Intended for healthcare professionals

Feature Christmas 2022: R-E-S-P-E-C-T

Taking the biscuit: defining excessive quantities of free refreshments in a healthcare library

BMJ 2022; 379 doi: (Published 19 December 2022) Cite this as: BMJ 2022;379:e072846

Linked Letter

Real world impact of Christmas BMJ research

  1. Andrew Tabner, emergency medicine consultant1,
  2. Stuart G Spicer, research fellow in applied healthcare2,
  3. Kerryn Husk, associate professor of health services research2,
  4. Holly Blake, professor of behavioural medicine3,
  5. Caroline White, manager4,
  6. Suzanne Toft, clinical librarian4,
  7. Graham Johnson, consultant1
  1. 1Emergency Department, Royal Derby Hospital, University Hospitals of Derby and Burton NHS Foundation Trust, Derby DE22 3NE, UK
  2. 2University of Plymouth, Plymouth, UK
  3. 3University of Nottingham, Nottingham, UK
  4. 4Library and Knowledge Services, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
  1. Correspondence to: A Tabner andrew.tabner{at}

Evidence suggests that complementary hot drinks and biscuits benefit an overworked and highly stressed healthcare workforce. But when signage in healthcare libraries asks patrons not to consume “excessive” quantities of free hot drinks and biscuits, how much is too much? Tabner and colleagues explore this resource allocation conundrum

As the festive season approaches, temperatures plummet, days shorten, and healthcare workers see glimmers of time off around the holidays, some might consider the provision of unlimited free hot drinks and biscuits a welcome token of appreciation; this is particularly the case for National Health Service staff, who are often felt to be underpaid and undervalued.12 A chance observation of signage in a hospital library requesting that patrons avoid “excessive” consumption of free hot drinks and biscuits (fig 1) does, however, raise the question: if some people take more than others in a system constrained by both finances and logistics, might some staff end up getting the short end of the teaspoon?

Fig 1

Observed signage in a hospital library

As sweet (and seemingly bottomless) as the ubiquitous communal box of Quality Street3 may be, the term “excessive” in the context of free refreshment consumption is open to interpretation. The Oxford English Dictionary defines excessive as “exceeding what is right, proportionate, or desirable,”4 suggesting that individuals may apply their own values and judgments. Interpretations may therefore vary depending on appetite, taste, income, the proximity of snacks to beverages, psychological determinants (eg, stress and guilt), and myriad factors not yet considered. But how much is too much? Furthermore, who judges etiquette in such situations, and how might opinions differ between staff members? One of the current authors described regularly succumbing to Bentham’s Panopticon effect,5 where behaviour is modified to avoid that uncomfortable feeling of being perceived as greedy by others. …

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