I’ve worked in hospitals since I was 16 years old — 42 years ago now. I was first an orderly, then a nurse’s aid, then a practical nurse, and a finally a surgical technician before I became a physician.

When I started, female nurses wore caps, the details of which identified which nursing school they had graduated from, as well as a pin that gave the same information. They wore starched, white dresses, white shoes, and white hose. They were never called by their first name except by those who knew them personally. Male nurses were few and far between. We had none in the medium-sized community hospital where I worked.

Of course things have changed a lot from those times. Female nurses no longer have to wear those awful hats and uncomfortable starched dresses. Having everybody in scrubs does improve comfort, although it can make it hard to tell the PICU nurse from the housekeeping person cleaning the PICU.

The most significant change to me is that nurses now expect both patients and doctors to address them by their first names. In fact, they have to: my name badge has my full name on it, but the PICU nurses only have their first names and the first initial of their last name. I’m told that at hospitals which still have a nurse’s last name on the badge, the nurses themselves put tape over it to obscure it.

I’m told the reason for this change is personal safety and security. Nurses have close, intimate contact with patients and families, and they fear stalkers. Yet I’ve also been told by security people that, if somebody really wanted to find out the last name of a particular nurse, it wouldn’t be that difficult. I’d love to see some actual data about this issue.

Medicine has long been rigidly hierarchical. Nurses, whose relationship to physicians for many decades was more or less a master-servant one, have struggled for recognition and respect. The fact that physicians were once overwhelmingly men and nearly all nurses were women compounded this effect. (In pediatrics, at least, this profile is changing — now over half of pediatricians in training are women.)

I have wondered now and then about calling nurses by their first names, but continuing to call physicians “doctor.” Is that fair? Somehow it seems to me it should be all one or all the other — both sides using the first name or neither.

This question crops up from time to time on nursing discussion boards, and always seems to lead to pro and con debates. Nursing leaders also ponder the implications of this new familiarity. I’m curious what anybody else thinks about it.

Christopher Johnson is a pediatric intensive care physician and author of Your Critically Ill Child: Life and Death Choices Parents Must Face, How to Talk to Your Child’s Doctor: A Handbook for Parents, and How Your Child Heals: An Inside Look At Common Childhood Ailments.  He blogs at his self-titled site, Christopher Johnson, MD.