Just as no man is hero to his valet (in the days when people had valets), some distance is a good thing. If the doctor-patient relationship becomes too close, there is the very real danger that the patient will realise that much of the time the doctor hasn't a clue what's really going on and is acting on a best guess basis. And the relationship goes both ways; I'm not a robot, I've got feelings, and I can be offended too.
So I draw the line at patients calling me by my first name. It erodes the mystique our ancient profession has painstakingly earned over the centuries, often in the face of prejudice and persecution.
We'll lose the doctor-as-drug effect, though I don't think mine was ever very potent, roughly equivalent to 'take two aspirin and see how you are in the morning'.
'Can I call you Liam?' said the new patient, obviously not yet up to speed with my traditional value system.
Some people are just uppity, I blame it on free education and communism and political correctness gone mad and, most of all, on rock music (it's just a bunch of satanic messages).
'Look,' I said, 'I didn't spend six years at medical school and four years as a junior doctor, a total of 10 years of exhaustion and ridicule and humiliation and blood and sweat and other less salubrious body fluids and drinking myself into a stupor and having wild sex with every agreeable female (OK, it wasn't all bad), in the process acquiring so many letters after my name (albeit accidentally) you could play Scrabble with them, just so I would have to put up with your risible attempts at offensive chumminess.
'I'm your doctor, not your buddy; if you want a friend, get a dog.'
Well, of course, I didn't actually say it out loud; old school, we never betray our feelings.