My Name is…

“My name is Brett Sinclair. Brett to my friends, but you may call me Darling.”

This is how Lord Sinclair (Roger Moore) introduces himself to “Maria” in the pilot episode of The Persuaders. One could say that he is trying to remove any hierarchy associated with his rank.

In Emergency Medicine we are proud of our flattened hierarchy. We encourage our juniors to call us by our first names, firmly believing that in doing so we are removing any barriers that may stop them asking us for help. It is one of our ways of promoting a safety culture.

Except that this is our perception, as seniors, and I wonder if we have given enough thought to what our juniors actually want? Could our perceived flattening of the hierarchy actually be creating new barriers? After all, regardless of what juniors call seniors, there will always be an actual difference in experience and knowledge. This moment of wonder first occurred to me several years ago, and then again a few months back. Let me tell you a story, so that you understand what I mean.

Once upon a time, when I was a registrar,* one of my juniors came to talk to me because something was worrying them.

“Kirsten,” they said, “I’ve just been to ask Dr ___ for advice about this patient, but before I even got my question out, they berated me for using their surname.”

“Oh yes?” I said, looking up to meet the wide eyes of my distressed junior.

“[She/He] wants me to call them by their first name. They’ve asked me to do this several times already, but it makes me feel uncomfortable, so I’ve not been doing.”

“So, what is it that makes you feel uncomfortable?” I enquired.

“Well, to me, calling someone by their surname is a mark of respect. In the same way I would call my teachers at school by their surnames, I want to call Dr __ by [hers/his] because they are who I am learning from. And, well, it just feels wrong.” They shrugged.

“Okay. So, did you explain this to Dr __ ?” I asked

“I tried to, but they didn’t want to listen,” protested the junior, “[She/He] said they would only answer me next time if I used their first name.” They flopped despondently into a near by chair.

“Ah. So, what do you intend to do about it?” said I.

“I’ll just have to stop asking them for advice.” exclaimed the junior.

As we then discussed how to talk to someone without using their name at all, I thought to myself, Dr __ has achieved the exact opposite of what they set out to do when asking the junior to call them by their first name. They have created a new barrier rather than removing one.

Fast forward several years and I am a new Consultant.

One of the Physician Associates, that I work with, approaches me during my first week. I’ve worked alongside her many times over the years in numerous placements, and we have always got on well. Being an introvert, I’m not really one for socialising, and generally avoid work nights out, so we don’t know each other outside of work.

She asks me if it would be okay if she called me Dr Walthall.

I was somewhat surprised, she has called me Kirsten for years. Why now the change to Dr Walthall?

Essentially, it was to do with what she would be comfortable with. She calls all the other Consultants by their surnames, and so to call me differently she felt was wrong and disrespectful. It was a really interesting conversation. I felt uncomfortable with her calling me Dr Walthall, because in my head it just sounds odd, and awfully grown up – which I do not profess to be. Also, very few people pronounce my surname well and, in truth, I find the mispronunciations irritating. Add to that, she’d always called me Kirsten before, so why should things have to change? Ultimately, we both compromised and settled on her calling me Dr Kirsten. It worked for the first few months, now it’s crept up to Dr Walthall, and actually I’m okay with that.

Mainly it’s because I‘ve realised that what is important in maintaining and promoting a good working relationship and a strong safety culture, is that we are both comfortable with how she addresses me at work – not simply how I want to be addressed but how she feels comfortable addressing me too.

So why does it matter what you call me, or what I call you?

Simply put, names are important. Both to the people bestowing them and to the individual who owns it, and names are frequently heavily engrained in culture.

The origin of an individuals name can have great significance. A child may be named after a relative or ancestor, or after an important event which occurred during pregnancy, labour, or shortly after they were born. Some cultures still bestow names divined through magic and incantation, and in certain cultures your name will change as you progress throughout your life, to reflect your changing identity.

In many cultures there are very strong links between names and identity. Chinese culture believes that an individual is shaped by the name they are given after birth, and that this will set them on a particular course for life. Names help us to distinguish one individual from another, whilst often retaining links to family or cultural groups. In France, Greece and Italy, you will always be the name registered on your birth certificate. In Taiwan, when you marry you retain your original surname, because your birth family and ancestry will always remain a part of your identity. In some countries when a woman marries she is still forced by law to give up her surname in favour of her husband’s, as a way of suppressing her individuality. When I reflect on who I am, I think, am I a doctor? Am I a daughter? Am I a friend? The answer is that I am all of these and none. They are all parts of who I am, but at the end of the day, I am myself, I am Kirsten Walthall.

Names hold power. Look at Voldemort. To not speak his name demonstrated fear of him as an individual. Blotting a name out of a register or society is seen as damning. Refusing to speak someones name can be a purposeful insult. A purposeful mispronunciation amounts to a distortion of identity, whereas an innocent mistake is easily forgivable. Nicknames should be approved by the recipient, they can be fluid, suiting certain times of someone’s life, but not others. Forcing a nickname onto an individual, if they do not want it, amounts to bullying.

There are blogs about how professional women should use their name, in order to control how they are perceived in the workplace. Avery Banks, writing for Forbes in 2018, recommends using your first name and your surname, because this holds more gravitas, making you come across as more professional. She advises using your title when you first introduce yourself, to mitigate others preconceptions. Banks also advises you to let people call you by your surname, noting that men are more likely to be called by their surname in the workplace, and that use of a surname relates to perceived importance. It occurs to me that my instinctive dislike of being called Dr Walthall had nothing to do with fear of creating hierarchy, but instead of imposter syndrome. I didn’t feel “grown up” enough to own it.