Junior doctors find consultants more approachable if they can address them by their first name, according to a UK study that has sparked intense debate over whether its time for the medical profession to scrap the formalities of hierarchy and titles.

With evidence suggesting that junior staff are less likely to raise safety issues with senior doctors who are less approachable, researchers conducted an online survey of 410 junior doctors in a large teaching hospital on whether they used terms such as Dr, Professor or first names when talking with senior doctors.

They found that on average 43% addressed consultants by their first name – with the same results for male and female respondents. And 71% said that being on a first name basis made these consultants feel more approachable.

Yet the results published in the Clinical Medicine Journal found a wide variation between specialties on whether junior doctors referred to consultants by their first name.

Those on the most informal footing were in anaesthetics and emergency medicine where 78% of junior doctors called consultants in the same specialty by their first name.

Yet in surgical specialties only 23% did so, the researchers from the Royal Victoria Infirmary in Newcastle reported.

In almost all cases (97%) junior doctors used formal titles when talking to a consultant from another specialty, the study found.

The differences in approach between specialties seemed to be reflected in the responses on social media where the research prompted a great deal of debate.

Dr Dan Furmedge, a consultant in geriatrics at Guy’s and St Thomas’ NHS Foundation Trust said in his experience first names fostered a different and nicer working environment.

He also pointed out that it is particularly odd that a junior doctor could move from a rotation in the emergency department using first names then move to medicine or surgery where they are expected to refer to the consultant as Dr.

So those in favour of first names of consultants for the rest of the health team esp junior doctors:
– almost all junior doctors
– allied health professionals
– many consultants

Those against or who feel their ego requires being called doctor
– a few consultants

— Dan Furmedge (@danfurmedge) July 24, 2020

Others suggested that to use a title was a mark of respect for a more senior colleague and some junior doctors felt very uncomfortable using first names even if asked to.

Personally wouldn’t call any of my consultants by their 1st names. I struggle even calling people that were SpRs by their 1st names when they become consultants. That mark of distinction is earnt. Equally, I’d not go by Dr XX with patients unless they’re elderly for reassurance

— Boatus (@Boatus_UK) July 25, 2020

I do it as a mark of respect.

— Toni Wallace (@alwaysawallace) July 23, 2020

The researchers did point out that it would not always be appropriate to refer to a consultant by their first name, for example in front of patients.

“It would be challenging but interesting to examine cause and effect with respect to the use of informal names; are consultants who use first names more approachable or do more approachable consultants use their first names?,” they concluded.

“In other professional fields such as architecture, law and teaching, colleagues are commonly addressed equally. In medicine, the practice of nominal hierarchy persists. Breaking barriers created by lack of familiarity with colleagues is one potential step in encouraging stronger teamwork – for the benefit of patients and staff, whatever their grade.”