Patient Name, uppercase family name debate

There is debate if the Family Name of a patient should be in uppercase. With the other words in the name each in title case.



Oliver, James

The NHS CUI Guidelines strongly advocate an uppercase Family Name.  

This uppercase approach also appears longstanding with NHS paper-based documents. Such as this sample NHS Birth Certificate - where the Family Name is in uppercase.

NHS Birth certificate, from UK

Arguments against uppercase

Most of the arguments against uppercase for the Family Name come from readability and accessibility.

Uppercase is known in practice to be slower to read than Title Case.

Uppercase is known to cause problems for those with reading difficulties such as Dyslexia.

The NHS CUI acknowledges these well-known facts, but states, that because the Family Name is short (e.g. not a full sentence) it is unlikely to cause significant slowdown or difficulty with dyslexia.

One article I came across suggested 15-20% reduced reading speed from uppercase. The NHS CUI also suggest that it likely is a ‘good thing’ if people actually read the name, rather than recognizing the ‘block’ of text as one is able to do quicker with title case.

Arguments for uppercase

The primary reason to make the Family Name uppercase is to remove any confusion for the reader of which part of the name is the Family Name.

This is discussed well on the Quora forum, "Why do French people write their surnames in capital letters?"

Separation of the Family Name can be particularly important in countries where the Given Names, and Family Names are the same. 

Adrien Lucas Ecoffet (Frenchman in America), points out that of the "50 most common French last names, 19 of them are first names, most of them common. In fact, 4 of the top 5 are first names.” 

Merle Tenney (Language Technology Consultant) notes that in many parts of Europe where names are compounded (sometimes with hyphens, other times without) and have prefixes (such as de la and van der) this all result in a situation where it is unclear where the Family Names ends and where the Given Names begin. The consistent use of uppercase Family Names removes this problem.


If our objective is to make a safe and clear EHR, it seems an uppercase Family Name, and title case Given Name is the way to go.

Uppercase makes the Family and Given names unambiguously different, and there likely is minimal (if any) effect on accessibility or readability.

To help improve legibility, when displaying the Family Name in uppercase, increased character spacing may help.

Nuanced articles discussing the science of word recognition

The science of word recognition, by Kevin Larson (2004)

100 Things You Should Know About People: #19 — It’s a Myth That All Capital Letters Are Inherently Harder to Read, by Susan Weinschenk (2009)

Why letter casing is important to consider during design decisions

How do we read words and how should we set them?

How did the distinction between capital letters and non-capital letters emerge

Why Text in All Caps Is Hard for Users to Read

Patient ID number display (EHR Conventions)

Patient Name Display, existing standards