What's in a name?

June 6, 2010
6 Comments

“Sticks and stones may break my bones, but names will never hurt me!”

Aren’t we all familiar with that childhood taunt? And, given our training and expertise, don’t we really know that it is a defensive response to a deep psychological hurt? Why else would parents be so concerned about what to name their child?

I know this well. If you ever wondered—and you probably have not—what the “H” in H. Steven Moffic, MD, stands for, it is my given birth name, which happens to be Hillard. Never heard of such a name? Can’t say I have, either, and I’m still not sure where it came from. Sometime long ago (when and why I must have continued to repress), I decided I did not like that name. But I apparently liked Steve, so everybody knows me as Steve, at least in a casual sense. Maybe I was teased mercilessly as Hillard, but nothing even emerged about that in my personal psychotherapy.

Ironically, now I have come to like the name Hillard. It seems unique and distinguished. But it is too late. Everybody knows me as Steve, Stevie, or Steven. Too bad all my formal documents are mixed up: Hillard Steven Moffic, Steven Hillard Moffic, or H. Steven Moffic are the most common designations. I’m slowly working to consolidate my identity.

“Children used to play Doctor; now they play Provider!”

Maybe this is why I am so sensitive to the names we use for ourselves and who we serve. I continue to like to be called Dr. Moffic. Yes, I know many professions use the “Doctor” designation, and some think it is too paternalistic, but to me it has a long and illustrative tradition in medicine. For a nickname, “Doc” is fine, as I find it endearing. But “shrink” is too stigmatizing, though when it is used, it may communicate a certain message that is helpful to hear.

However, ever since managed care rose to prominence, I’ve been called a “provider” more and more. A provider of what? Medication, advice, food? Pretty nondescript, if you ask me. Maybe that is the purpose; lump all providers together. If we needed some sort of common term, I would much prefer “caregiver.”

Sometimes, since I work in academics, I’m called a “professor,” which I am. But what relevance does that have to direct treatment?

How about who I serve? I’ve always called them patients. Again, to me, a time-honored designation. Yet, over the years, it’s been suggested that I use consumer or client. Or, in the case of Clubhouses, a member. Or, at the prison where I work part-time, inmate or offender. Why, I heard recently that in the California prisons, all those terms feel demeaning, so “individual” is the term of choice.

All these terms, and maybe others that I missed, I saw in the April, 2010 hard copy issue of our own Behavioral Healthcare. Come to think of it, how did this publication get this name? Why not Mental Healthcare? Was it because behavior could be seen and measurable?

Are these variations a reflection of the individuality and particular politics of the United States? I’m not sure, though in Great Britain, patient, client, user, and survivor all vie for attention.

Is somehow all this confusion a reflection of the stigma of mental illness? You never ever hear such variation about those receiving care for cardiac illness, do you?

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In his August 6 column as President of the American Medical Association, Dr. Wilson noted the confusion with using "Doctor". Half of patients think that optometrists, psychologists, and doctors of nursing are physicians they are not.

Steve Moffic

We've had similar conversations within our mental health/behavioral health/provider organization for many years. Our staff/employees/associates all seem to agree that our customers/consumers/clients/patients/persons served as well as the staff/employees/associates are just plain... people. If we stick with "person first" language and person-centered care we should be OK, as long as the managers/leaderscoaches/mentors/bosses work to develop a respectful organizational culture.

You like to be called Steven or Steve, not Hillard, so I'll call you Steve. The same respect should be given to the people we serve. While I agree with Anonymous 12:33 PM that as you are an MD, the people you provide care may be called patients by you, as a social worker I am not sure they are patients to me, but clients, or consumers or whatever they like to be called.

I greatly appreciate the comments for this and my first blog. I now realize that both of them had some focus on the psychological meanings of terms and names. I don't necessarily disagree at all with the comments, and find their emphasis on using terms that are respectful and acceptable to be worth emphasizing. However, I would suggest that all the different terms we use for ourselves, those we try to help, and even for our organizations have deeper meaning and, possibly, deeper concerns. We certainly do not see such variety in other areas of medicine, so maybe this reflects some role confusion, or at the least, changing roles in our field. If so, this may warrant more discussion and attempt to clarify.

Businesses know well the power of names. That is why they often hire naming companies to help them choose an effective name. Pharmaceutical companies do this regularly the name Viagra was not a random choice, nor was it a consumer choice. I could readily foresee that a managed care company with the name of Take Control was going to be too authoritarian. These kind of powerful associations are also why "Native Americans" do not seem to want the term "Indian" to be associated with any sports team. Maybe our field could use such a consultation from a naming company.

In everyday clinical work, it seems that asking who we serve what they would like to be called—in terms of first name, last name, patient, consumer, etc.—should be a minimal, but not sufficient, requirement. How it is answered may even give us some useful psychological information. The same goes for asking what they would like to call us my preference at work is Dr. Moffic, but I like knowing and hearing if they would rather call me Doc or Steve or shrink. Everything is grist for the therapeutic mill.

Our basic goal—in everything we do and say—should be to enhance psychological well-being.

A provider is one who "provides" services. Patient seems appropriate if the provider is a medical professional, but increasingly recovery support services are not exactly medical, but rather supportive employement, supportive education, skills training, psyhoeducation etc. The non-medical provider might more appropriately be called clients, or consumers etc. If you are in the "role" of physican you may be called Doctor, if you are teaching in the University you may be called Professor, if you are fathering your child you may be called "Dad". As we move toward a recovery orientation, focused on helping people get a life worth living rather than just stabilizing thier symptoms, we are also moving towards a more egalitarian relationship (true for other medical specialties, not just psyhiatry). It is the expert role to lay out options for people so they can make informed decisions about treatments. With this in mind one might want to get comfortable with being called "Doctor", "Doc" or "Steve". What is the problem with making this the patient's, the client's, or the consumer's call. If you are giving people what they need in a respectful and compassionate way you needn't get too uptight about losing the illusion of power.

I heard that every time the word "provider" is used, an angel dies.

Once, a referee for a paper I submitted, who identified himself as recovering from schizophrenia,emphatically insisted I replace all references to "client" with "patient", and he made a good case for it, very similar to what Dr. Moffic wrote in his cogent and amusing posting.

Some patients who call me by my first name has done very well in psychotherapy. However, for most, "Dr. Pulier" has seemed appropriate. I have always felt that pushing "Dr. Myron" on patients would be a patronizing way of "coming down to their level". It is a studied attempt to deny the power relationship between physician and patient that should be dealt with some other way.