Is it wrong/unethical for a psychiatrist to allow a patient to use his/he first name?

Factual Questions
1

Just like it says. Is it considered unethical or not professional for a psychiatrist to tell her/his patient, “if it makes you feel comfortable, you can call me Fred”? You know, whatever makes the patient feel at ease?

I suppose this might not be a GQ, but there might be some official handbook or some doctors here might know what’s considered kosher or not.

I know with some therapists I’ve had, who were not doctors, I was never exactly told that I could call 'em by their first names, but I always thought of them as “Fran” or “Mary” or whatever. But would it be different for a psychiatrist? And why, since the relationship between patient/therapist and patient/psychiatrist is basically the same, other than dispensingwise?

2

I’m not sure this has a factual answer, but I’m going with ‘‘no.’’ I can’t see that calling a psychiatrist by his/her first name, absent any serious boundary issues, would be in itself unethical, or even affect the relationship in any way. I called my psychiatrist by her first name for years. I’m willing to bet it didn’t affect the success or failure of any prescribed medication.

3

In a culture in which it was a sign of great intimacy to use the personal name, or the informal pronoun, it might be. But that’s certainly not the case in English-speaking society any longer. My therapists have generally introduced themselves by first names with no further comment.

4

Funny, I call my therapist by her first name but my family doc by Dr. Lastname. The relationship between the the two physicians and me are completely different so it works. I never even considered addressing the therapist by Dr. Lastname. I’m fairly certain that she introduced herself to me by her first name only…

5

The American Psychiatric Association’s Ethic Guidelines are here. From a quick look, I don’t see anything specifically prohibiting use of a first name.

6

That’s interesting, thanks all. I saw a few discussions online but couldn’t find anything solid. Doesn’t seem as if there is a hard-and-fast rule.

7

I was going to weigh in with my own opinion, but instead I am querying a psychiatrist friend of mine about his opinion. More later, I hope.

8

Ooh thank you, Qadgop the Mercotan! I’d really appreciate that.

9

Ok, heard from my pshrink buddy:

Q: What do you think of having a psychiatric patient call their psychiatrist by their first name?

A: There is not a simple answer to the question…

some of the issues are about the nature of the doctor patient relationship…for example is the patient seen soley for medication managment, versus combination treatment with medication and psychotherapy, versus longer term depth psychotherapy with little emphasis on medication - the frame of treatment and both the patients and doctors expectations may be different in each of these.

whose ‘choice’ is it? the patient or the doctors? Is the patient being overly familuer with the doctor or visa versa?

Context may also help understand what it may mean. If the patient spontaniously and without the doctors concent uses the doctors first name does it denote hypomania, mania or narcissism? Does the patient only use the doctor’s first name at times of immature acting out in treatment?

Are there ethnic/social class differences. For example I have seen many young African Americans call me Mr…but it seems an honorific that has special use. Do they culturally understand Dr…or is Mr even higher to them? Try treating profesionals and they all want to call you by your first name…it may or may not be appropriate.

As for myself, I have never been just ‘Carl’…I am willing to admit I have biases, meaning since 18 years old, I have always had some title, Private, Sargeant, Doctor, etc so I feel very uncomfortable without it. I have been Dr C, Dr Carl, and Dr Young, depending on individual patients…and usually with discussion about the meaning and why and was I okay with anything other than Dr Young.

hope this helps,

Carl

10

If a healthcare professional calls me by my first name I do the same. Health care is a collaboration between provider and patient. Putting themselves in a position of greater authority, providers subvert that partnership.

That said, I’m unfamilar with psychiatric interaction. It may, as QtM’s friend said, the disparity may be important to the therapy.

11

Interesting QtM.

The more I think about it, I call my therapist (talk therapy only) by her first name but I call my psychiatrist (meds only) by “Dr. Lastname”.

I’m guessing it’s believed to be more “comfortable” to the patient to be more open to talk with “John” or “Betty” instead of Dr. Lastname.

12

Excellent answer and of much help, QtM (or perhaps that should be Dr. QtM :D). Thank you very much for going to the trouble of asking, and please thank Dr. Carl for me if you get a chance.

His response puts me at ease, because my own thinking was along the lines of his wonderfully detailed answer: that it would indeed depend on both the form of treatment/therapy, but also the specific doctor/patient relationship.

It seems to me that with some patients, the pdoc might offer the use of his/her first name depending on whether the pdoc suspected this particular patient might be more comfortable by doing so (if, say, the patient had a fear of authority figures or doctors specifically and seemed to be ill at ease). I think a sensitive psychiatrist might say something like, “please feel free to call me Jane if it makes you comfortable” in such circumstances.

I don’t think it would necessarily be appropriate for a psychiatrist to tell the patient to use a first name, but offering it as a possibility – that’s left up to the patient – seems like a kind thing to do. At least if the doctor senses that this might be better at making the patient more at ease. Sort of like what picunurse says: in some cases, the doc might want the patient to feel this is a collaborative effort. At other times this might not be effective.

Anyway, I’m glad my instincts were correct, at least as far as it not being a cut-and-dried situation.

Personally, I’ve had a few different talk therapists, including one who was a psychiatrist, and a few meds-only psychiatrists. All of the docs were Dr. ____, no matter what the relationship was. But with the talk therapist pdoc, whom I liked very much, I felt a bit awkward referring to her as Dr. ____. I never had the nerve to ask her if I could refer to her with a first name, however, because I thought she’d be insulted.

(But this question doesn’t actually relate to me – it cropped up when I was writing a scene with a fictional shrink and I became curious.)

Anyway, thanks very much for all the answers so far!

13

For talking therapists, in Australia the vast majority use their first names. I cant think of anyone doing otherwise in fact. Its fairly common with doctors too, although less so.

It might be clinical useful to note changes in names being used or the like and that might be worth exploring, but I couldnt imagine it ever being considered unethical here to tell anyone it was OK to address the professional by their first name instead of their title. Nor can I think of it being inherently an ethical issue if the client decided to call the professional Brucie and that the professional normally would have an obligation to enforce their title in that situation.

Of course it would be impolite to insist on someone using a less formal mode of address, if the person was clearly uncomfortable with doing so. Thats just basic manners really.

I can think of some contexts where it would be a problem I guess, eg a client says they love the professional then the professional says ‘call me Bruce’, but in your normal first meeting scenario ‘what can I generally call you’ situation that the original question refers to I cant.

I suspect this is more about cultural or professional tradition or status than a really being an ethical issue as such. if it is one, practitioners seem to be surviving just fine without worrying overmuch about it, at least in the Australian context.

Otara