The future of doctors’ messes
BMJ 2019; 364 doi: https://doi.org/10.1136/bmj.k5367 (Published 07 January 2019) Cite this as: BMJ 2019;364:k5367
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Dear Editor,
I commend you for your commitment to rejuvenating your hospital mess. Having worked in Scotland in a hospital which has an active mess, then moving to Northern Ireland were mess culture doesn't exist, I can understand how important a mess is to the running of a hospital.
Yes, the mess is an area to relax in during break times but it is so much more. It is a place to relieve stress and discuss interesting/difficult cases with your peers in the safety of a private space. Mess social events encouraged a sense of comradery across specialties. This is vital as it helps us realize we are all working for the same cause, the best interest of the patient.
The mess provided basic necessities such as tea, coffee, fruit and breakfast cereals on a daily basis.
Without a mess, break times are often spent in the canteen alongside members of the public or in an office by the ward. You would spend lunch with your team but rarely would you socialize with other specialties. If you are busy during canteen opening hours your only snack option often comes from the unhealthy selection provided by a vending machine.
The mess is truly the heartbeat of the hospital, and having experienced working in a hospital without a mess I would strongly urge everyone to hold onto them.
Competing interests: No competing interests
Sir,
The G.P's doctors' mess, surely, used to be the Post Graduate Centre in their local hospital. Over a convivial lunch and cup of coffee, the consultants and G.Ps could talk, in private, about cases and discuss who was the 'right person for the job' or get advice about problems their patients were experiencing, in both directions. The lunchtime lectures in the PGC were informative CPD and led to cross referencing practice at all levels with out the need for triage centres, IFRs and a lot of cyberwork by medical staff.
If they were re-introduced, I vouch that patient care would be improved overall but then, how does the NHS measure that? And there is the rub. If 'it' cannot be measured and reported 'it' is of no worth!
Nigel Mercer
Competing interests: No competing interests
Dear Editor,
We read your article "The future of doctors' messes" (BMJ 2019;364:k5367) with interest and thought we would share our experience of a collaborative approach to improving the working lives of trainee colleagues in the Shrewsbury and Telford Hospitals NHS Trust across two district general hospitals. Our approach has been an unusual one engaging not only our medical staff but also seeking to involve management colleagues and community partners in creating an opportunity to improve our doctors’ mess and also their accommodation.
Our work was inspired by a number of threads:
· Our trainee workforce is a highly valued one, for a rural district general hospital it can be difficult to attract candidates and when they are here to retain them. For our community partners this can have significant effects on the ability to provide acute services - a major concern across the UK in smaller centres.
· Life in the NHS is tough at the moment, and even the rosiest of tinted spectacles are not enough to improve the view. What can we do to improve the working conditions of colleagues? What can we do to help to reduce the impact of rising burnout (BMJ 2017;358:j3360) and to mitigate the risk inherent in physician fatigue which we are beginning to understand more (https://www.bmj.com/wellbeing)
We approached Public Sector colleagues in the community, talking directly to one of the authors, the leader of Telford & Wrekin Council. Our initial aim was to improve accommodation for trainee doctors on site. Somewhere for junior doctors to live; recreating the spirit of camaraderie of the past, close to work to avoid long commuting time, somewhere restful. We began asking community leaders for support in terms of funding and also expertise, time and the donation of supplies. A group was created, chaired by a senior hospital director involving input from our junior medical colleagues, communications teams, postgraduate education department and with representatives from the Council with expertise in planning, funding and publicity. The response to a call for help was overwhelming raising to date in excess of £30k and securing help with flooring, painting, gardening, kitchen and bathroom supplies from local businesses. The contacts of our council colleagues and a combined will to 'make it happen' has meant we are now able to offer free, high quality refurbished accommodation to F1s in Telford which we hope will continue to attract high applicants. Our community colleagues are examining ways in which we can welcome people in to our communities, looking at options to help with travel, access to public amenities and providing information about schooling and local facilities. Real community action.
As part of this programme of improvement, and with the help of the assembled experts, although this time funded by the Trust we have committed to completely refurbishing the doctors mess in Shrewsbury and are in the final stages of a more ambitious move from an off-site mess at Telford to repatriating it into the hospital. We have developed a space trainees can call their own, a place for rest, somewhere to prepare and eat hot food away from the hustle and bustle of the acute hospital. We hope to create exactly the atmosphere described in your article - a place for doctors to rest and relax but also to engage with colleagues in a less formal way. We firmly believe this will improve the productivity of our colleagues.
This enterprise has transcended party political lines with no political capital sought by any contributor.
The lessons we have learned are that by harnessing the expertise of community partners, hospital executives and with the enthusiasm of trainee doctors it is possible to make big change in small amounts of time. Bringing the force of the community to bear on the wider NHS has proved a powerful improvement strategy. It has brought us closer together and reinforced the sense that we are all in this together - local politics with NHS staff and our community, which we are all shared members of.
Yours Sincerely,
Dr Chris Mowatt – Consultant Anaesthetist and F1 Training Programme Director
Dr Jenni Rowlands – Consultant Radiologist and Director of Medical Education
Dr Adrian Marsh – Consultant Emergency Medicine and F2 Training Programme Director
Shaun Davies – Leader Telford and Wrekin District Council
Competing interests: No competing interests
It was great to read this timely article emphasising not only the importance but also the benefits to hospital colleagues of having "Space to Breath" in the midst of busy, and invariably stressful days.
I would also suggest the importance of this type of safe space and protective environment for staff in primary care too. Our days are equally as pressurised and also involve dealing with people who are often going through terrible crises in their lives, or struggling to deal with awful situations in the lives of those they love. Then there are the frequent attenders who we find difficult to manage and who cause us more than the odd sleepless night each time they're seen. And in primary care there's the added challenge of switching from a paediatric consultation, to one dealing with diabetes, then to one about the disability caused by osteoarthritis, followed by a potential new cancer, then a suicidal teenager, a bereaved mother and so on.
In my practice medical and nursing clinicians as well as the managers make sure we meet every day for lunch. It's often a working lunch, fielding queries from reception, signing prescriptions and triaging visits. But like the doctors in Rimmer's article, it is also a time to share difficulties and benefit from peer support, discuss clinical conundrums and draw on each others experience for advice and just as importantly, to simply chat; about our weekend, how our football team is doing, what our children are up to and anything else we've seen at the cinema or o TV, read or heard about on social media that we want to share. In fact this time is often at its most therapeutic when we are simply 'shooting the breeze'.
Our new trainees, visiting medical students and locums often tell us that we're unusual as a practice and that in many others they visit, GPs keep themselves to themselves, scoff a sandwich at their desks or in the car bound for home visits and share little more than a passing nod with colleagues unless at an official meeting.
I could not cope with my day under those circumstances and I know my colleagues would agree. And like the doctors in the article I am sure that having our 'mess' not only helps us as clinicians to de-stress, access support and even detoxify before getting back to seeing our patients. But because of how it positively affects us to have that thirty or so minutes in our oasis, it must be good for our patients as well.
In short, GPs should have doctors' messes too.
Competing interests: No competing interests
Abi Rimmer’s article framed the Doctors’ Mess as a social space; however, it may be better described as a professional space. Seen as a social area, doctors’ messes have been quietly closed over the years under the guise of increasing productivity and squeezing in extra beds.
The Mess should be seen as a safe space in which to discuss cases, learn from, and teach one another. Different specialties can meet and appreciate each other’s viewpoints and expertise. Moreover, doctors can freely reflect on difficult or emotional cases, training issues and personal problems without fear of being overheard or penalised. This informal process is perhaps the most valuable pastoral care in medicine and we should support and encourage its development.
Having professional spaces that are well maintained, accessible and comfortable should engender a better sense of community within hospitals. This medical community is where the hidden curriculum operates and is how individuals develop a sense of professional belonging. Strong professional identities will give trainees more resilience to cope with stressful and complicated working conditions.
Competing interests: No competing interests
Re: The future of doctors’ messes
Dear Editor
It is great to read this correspondence about the importance of doctor’s messes (BMJ 2019;364:k5367) and it was all pre-Covid. I started as a ‘Lead for wellbeing for doctors-Covid’ in March 2020 and helping organise a much larger doctors mess has been a really important project.
As the previous authors have highlighted, it is time to acknowledge that doctors have vulnerabilities and have basic physical and psychological needs. This is emphasised in the 2019 GMC report on doctor’s wellbeing Caring for doctors Caring for patients which says “Medicine is a tough job, but we make it far harder by neglecting the simple basics in caring for doctors’ wellbeing”. The report is clear that workplace factors which affect doctor’s wellbeing should be addressed rather than trying to increase individual resilience.
Doctors need a safe space where they can socially distance, have a sense of community and benefit from refreshment and rest. Setting up of this mess facility took a lot of work, with hundreds of practical details to arrange. The hospital’s volunteers, unable to do their usual ward duties, created a rota to tidy the mess and put out tea, coffee, biscuits, bread for toasting and jars of Nutella. Originally the food was donated but is now covered by doctor payments. The mess is open 24 hours with swipe card access and camping mattresses are used for naps at night. On weekdays there are over 100 visits, demonstrated by the number of mugs and glasses to be washed. About 30 doctor’s backpacks dot the floor after 8am. Isn’t this ordinary?
The volunteers worked hard and loved it! Instantly recognising that caring for doctors is no different from caring for patients. It is marvellous to hear the doctor’s laughter, the offloading, the bonding and the sense of belonging a safe space creates. It is still an educational space. So much factual knowledge is exchanged, compassionate listening by trainees for trainees and spontaneous advice obtained. We created this intuitively but it fits with the findings of Shanfelt et al on the needs of health care professionals in the pandemic. They encapsulate the needs of healthcare staff as “hear me, protect me, prepare me, support me and care for me.”
So, what about the future? The mess is unlikely to last in its current form. The volunteers will go back to their roles on the wards. The case for expanding volunteer numbers so that caring for staff could be included as part of the volunteer’s remit is yet to be accepted and organised. There is a tension between the perceived value of formal teaching days and the current informal education that goes on. The amount and effectiveness of less formal social, workplace and tacit education in what are called ‘communities of practice’ has been known in educational circles for over 30 years but is often insufficiently acknowledged and incorporated into medical training.
Unfortunately, there is a shadow side to our profession and our organisations which has come to light. A difficulty admitting doctors might have vulnerabilities, that basic physical and psychological needs are important and are not being met. Covid has created the circumstances for outsiders, to showcase practical new ways of thinking and what the future might look like. But for a safe rest and refreshment space to continue for all doctors, the profession itself must step up. Doctors need to make the case to their organisations, get heard, put time into local doctors’ organisations and make a small, regular financial contributions. There’s no reason why this can’t be a rallying call to allied professions as well. The indifference and denial used in the past will not lead to change but honesty about basic needs and hard work will.
Sally Webber
Sally Webber (sallywebber@nhs.net) is a retired hospital doctor and a leadership and developmental coach working in healthcare. She is part of Bristol and Bath Healthcare coaching BBHC.org.uk and interested in distributed leadership and wellbeing.
Competing interests: No competing interests