November 18th, 2015
The Name Game
Nice to meet you, my name is Elizabeth… I think. My mother, a woman who was referred to by her middle name for her entire life because her own grandmother had such a distaste for her actual name, insisted that her daughters would always be known by only their given names. Yet as far back as my memory goes, I have been “Lizzie” to my family, “Liz” to my friends, and countless other variations throughout the years, depending on my mood. I even tried “Beth” out for a limited run lasting just the academic year in second grade (it didn’t feel right; I dropped it in June). So much for the no-nickname rule, Mom.
I guess given our family nomenclature history, it’s not surprising that I continue to have an identity crisis in my professional career. At least once per week I am conferred an honorary degree without any formal ceremony; I receive a consult letter or request from another facility or provider addressed to Doctor Donahue. Voila, a doctor — no further education, experience, or student loan debt required! And with a bit less frequency (thankfully for my ego), a patient occasionally refuses my care because I am “just a nurse” or “not a real doctor.” I remember one patient fondly from my first practice who insisted on referring to me at each and every visit as Nurse Practitioner Donahue — very accurate, though a mouthful to be sure. The vast majority of my patients simply address me as Elizabeth — fulfilling my mother’s first wish for me, one she could not manage to execute herself.
The confusion of my patients seems a symptom of a larger problem: My colleagues, employers, and an entire healthcare system have struggled to “name” me. The In Practice blog was created to engage the growing number of NPs and PAs who have joined the provider workforce but who are not physicians. Yet the educational and healthcare systems that train and employ us have grappled with what to call us, creating a hodgepodge of references — most of which, in my estimation, fall flat. We have been collectively called non-physician providers and advanced practice clinicians — both accurate though leaving something lacking. Less enticing is the title mid-level provider, which to me suggests that the care itself or the person providing it is less than ideal, only mediocre, not high-quality. My least favorite of these names is physician extender. So many of my colleagues provide care in emergency situations, are the first providers a new patient sees, or work collaboratively with physicians in roles that do not overlap.
Thinking of all of the available choices and their meanings, my real question is, do we need another name? I would challenge my colleagues in healthcare and academia to strip it down and keep it simple. And then it can be simple for patients as well. What names can we use and apply to all? Can we adapt our vernacular to utilize simple, all-encompassing names and discard the “nicknames” that force us into more specialized categories? We are all providers. We are all practitioners. We are all clinicians. We are all members of a patient’s team. We are here for the same purpose.
As Shakespeare wrote in Romeo and Juliet: “What’s in a name? That which we call a rose by any other name would still smell as sweet.” We should stop playing the name game and apply this famous playwright’s supposition to our practice; a clinician by any name has the same goal — to provide high-quality, patient-centered care. And this should be our focus.
P.S. Hi Dad, I included that Shakespeare quote for you, in case you were feeling left out by my mention of Mom. Thanks for sharing your love of literature with me — can you believe I’m a “writer” now?