Monthly Archives: November 2009

The practice of medicine in a busy academic hospital often involves a degree of anonymity. The daily experience of any given inpatient includes an endless, unpredictable parade of nameless scrubs, white coats, and suits, each entering the modified and impersonal bedroom with a specific agenda: to obtain vital signs, to examine the body, to ask questions about the recent illness, to discuss discharge planning. Many, if not most, of these individuals will introduce themselves: “Hi, I’m John, I’m your nurse for today.” “Hi, I’m Ann, one of the medical students on the team taking care of you.” “Hello, I’m Dr. Thompson, a nephrologist.” However, a considerable number of patients cannot manage to recall the names of the doctors and nurses who take care of them in the hospital: there are too many of them, and it isn’t easy to remember much when you’re sick. Many patients also have trouble remembering or spelling the names of primary care doctors or specialists they see in the clinic. Instead, these individuals fit into a role: the cardiologist, the physical therapist, the night nurse. Is this an inevitable failure of human memory or a lack of sufficient effort on our part to make our names known to our patients?

On my part, I find it difficult to hold on to names unless I have associations built around an individual’s identity. For example, I can remember the name of an interviewer I am going to meet tomorrow because I know there is a specific context in which I will be speaking with her. In the absence of these associations such as when I’m meeting someone without prior arrangement, the best way for me to remember a name is to learn a person’s name while shaking his hand. Almost without fail I can remember a name if learned in such fashion. However, if I don’t shake someone’s hand (especially if I am meeting many people at once), there is a significant chance that I will forget that name. In the hospital, it is not uncommon for medical personnel to decline to shake the hands of their patients (or even colleagues) for concern about the spread of germs. If others follow the same method of storing names in memory as I do, then it isn’t difficult to see how it would be easy to forget recently acquired names.

There is some measurable appeal to anonymity in the hospital: it’s harder for trouble to arrive at your doorstep if it doesn’t know your name and address. I’ve closely observed the many attending physicians with whom I have worked and noticed a wide variety of approaches to the simple task of introducing oneself: some walk into the patient’s room and start the interview and exam without ever mentioning their name, while others go so far as to give each patient a business card (with a photograph). Exposing one’s name has the logical benefit of spreading one’s reputation among the patient populace (i.e. recruiting new patients among friends and family members of the patient), but it also exposes one more readily to the manifestations of patient frustration, litigation (e.g. pick a name and sue), and potentially excess interpersonal contact (i.e. too many phone calls and e-mails). A fellow medical student alerted me to a built-in feature of the iPhone that allows one to turn off one’s caller ID so that one’s calls show up as “Blocked” on the recipient’s cell phone: this is shared among medical personnel as being a useful tool for making calls to patients and their families. In many ways, our interactions with patients and their families must fit into small, discrete boxes of time and effort: there cannot be a trail or a route of communication that leads back and permits future interactions that are not initiated by the doctor.

On the other hand, giving one’s name to another person is a powerful gesture: it is a gesture of trust and connection. Names carry a great deal of weight in every human culture, else parents would not agonize over the task of selecting the right names for their children. Introducing oneself gives the other person access to one’s social network: in the context of the medical system, the giving of a medical provider’s name is a transaction that permits the repetition of medical services in the future. Beyond the business implications, this gesture also can clearly state an intention: “I am here to take care of you now, and I will take care of you in the future should you need me.” I always introduce myself to every patient under my care and find pride when they include me or refer to me as their primary “doctor.” However, I am in a privileged, protected position as a medical student because I do not have a longitudinal practice: patients cannot find me. Nonetheless, there are a few patients for whom I have taken extra measures to provide my name and contact information: the patients whom can benefit most from my ability to seek and find meaningful medical information or the right people to help address complex medical issues (that also interest me). Recently, though, I found myself thinking as I gave a patient my contact information, “I might be practicing medicine here in the future. If you are in need of a neurologist, I would be happy to take care of you or find the people who can.” Here is my name.

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