While shadowing a senior colleague during Mental Health Act assessments in the U.K. a few months ago, I noticed something small but instructive. In his documentation for two different patients we had seen together, he referred to me as Dr followed by two different versions of what he assumed to be my surname.

Later that same day, while introducing me to colleagues who were joining us, he hesitated. Unsure which name to use, he looked at me and asked, almost apologetically, “What is your name, in truth?”

I smiled and replied, “Just Loshi is fine.”

What is often assumed to be my surname is not, in fact, a surname at all. It is a patronym, my late father’s name.

I do not say this with any resentment. I value carrying my father’s name, particularly when it is preceded by the title Dr. In many ways, it feels as though I am carrying forward a dream he was unable to fulfill himself: that of being a qualified doctor. Using his name connects me to him in a way that feels both meaningful and honoring.

However, when I am referred to formally as Dr Rajentharan, or informally as Dr Rajen, my father’s nickname, something subtle but important occurs. In clinical notes, correspondence, and professional conversation, the name no longer refers to me. It refers instead to a man who is no longer alive. And, incidentally, to a man, when I am very clearly not one.

As I do not drive, during on-calls, I rely on taxis booked for me by my trust. The taxis will always be booked under my perceived surname. Many a time I have noticed South Asian taxi drivers, who intuitively realize Rajentharan is a male name, scan the vicinity and then hesitantly ask if I am in fact Dr Rajentharan. One driver once outright told me, “I thought you were a man.”

This may sound confusing to those unfamiliar with non-Western naming systems, but not all cultures use inherited family surnames. I am from Southeast Asia, specifically Malaysia. Malaysian and Singaporean Tamils, like Malays from both these countries, do not traditionally have family names in the Western sense. Instead, we use patronyms: our given name followed by our father’s name. Other cultures use matronyms. These systems are not deviations from a norm; they are simply different norms.

In such contexts, a person’s name is exactly that, their given name. The additional parental name functions as a descriptor of lineage, not as a fixed family label intended to serve as the primary mode of address across generations.

This distinction has practical implications in clinical practice. When introducing myself to patients, I avoid saying “I am Dr Loshini.” The assumption is often that Loshini must be my surname, followed by a request for my “first name”, usually for documentation by accompanying staff. What follows is an explanation that is frequently only partially understood and rarely retained. Over time, I have found it simpler to introduce myself simply as Loshini.

I have tried to explain this to colleagues as well. Some understand immediately. Some understand but forget. Others default to convention because that is how the system is structured. None of this is ill-intentioned. It is, however, revealing.

What interests me is not confusion, but expectation, specifically, why the responsibility to adjust consistently falls on the individual whose name does not conform, rather than on the system that assumes conformity.

This reflection resurfaced a while ago while watching a re-screening of The Lord of the Rings. Characters are routinely introduced through patronymics: Gimli, son of Gloin; Aragorn, son of Arathorn, yet no one assumes they are addressed by their fathers’ names. The distinction is intuitively understood.

Out of curiosity, I later spoke to former medical school peers from Southeast Asia now practicing across the U.K. Their experiences were strikingly similar. One colleague told me that, for simplicity, he now introduces himself professionally using only his father’s name.

There is nothing inherently wrong with this. For many, it is a genuine honor. But it does raise a broader question: Why is adaptation expected primarily from the individual, rather than reflection from the system?

Names are not merely administrative conveniences. They carry identity, lineage, gender, and cultural meaning. In medicine, where accuracy and person-centeredness are foundational values, how we refer to one another matters. Something as small as pausing to ask how a colleague wishes to be addressed can be the difference between accurate recognition and inadvertent misidentification.

Medicine rightly places increasing emphasis on cultural competence. Yet some administrative assumptions remain so embedded that they go unexamined. The idea that everyone must have a “surname” is one such assumption: efficient, familiar, and culturally specific.

I am not suggesting systemic reform. I am simply proposing awareness. If even one reader pauses before defaulting to a surname and instead asks a colleague how they prefer to be addressed, this reflection will have served its purpose.

The colleague who prompted this essay was well-meaning. When I explained patronyms to him, he responded that my patronym is still my last name and therefore remains my formal work reference name. His point was practical: This is how the system currently functions.

That may be true. But systems are created by people. And perhaps it is worth asking whether, in a profession built on listening carefully to others, we might occasionally apply the same curiosity to one another.

Loshi Rajen is a psychiatrist in the United Kingdom.