It’s common practice for patients to address physicians using the title “Doctor,” to acknowledge the doctor-patient dynamic and signify respect.
An analysis of electronic messages from patients shows that women doctors were twice as likely to be called by their first names instead of "Doctor" than male physicians. Women physicians are also often mistaken for other healthcare professionals.
Women physicians and their male colleagues can intervene by promptly addressing misguided comments, gently correcting patients, and establishing boundaries.
How would you feel if a patient dropped the term “Doctor” and instead called you by your first name? If you're a female physician, odds are, you may feel less respected.
Calling a physician "Doctor" is an established social custom that demonstrates respect and recognizes the physician-patient relationship. And while some physicians may prefer that patients call them by their first name, others—particularly female doctors—may see it as gender bias.
In an analysis of electronic communications between patients and physicians, women doctors were twice as likely to be called by their first name than males, according to a study published in JAMA Network Open.  Research has provided steps to help physicians mitigate the harms caused by potential gender bias and reassert their authority.
Women more likely to ‘lose’ their title
Women physicians often bear the brunt of patient gender bias, research has shown.
Authors of an article published in the Canadian Medical Association Journal wrote that in face-to-face medical situations, patients often call female clinicians “Honey” or “Sweetie,” and assume they’re inexperienced—or simply not a doctor.
This communication dynamic persists when patients interact with their physicians through electronic messaging, too.
Titles dropped online, as well
The JAMA Network Open study reviewed electronic messages sent by Mayo Clinic patients to their physicians via the electronic medical record system from October 1, 2018, to September 30, 2021.
Researchers evaluated the messages with a natural language processing algorithm to examine the level of formality patients used in their greetings. The authors defined a formal greeting as “Dr. (or Doctor) Last-name” or “Dr. (or Doctor) First-name Last-name.”
After adjusting for patient gender, messages sent by others on the patient’s behalf, and physician age, degree, level, and specialty, researchers found that women physicians were more than twice as likely as men to be addressed by their first name.
The study also showed that DOs were twice as likely to be called by their first name, while PCPs were 50% more likely to be addressed this way. Women patients, however, were 40% less likely than their male counterparts to place their doctor on a first-name basis.
The researchers commented that when a doctor’s title is dropped, whether by patients or professional colleagues, it negatively impacts the doctor. It conveys a lack of respect, and it reduces the formality of the doctor-patient relationship and the medical setting.
The authors, therefore, urged institutional leadership to uncover and address hidden biases, even if that means establishing formal guidelines and patient education plans. Such efforts will help instill a culture of support.Related: Real Talk: When women doctors are victims of sexual harassment
How does it make doctors feel?
To get first-hand knowledge of how title-dropping can impact women physicians, MDLinx spoke to Kristen Fuller, MD, a regular contributor to MDLinx as Medical Advisory Board member, writer, medical reviewer, and Real Talk columnist.
"I have been called ‘Miss,’ ‘Kristen,’ and ‘Dr. Kristen’ more times than I can count."
— Kristen Fuller, MD
“It used to really bother me because I viewed it as a sign of disrespect. However, over the years, I have lightened up about it and have actually introduced myself as ‘Dr. Fuller,’ but tell patients they can call me Kristen,” Dr. Fuller recalled.
“I sometimes do this to help patients feel more comfortable with me as their doctor—and as a person,” she said. “[This] can ease them and allow them to open up so we can get to the bottom of their diagnosis.”
“On the other hand, if a patient is showing signs of disrespect and calling me by my first name with a disrespectful tone, I will quickly correct them,” Dr. Fuller added.
“As a patient, I would always address my doctor by their title, but I call my veterinarian by his first name since that is what he goes by,” she said. “I really think it depends on the patient-doctor dynamic and how comfortable the physician is with it.”
"I do not think it is ever solely up to the patient to decide."
— Kristen Fuller, MD
Addressing patient bias
If a patient calls you by your first name in the clinic or on the patient portal, and you prefer they call you "Doctor," there are several actions you can take. This is especially important for women physicians, who often find their authority challenged when patients mistake them for another type of medical professional.
According to the Canadian Medical Association Journal article, women physicians can address patients who untitle them by doing the following:
Promptly address erroneous comments. Be blunt! If a patient drops your title, offer to write it someplace where they can’t miss it. This is an efficient way to avoid future untitling.
Gently, kindly correct patients. For patients who refer to you by another title, politely respond with a clarifying statement, such as, “Thank you for the compliment—but as your doctor, I hope you find my medical skills just as excellent.”
Set boundaries that prohibit sexist insults. You are the authority figure in interactions with patients. It is within your rights to establish boundaries that identify and put an end to sexist comments.
Ask male colleagues to support you. When patients wrongly assume your title or role, ask your male colleagues to show solidarity by correcting the patient and clarifying that you are a doctor.
What this means for you
Patients who don’t address doctors with their rightful title may have a negative impact on the physician and the doctor-patient relationship. Women physicians are more likely than men to encounter this behavior. To restore their authority, women physicians can gently correct their patients, address misguided comments, and establish boundaries that prohibit sexist insults.