I came across a blog by Edward Leigh, the director of the Center for Healthcare Communication in the USA, in which he addressed the habit that some health professionals have of addressing patients by nicknames or terms of endearment. He pointed out how offended many patients are by this:
‘The lyrics to Janet Jackson's song, Nasty, includes this line, “No, my first name ain't baby, it's Janet. Ms. Jackson if you're nasty.” Miss Jackson doesn't like being called, “baby,” and neither do a lot of patients.’
Terms he highlighted such as ‘baby’ and ‘honey’ may be less commonly heard in the UK but we have our equivalents—‘dearie’, for example. He concluded that our names represent the essence of who we are and for that reason it is vital that we correctly address patients and their family members. From a very early age, our identity is tied to our names, and names tied up with our identity. If you think about all the people you know, you no doubt have friends, family or colleagues who are known routinely by names different from their formal first name. Young people may be known by a nickname, while there are plenty of elderly relatives or others who for one reason or another would never be known in a public domain by the first name that would appear on their NHS record.
Parsons et al (2016) undertook a survey of 300 patients and one of their objectives was to investigate how patients prefer to be addressed by healthcare providers. Patients were asked their preferred mode of address including first name, title and second name, abbreviated first name or another name and whether patients disliked the formal address of title and second name. The results showed that over 99% of patients prefer informal address with greater than one-third having a preference to being called a name other than their legal first name. Their findings supported patient preference of informal address; however, they did point out that healthcare providers cannot assume that a documented legal first name is preferred by the patient.
One of my friends, Dr Michael McCabe, is a consultant anaesthetist who shared a story with me last year that really got under his skin. He described it as ‘an awkward and humiliating clinical interaction with a transgender patient’ and felt compelled to make a change. Mike set about an improvement piece of work that I feel needs to be scaled up to the national level.
The #CallMe project is a beautifully simple project that leads to significant improvement in patient and family experience. Patient respect and dignity is at the centre of health care and #CallMe has the ability to change the experience for patients and their families. To help bring about a cultural change in how we interact, and respect patient wishes, Worcestershire Acute Hospitals NHS Trust has added an italic #CallMe field to wristbands and name stickers. This field is completed with the patient's preferred name and/or title.
The patient sees the wristband as a part of their public identity and, especially in the transgender population, it gives comfort and reassurance to them, that their preferred name is visible without them having to correct staff. This also has significant benefits for a number of other patient groups, including the postoperative patient, the frail elderly patient, the confused patient or the unconscious patient. Those with names that are unfamiliar to staff, due to origin or heritage, will have the opportunity to tell staff how they would like to be addressed.
Mike shared another patient story with me, which occurred during the COVID-19 pandemic and involved the daughter of a patient waiting just outside the curtains while last offices were being performed:
‘I found this whole situation really upsetting as I realised that my Mum must have been referred to as “Elizabeth” for the whole of her last day alive. I pulled the curtain back and said, “my Mum's name is ‘Maria’, she was never known as ‘Elizabeth’” to which the response strangely was “Oh are you sure, we thought her name was Elizabeth?”. I asked the nurses to please refer to her as “Maria” as my Dad was on his way and I didn't want him to hear her being referred to by a name that she was never called.
‘To this day, I am so, so sad that as my Mum lay dying in a hospital bed, without her family, or anything familiar around her she wasn't even called by her name. This whole situation doesn't sit well with me and I really wish I could have done more to get this right for her in her last hours.’
‘#CallMe would have allowed staff to enter Mum's record and printed a wrist band that would have stated the name she was known as, leading to her being called by her correct name during her last day of life. Such a simple idea, which would have been so nice for my Mum and would have been so comforting for her family.’