R.E.S.P.E.C.T.

A while ago, on another blog, there was an interesting discussion of forms of address. That is, what you call someone, depending on context, relative status, level of acquaintance, and whatever other factors come into play in social interactions in your particular cultural setting. For example, around here I might be addressed as Mike, Michael, Mr. Chisholm, sir (respectfully), sir (sarcastically), mate, "Oi you!", and so on, right across the spectrum that runs from terms of endearment to outright terms of abuse.

Despite our (utterly unwarranted) reputation for politeness in Britain, our language is fairly unsubtle in this regard, at least grammatically-speaking, especially since the loss of "thou" and most of the inflection of our verbs. In more highly-inflected languages – European languages, that is, which are as deep as I can go, linguistically – there is often a nuanced interplay between the use of second person singular, second person plural, and even third person expressions as forms of address. I believe in these less hidebound times such distinctions are eroding, but it would still be unusual and quite possibly insulting to address an adult stranger as "tu" in French, for example, rather than "vous" [1]. We do have more than a few ways of being rude to each other – in fact, we're pretty world-leading at that, and we've come up with some new ones lately – but I'm not about to wander into the voguish etiquette minefield of the "pronoun / misgendering" thing, you'll be relieved to hear. As it happens, I have used "they" as a non-specific pronoun all my life – I assume it was a standard-issue part of my native dialect kit – but I had retired from work years before people started routinely adding pronoun prescriptions to their email signature blocks, something I find very odd. But then I'll be seventy in the new year, which means I'll be entitled to shake my head, walking stick, or even my fist at anything I choose to with impunity...

Which reminds me of one of the things that came up in that discussion about forms of address, which was the use of "young man" to address obviously elderly men. In a post about haircuts and barbers that I wrote back in May (Something for the Weekend) I referred in passing to the way this infuriating usage seems to have become established in Britain. Typically, at the garage the youngster handling payment for a service will address an obviously elderly man (me, for example) as “young man”. Now, I'm an easy-going sort of bloke, but to be addressed condescendingly as "young man" by some actual young man really makes me bristle. If I were larger, younger, and more aggressively-inclined I might even choose to make something of it, starting with some form of address from the abusive end of the spectrum. But then, if those things were the case, I don't suppose any patronising grease-monkey would be calling me "young man", would they? Hilariously, though, I discovered recently that an even older friend had been taking this as a compliment on his youthful appearance, rather than the smirking ageist jibe it really is. I was happy to disabuse him. [2]

But the main thing raised by the American owner of the blog as a pet peeve was the way that in medical contexts address by first name seems to be automatic and universal. Certainly, in my experience this seems always to have been the case in the NHS, no matter what the official guidelines may say [3]. It starts when you’re a child, of course, so you don’t really notice until one day you have reached the age when you are older than the typical GP, and you think: Hang on a second there, young man… Certainly, every receptionist at every hospital, health centre, or GP surgery I have ever used has always used my first name as a matter of routine. Having carefully identified myself by reciting name, date of birth, NHS number, or whatever else they have asked me for, the inevitable reply comes: “So, Michael, how can we help you?”. So far, I have resisted saying, "No, madam, until we have been properly introduced I remain 'Mr. Chisholm' to you, and the use of my first name is an infuriating presumption upon the dignity of a senior citizen!", but it's only a matter of time before I do. Did I say I'll be seventy in the new year? I probably did. If I say it often enough I might even begin to believe it myself.

I have always suspected that this custom began as a strategy back in the earliest days of our National Health Service, designed to ensure that users of the new “free at the point of use” health service still knew their proper place in the scheme of things. Doctors had a certain godlike status in working-class communities, anyway, not least because our parents and grandparents had grown up in a world where a visit to the doctor was a rare, often humiliating and costly experience (here's a good description of pre-NHS healthcare in Britain by the Nuffield Trust). I can remember being taken as a child to see our family doctor in the late 1950s, in his custom-built New-Town health centre, when my mother would dress her best and use the highly embarrassing vocal manner she had acquired as a telephone receptionist ("Hellay, kennay hep yoo?"), both to show the necessary respect and also to signal that we, unlike some people we could mention, were to be taken seriously as aspiring, responsible citizens. She was "Mrs. Chisholm" in front of me, Young Michael, but doubtless she was on one-way, asymmetric first-name terms when being seen in her own right by the doctor.

I do wonder whether doctors in private practice also routinely use your first name? I have no idea: perhaps someone reading this would know? But, even if they do, there must surely come a point where one's status and consequent command of respect outweigh any strategic familiarity on the part of medics. I recall that Bob Dylan sang, "even the President of the United States sometimes must have to stand naked" [4], which is doubtless true, but, when he does, I bet the doctor doesn't say, "Now cough for me, please, Joseph!" And I'm absolutely certain he doesn't get called "young man" by anyone... Not yet, anyway.

1. I read an anecdote somewhere (by George Steiner, I think), that related how a woman with whom he was about to have sex was outraged by his shift at the, um, crucial moment from "vous" to "tu"... As I say, it's nuanced. 
2. I should confess that I suffered a similar disillusionment when I realised that the women working the tills in the Students' Union shop who used to call me "babe" or "hon" were not complimenting me on my attractive appearance. Although I choose to believe they were...
3. One of the commenters on that Language Hat post referred to this document from NICE (National Institute for Health and Care Excellence): Patient experience in adult NHS services: improving the experience of care for people using adult NHS services (Clinical guideline [CG138] Published: 24 February 2012 Last updated: 17 June 2021), in which, under "Communication", it states: "1.5.3 Ask the patient how they wish to be addressed and ensure that their choice is respected and used". Oh, really? I don't think I have ever been asked that, not once. I should get a copy to wave in the face of the next presumptuous medic I have dealings with. That will go down really well, I'm sure... 
4. "It's Alright, Ma (I'm Only Bleeding)" from the album Bringing It All Back Home.