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Matt Morgan: Cold food on hot desks

BMJ 2019; 367 doi: (Published 10 December 2019) Cite this as: BMJ 2019;367:l6829
  1. Matt Morgan, intensive care consultant
  1. University Hospital of Wales
  1. mmorgan{at}
    Follow Matt on Twitter: @dr_mattmorgan

As I approach the hospital, my day is already planned out. Handover, then a ward round, and family discussions, before an attempt to eat a sandwich, one handed, while balancing on the corner of a crowded “hot” desk. Then a meeting here and a meeting there, before another ward round and a late exit, probably hitting the traffic at just the wrong time to get home for a family dinner.

However, as the hospital doors slide open I see a colleague I need to speak to about a problematic research project, who’s just finishing a night shift. Standing in the recess as the doors repeatedly open and close, we get the problem solved. I have another impromptu meeting while queuing for coffee, this time with a medical student designing a conference poster. Three floors in the lift give us sufficient time to arrange my next job appraisal. These serendipitous, grabbed moments are the most productive of the day.

While these “watercooler” moments can help us to solve admin problems, clinical problem solving is more restricted. No phone signal, a busy outpatient clinic, and off-site working all stand in the way of progress. Hushed words with surgeons in the corridor and leaning on windowsills chatting about organ donation are not conducive to good communication, or privacy, in the clamour of a busy lunch hour.

There used to be a place where clinical “watercooler” moments happened. This third space—the staff canteen, the doctors’ mess, or a separate coffee area—was where staff could meet, talk, eat, solve problems, and socialise. It provided the luxury of space, unaffordable in the land grab of modern hospital services. This has been replaced with franchised coffee shops and vending machines, which offer little in the way of solace or privacy. Viewing those spaces simply as a place to deliver calories undervalued them. In reality, they contributed to the delivery of medicine: cross specialty working, with comorbidities being balanced by teams across multidisciplinary tribes.

As I eat my cold sandwich at a crowded hot desk, I long for nuanced conversation in that lost space. Please can we bring it back?

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  • Competing interests: I have read and understood BMJ policy on declaration of interests and declare that I have no competing interests.

  • Provenance and peer review: Commissioned; not externally peer reviewed.

  • Matt Morgan is an honorary senior research fellow at Cardiff University, consultant in intensive care medicine, research and development lead in critical care at University Hospital of Wales, and an editor of BMJ OnExamination.

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