Over 40% of patients refer to their doctors by their first names, with female doctors, general practitioners, and doctors of osteopathy more likely to receive this informal treatment, according to a new study published in JAMA Network Open.

Patients are calling doctors by their first name

For the study, researchers from Mayo Clinic analyzed messages their patients sent to their physicians between Oct. 1, 2018, and Sept. 30, 2021. In total, there were 90,830 messages sent to 1,092 physicians from 34,829 patients.

Of the participants, 14,958 patients addressed their physician by their first name either in the greeting or closing salutation of a message. Roughly a third of all messages referred to the physician by their first name instead of their title.

According to the researchers, female physicians were more than twice as likely as male physicians to be called their first name. Primary care physicians and doctors of osteopathy were also roughly 50% more likely to be called their first names.

When it came to patients, male patients were more likely to call their doctors by their first names than female patients. Overall, female patients were around 40% less likely to address their physicians by their first names.

Age, either of the patient or the physician, and whether the physician was in training did not affect whether patients called a physician by their first name. However, the researchers noted that they could not account for whether a physician preferred to be addressed informally or for "potential cultural, racial, or ethnic nuances in greeting structure."

Overall, the researchers said that "untitling (not using a person's proper title) may have a negative impact on physicians, demonstrate lack of respect, and can lead to reduction in formality of the physician-patient relationship or workplace."

How doctors feel about this 'tilt toward informality'

According to the New York Times, some doctors likely do not appreciate the "tilt toward informality" when patients refer to them by their first name. For example, a survey from 2000 found that 61% of physicians said they were annoyed when patients addressed them by their first name.

Debra Roter, an emeritus professor of health, behavior, and society at Johns Hopkins University's Bloomberg School of Public Health, said using a doctor's first name may overstep the professional boundaries between them and their patients.

"Doctors might find it is undermining their authority," Roter said. "There's a familiarity that first names gives people."

Roter also noted that a doctor referring to their patients by their first names could be problematic. "It could infantilize the patient or establish the paternalism of the doctor," she said.

In an accompanying commentary, Lekshmi Santhosh and Leah Witt, both from the University of California, San Francisco, said the study's findings reveal "a subtle but important form of unconscious bias" against female physicians, primary care doctors, and doctors of osteopathy.

"Use of formal titles in medicine and many other professions is a linguistic signal of respect and professionalism," they said.

Going forward, the study's authors said that efforts to improve any negative effects of untitling "should focus on a supportive culture," with a specific emphasis on how to address unconscious biases. Some examples of potential efforts include "formal guidelines, practice changes, direct patient education, and further research to explore other areas of unconscious bias." (Kolata, New York Times, 10/13; Archie, NPR, 10/14; Harvey et al., JAMA Network Open, 10/5; Henderson, MedPage Today, 10/5)