I waited my entire life to be Dr. Jeremy Faust and to write my first orders as an M.D.

On the way to my very first shift in the emergency department this past July, I was tweeting back and forth with several emergency physicians, wondering aloud what my first case as resident might be.

My friend, Dr. Seth Trueger, Tweeted that his first patient was a guy with a Bic pen coming out of his neck (no, it was not an attempted airway). How could I top that? Fate would have to be on my side. Well, it wasn’t.

After 4 years of college, followed by graduate school and then medical school, my first orders as a bona fide M.D. were for … wait for it … ibuprofen, a drug I could buy at a pharmacy at age 14. But until that day, I could not legally order it in a hospital. And just to add some spice to my humble pie, the nurse then asked if I could write for Maalox because the patient had not eaten in a while, and she found this to be helpful in such cases.

It was hardly procainamide for a Wolff-Parkinson-White arrhythmia or some other exciting order. As it turned out, my first patient was unremarkable. And in fact, what I most remember was my attempt simply to establish myself as my patient’s doctor. Literally, I tripped up on the first sentence. “Hi, I’m Jeremy. Uh…um, I’m Doctor Faust.” I just could not get the words out. It felt wrong to say, even though I had already become accustomed to my friends and family jokingly calling me doctor.

A doctor, I thought, is someone who knows everything. I may know something, but now that I have officially become a doctor, I feel like more of a “half” doctor.

I now realize that the real doctors are the attendings. And who knows, maybe when I become an attending, I will think that the real doctors are the illustrious living legends among us who have been at this for decades. Maybe in turn, they revere luminaries long gone.

Maybe, ultimately, the word doctor is more of an ideal to strive toward rather than just a bestowed title.

In light of this, and the sense that the doctor-patient relationship has changed from the days of “doctor’s orders” from on high, I and many of my resident colleagues often default to introducing ourselves by our first names, not our well-earned title: Doctor. Inviting patients to be on a first-name basis with us seems friendlier, more approachable, and less egotistical. And it perhaps lengthens our waning days as “young” adults.

But it comes at a price: confidence – in ourselves and from our patients.

When patients enter the emergency department, it is because they are having one of the worst and possibly scariest days in their lives. They are not looking for a friend. They want the confidence that we will take care of them and that we know what we are doing. And while it may be partly an illusion (especially in July of intern year), a certain dose of decorum might even be a form of therapeutic reassurance that we are taking their care seriously.

If we comport ourselves with dignity, patients will take even the greenest of doctors quite seriously and trust them that much more. It is for similar reasons that judges wear robes. When on the bench, they are not just themselves; they are justice. Similarly, when we are in the emergency department, we are just not ourselves; we are medicine.

This is important for patients, but often even more so for their accompanying and anxious loved ones, who so often have an all-too-keen instinct for sniffing out when we are not giving our best. First impressions, how people present themselves in the first few seconds – even milliseconds – of new interactions prove to be crucial, studies show. People make snap judgments when they meet someone, and leading with professionalism can only help.

Sure, some patients will require nuance, but as a default position, a little formality pays dividends.

An area where the inverse logic applies is when interacting with nursing. I always introduce myself to nurses by my first name and position. “I’m Jeremy, the new resident.” But unless they correct me, I refer to them by their title and last name. Nurse Hayes was extremely helpful to me on my first shift, and I wanted her to know from the get-go that I respect the title she has earned and her expertise by addressing her properly.

I hope that, by showing the nursing staff a sign of respect, I will earn trust and respect back over time. However, it is important to remember that humility is a good thing, and its antithesis, hubris, is downright dangerous.

Just because formality confers some benefits does not mean we should take ourselves too seriously. There’s an old story about a cocktail party in which two people meet. One inquires as to the other’s name. “I’m Dr. Williams,” one says. To this the other replies, “I asked your name, not your title!” Touché.

So in everyday life, I’m still Jeremy, liable to sing karaoke at the top of my lungs, make a lot of jokes of which only some work, and enjoy a fine cerveza should opportunity arise.

But when I walk into the emergency department and don a long white coat and address a new patient, “I’m Dr. Faust. Pleased to meet you. How can I help you today?”

Dr. Faust is an EM resident at Mount Sinai Hospital, New York, and tweets about #FOAMed and classical music @JeremyFaust.