As a student nurse I was taught to address patients formally - Mr, Mrs, Miss, Ms - unless they requested otherwise. It was drummed into us that patients must never be labelled as bed numbers or by their diagnosis - “the stroke in bed 4” was deemed unacceptable as were terms of endearment such as “sweetheart”.
I found these rules relatively easy to follow. I had been brought up to address adults formally and it still makes me laugh that my mother never granted permission to use her first name, not even to her children’s partners.
But such rigid social conventions are no longer the norm and walking the line between formality and informality is a difficult one. So, a cautionary tale…
I once nursed a lady, let’s call her Mrs Devlin. Her first name was Elizabeth. She lived alone and had no family in England. She had long-term mental health problems and was very suspicious of nursing staff. Every time I looked after her I addressed her as Mrs Devlin and we got on brilliantly, but some nurses found her uncooperative and difficult.
No one noticed a connection between her name and how she related to staff until her sister visited from Ireland. She noticed that some of the staff referred to Mrs Devlin as Elizabeth. Apparently, from childhood, Mrs Devlin hated her first name and had always refused to answer to it, preferring to call herself Lily. No one asked Mrs Devlin if they could call her Elizabeth and she responded by withdrawing from them. Clearly, an attempt to break down barriers through informality had only created yet a bigger one.
Many nurses ask their patients whether they would prefer to be addressed by their first name or as Mr, Mrs, Miss or Ms. This is a loaded question which perhaps implies that nurses want to be on first names terms, and I am sure many patients feel pressurised to comply with this expectation.
We can never make assumptions about patients and basic social conventions are vital in establishing relationships, particularly when patients feel vulnerable, dependent and emotionally fragile. Patients must retain the right to decide how they are referred to by health professionals and to assume otherwise is disrespectful.