Research

Nominative
determinism
in hospital
medicine
Can our surnames influence
our choice of career, and
even specialty?
C Limb Foundation Year 1 Doctor,
East Surrey Hospital
R Limb Medical Student,
University of Nottingham
C Limb General Practitioner, Wakefield
D Limb Consultant Orthopaedic
Surgeon, Chapel Allerton Hospital

DOI: 10.1308/147363515X14134529299420

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I
t is appropriate that the fastest man on
Earth is called Bolt. However, did the name
he was born with influence his life choices?
Also, is there evidence in the medical register
that names have influenced the career choices
of hospital doctors in selecting medicine as a
career and in their choice of specialty?
This phenomenon was termed ‘nomina-
tive determinism’ by New Scientist, which
ran a regular column dedicated to it from
1994 onwards. Among the first entries was a
reference to an article on incontinence in the
British Journal of Urology authored by Splatt
and Weedon.1 There is already evidence that
names influence the choice of a career in
medicine,2,3 but does it also influence the
choice of specialty thereafter?
The authors of this article are from a
medical family who frequently hear their
names quoted on radio phone-ins. Little does
the radio audience know that all members of
the family climb for a hobby, and two of the
family have names more appropriate to this
pastime than to medicine.
We wanted to ascertain if there is evidence
that an individual’s name, as recorded in
the medical register, has influenced his/her
choice of specialty if they have followed a
career in hospital medicine.
METHODS
We obtained a copy of the medical register
from the General Medical Council in
November 2011. The register was sorted
into the principal hospital specialties. Then,
three of the authors reviewed the list of
practitioners independently to identify
surnames that were ‘apt’ for the specialty (eg
Limb for an orthopaedic surgeon; Brain for
a neurologist) or for medicine in general (eg
Ward, Kurer, Doctor).
Then the three lists were merged by
consensus. The fourth author, a general
practitioner, checked the frequency of apt
names appearing in the hospital specialties
against their frequency in the register in
general. Some names that were felt to be
indicative of character traits perceived as
typical of some specialties were also enu-
merated by specialty.
RESULTS
There were 313,445 entries in the medical
register. This figure referred to all registered
doctors, including those in training, those no
longer working but maintaining registration,
those on general practice and specialist
registers and those in other medical careers.
There were 17,901 surgical specialists,
25,013 physicians, 11,528 anaesthetists, and a
range of smaller specialties (psychiatry, 8,143;
radiology, 5,156; obstetrics and gynaecology,
4,445; accident and emergency, 997; microbi-
ology, 997).
Median frequency of names relevant to
medicine was 1 in 149. Median frequency
of names relevant to the subspecialty was 1
in 486.
One wonders if
the comforting
words of
Dr Lie carry less
impact because
of the name
The specialty most likely to have a name
relevant to medicine was medical: neurology
(1 in every 21 doctors). Specialties least likely
to have names relevant to medicine were
cardiothoracic surgery and maxillofacial
surgery (both zero). Neurologists had names
relevant to medicine in general, but far fewer
had names directly relevant to the specialty
(1 in every 302).
The specialties next most likely to bear
names relevant to a career in medicine were
genitourinary medicine (1 in 52) and urology
(1 in 59). Unlike neurology, however, all
names in genitourinary medicine were rele-
vant to the specialty, rather than to medicine
in general, as were most of those in urology
(1 in 75). The frequency distribution for each
of the specialties considered is illustrated in
Research
Figure 1, along with examples of nominative
determinism in that specialty.
DISCUSSION
The frequency of names relevant to medicine
and to subspecialties was much greater than
that expected by chance. Some specialties
had a high composition of doctors with
names relevant to medicine in general (eg
Doctor, Nurse, Ward, and a wide range of
anatomical terms). Specialties that had the
largest proportion of names specifically
relevant to that specialty were those in
which the English language has provided a
wide range of alternative terms for the same
anatomical parts (or functions thereof). Spe-
cifically, these were genitourinary medicine
(eg Hardwick, Kinghorn, Woodcock, Bell)
and urology (eg Burns, Cox, Dick, Koch,
Cox, Balluch, Ball, Waterfall). Some terms
for bodily functions have been included in
the frequency counts but are not mentioned
because they are colloquial terms that may
lower the tone of this publication.
Some other variations between spe-
cialties were also uncovered in perusing
the register. For instance, practitioners of
almost all specialties were more likely to be
Little than Large. Counterintuitively, only
cardiothoracic surgery and cardiology were
more likely to be Large than Little. Paedi-
atric medicine was much more likely to be
Wong than White (10:2), whereas anaesthe-
tists were far more likely to be White than
Wong (22:4). Surgeons were distributed
more evenly.
For those who wish to pass a few idle
moments, it is even possible to muster some
relevant sentences using only surnames
from within a specialty. For instance, in
obstetrics and gynaecology we have ‘Love’
for the ‘New’ ‘Bourne’ ‘Child’. Dr Pain
appeared most commonly in general
surgery but fortunately not Dr Handslip
(respiratory medicine – though chest drain
insertion may be traumatic). One wonders
if the comforting words of Dr Lie carry less
impact because of the name, or whether
consultations with Dr Dark in oncology are
made any more ominous.
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Research

Figure 1

Specialty Frequency of names relevant Frequency of names relevant Examples

to medicine to specialty
Cardiothoracic surgery 0 0
ENT 1 (1 in 1496) 8 (1 in 187) Lancer
General surgery 16 (1 in 318) 56 (1 in 91) Gore, Butcher, Boyle, Blunt
Maxillofacial surgery 0 0
Neurosurgery 2 (1 in 303) 3 (1 in 201) Barber, Hope
Ophthalmic surgery 3 (1 in 839) 3 (1 in 839) Ball, Saw, Turner
Paediatric surgery 1 (1 in 325) 4 (1 in 81) Young
Plastic surgery 3 (1 in 327) 7 (1 in 140) Carver, Mole, Price
Trauma and orthopaedic surgery 13 (1 in 338) 17 (1 in 259) Carpenter, Cartlidge, Limb
Urology 18 (1 in 75) 23 (1 in 59) Ball, Burns, Cox, Dick, Waterfall
Accident and emergency 0 12 (1 in 83) Cutting, Payne, Boyle
Obstetrics and gynaecology 12 (1 in 370) 18 (1 in 247) Child, Dada, Kidd
Psychiatry 24 (1 in 339) 65 (1 in 125) Downs, Lowe, Bhatti, Moodie, Nutt
Microbiology 0 1 (1 in 990)
Anaesthesia 3 (1 in 3843) 100 (1 in 115) Heal, Payne, Painstil
Cardiology 5 (1 in 340) 8 (1 in 213) Hart, Pump, Payne
Dermatology 2 (1 in 486) 4 (1 in 243) Boyle, Hickey
Endocrinology 0 1 (1 in 778)
Gastroenterology 3 (1 in 338) 8 (1 in 127) Freshwater, Kitchen, Salmon
General medicine 5 (1 in 1271) 63 (1 in 101) Mysore, Reckless, Safe, Warning
Geriatric medicine 8 (156) 15 (1 in 83) Gerry, Gerrie, Dyer, Vitale
Genitourinary medicine 11 (1 in 52) 11 (1 in 52) Horn, Hussey, Hardwick
Haematology 0 6 (1 in 249)
Infectious diseases 1 (1 in 255) 2 (1 in 128) Ayles
Neurology 4 (1 in 302) 58 (1 in 21) Counsell, Panicker
Oncology 5 (1 in 307) 9 (1 in 171) Last, Makepiece
Paediatric medicine 17 (1 in 323) 46 (1 in 119) Boys, Gal, Child, Kinder
Renal medicine 2 (1 in 305) 3 (1 in 203) Foley
Respiratory medicine 0 7 (1 in 886)
Rheumatology 1 (1 in 891) 6 (1 in 149) Bracewell

Some promising partnerships failed to choice of an individual before acquisition of References

materialise: Doctors Batman and Robin
are registered but failed to team up in any
specialty. Finally, it was surprising to find
no Dr Who. Doctors Why and Where,
however, appeared in the register, but not in
a hospital specialty.
Our study had limitations. Without
specialist knowledge it may be that some
appropriate names may have been missed.
However, one assumes that if specialist
knowledge is needed to spot the connection
then this could not have influenced the career
that specialist knowledge. Furthermore, the 1. Splatt AJ, Weedon D. The urethral syndrome: experience
with the Richardson urethroplasty. Br J Urol 1977: 49:
medical register is not an accurate record of
173–176.
the specialty in which an individual practices.
2. Abel EL. Influence of names on career choices in
It is a historical record of the specialty that
medicine. NAMES 2010; 58: 65–74.
each individual recorded at their point of
3. Doctor’s names list. http://www.u.arizona.
registration. Although individuals can (and edu/~stoddard/doctor.htm.
do) move between specialties throughout their
careers, the medical register is not altered
after registration. For example, ‘Ah See’ could,
for all we know, have become an ophthalmol-
ogist even though he is documented as an ear,
nose and throat surgeon.

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