Based on 50 years experience in the practice of medicine, I believe that the reverse of this situation also applies. I always made it a practice to refer to patients formally (Mr., Mrs., Miss, even "Ms." in later years). Exceptions were children, adolescents and adults who preferred to be referred to by first name. In the relatively few cases where the patient referred to me as "John", I chose to ignore it, but continue to refer to him/her formally. The author makes a good point, however, about the need to be mindful of the "message" that the patient or surrogate is sending by this seemingly expression of disrespect.