in the Exam Room - NYTimes.com A patient of mine is a dental hygienist in her late 50s who works in her son's dental practice. On her first day of work, she told me, her son asked her to call him "Doctor." And, he asked, "Is it O.K. if I call you "Barbara"?" Sure, she told him. They set to work on the first patient, and after she handed her son an instrument he needed, he graciously said, "Thanks, Mom." This got me thinking of how, in my own career, I have always been addressed as "Dr. Valinoti." Freshly minted M.D."s, some as young as 25, get a title of respect while seasoned nurses in the hospital are Betty, Kaye or Nancy. I remembered the absurdity of this situation when, as an intern, I was addressing critical care nurses with decades of experience by their first names while they deferentially called me "Doctor." These were women who had started their careers when I was still playing with Barbie dolls, yet where were their professional titles? Like most things in medical training, I got used to it, and it became second nature. One thing I am still getting used to, though, is when patients call me by my first name. There seems to be a void in this area of etiquette: How does one address one's physician? It is almost always an older patient who will use my first name, in a friendly, offhand way. And, I have observed, these patients are usually men. It might seem natural if I have had a long-term relationship with these people, caring for them over the years, but often these patients seem to make a decision at the outset to be on a first-name basis with me. I wonder about these people. Are they trying to be chummy? Is it a power thing, making them feel less vulnerable while they sit half naked on the exam table? Do they just call everyone by their first names? At first I thought that perhaps this was a phenomenon particular to female physicians. For example, a colleague with whom I worked was a distinguished physician in the community, yet, she said with a sigh, "All my patients call me "Sally." " Clearly, she did not insist on this with her patients; it had just evolved. But the male physicians in my practice have described the same situation. I remember being on call for the practice one night and speaking to a patient of another physician in my group. She went on in detail about the tests and treatment she was receiving from Adam, her doctor. After the conversation, I assumed that she was his personal friend. "No," he told me the next day. I really just only met her. Regardless of whether I am "Anne Marie" or "Dr. Valinoti" to a patient, I rarely call a patient by his or her first name. As a rule, patients who are my senior are always "Mr./Ms./Dr." Patients I meet for the first time are always addressed by their title, even teenagers (it seems silly, I know). Although many patients introduce themselves by their first name, I would never presume to address them as such without their specific permission. And even then, frankly, I find it hard to call a man old enough to be my father "Frank" or "Jim." It is akin to my habit of still addressing old friends of my parents by their formal titles. A study published in The British Medical Journal looked at the question of patient preferences regarding how doctors address them. Interestingly, most patients surveyed, particularly those younger than 65, preferred that their physicians call them by their first name. But doctors do this at their own peril. A physician friend of mine experienced this firsthand when he made the mistake of calling a woman of a certain age by her first name during a visit. "That's Mrs. White, thank you," she told him, icily. "I never forgot that one," he said, remembering how he sheepishly finished her exam. It is helpful for me to think about the doctor-patient relationship from time to time, especially in terms of how my patients and I communicate. The importance of effective communication in that setting cannot be overemphasized. Accurate diagnosis and treatment of medical ailments depend on the doctor's clear understanding of the entire person who sits before her. A good internist will recognize dozens of subtleties during a simple face-to-face interview - subtleties that cannot be detected by the most sophisticated and expensive scans. As medical costs climb skyward in our country, there is growing recognition that excellent primary care might be the foundation of a more accessible, affordable health care system. Great primary care doctors are, by necessity, great communicators. And, let's face it: all communication starts with what we call one another. Dr. Anne Marie Valinoti is an internist in northern New Jersey.