Lessons from a Sprinkled Donut: A Pastry Almost Took out Our Hospitalist Group

The doctors’ lounge. A place of collegiality, medical discussions, and food breaks. It’s a showcase for new doctors. During a lunchtime visit it can be a window into how well the medical staff interacts. Since many hospitals are removing their doctors’ lounges, the fact that my hospital provides 24/7 access to coffee and food seems a privileged perk, a disappearing commodity.

Each morning our lounge provides some fresh fruit, a state of the art coffee maker, and a daily assortment of pastries from a local bakery. The chocolate muffins or cream filled donuts provide the perfect treat after a long seven day stretch, the weekly sugary carrot. Yet, somehow, those sumptuous scones led to a litany of surgeons calling the hospitalist office one day yelling, “Get me Messler!” How do delicious freshly baked good bring down a hospitalist group?

It started a few months earlier. One of our hospitalists decided to join the nutrition committee. They discussed meal and dietary suggestions for the cafeteria, trying to determine how the hospital staff could eat healthier. They led an effort for the hospital cafeteria and staff to begin walking the walk, instead of just talking the talk.

We weren’t a hospital with a McDonald’s parked out front, but we were heavy on the fried food and light on low calorie options. Most of the unhealthy options didn’t disappear, but many nutritious choices became more prominent. Calorie counts appeared, a larger salad bar, fresh sandwiches and more variety – a reasonable approach.

These changes drifted over to the doctors’ lounge and the physicians’ area outside the operating rooms. Yogurt and granola for breakfast, more fish or vegetarian lunch options. Plentiful fruit.

The pastries were still there, but other choices abounded. Then, one day, the baked goods, bear claws, and fritters vanished. Without warning. I noticed the change, was mildly disappointed, but figured I was probably better off without the temptation.

The next day, the calls start coming in. And I couldn’t walk into the lounge without getting attacked by several surgeons.

“Where the &$#% are my donuts? Look what those hospitalists did. Get me my donuts back, Messler!”

As the director of the hospitalist group at the time, I received numerous calls. All surgeons. I had no idea what they were talking about. I had nothing to do with any donuts. I asked my colleagues and they weren’t sure, but they did remind me that one of our docs was on the nutrition committee. But that was a committee with many hospital staff. Why were they blaming us?

This scenario reminded me about a classic internist vs surgeon joke.

An internist, a surgeon, and a pathologist are duck hunting.
Some birds fly by, the internist steps up, and raises her rifle overhead.  She says to herself, “Looks like a duck, flies like a duck, quacks like a duck, rule out quail, rule out pheasant. Goose versus duck likely.”  BANG!  She bags herself a duck.
Another flock of birds flies overhead and the surgeon raises his gun at the flock.  BANG! BANG! BANG! BANG! BANG!  He fires multiple rounds at the flock and dead birds drop everywhere.  The surgeon lowers his gun, walks over to one of the dead birds, picks it up, hands it to the pathologist and says, “Tell me if this is a duck.”

I was the nearest bullseye, and about to become a dead duck.

“How can I operate if I don’t have any donuts?”

“I have 5 cases today, if I don’t get my friggin’ pastry, I will have to cancel my afternoon.”

Bang!

Delays, post op complications, everything was being blamed on the donut deficiency, and hence our group. The surgeon without his bear claw became a grizzly monster. To this day, 5 years later, I still have surgeons reminding me when the hospitalists took the donuts and crashed the hospital.

The group and I received the brunt of the complaints. Despite there being a full committee that was making decisions, we turned into an easy scapegoat.

It took a couple of weeks, but the donuts made their way back in the lounges.

After the dust settled, it turned out that the nutrition committee never meant to take any of the pastries away. The supplier for the doughnuts and bagels switched at the same time those healthier menu choices were appearing. Pure coincidence. There would have been no baked goods those two weeks regardless of the committee.

Bang! Bang!

I learned a lot during those two weeks. Of course, the primary lesson being that glazed donuts apparently fall somewhere between a Time Out, anesthesia, and the first incision.  In addition, I was reminded of a lesson we all learn over and over; that what one of us in our group does, good or bad, reflects on the whole group. Even though we see patients individually, we are a team of hospitalists. One for all and all for one.

Also, that gut decisions beat rational decisions. Following our stomach seemed all too true in this scenario. Some of the docs responded a bit irrational, jumping to false conclusions, pointing fingers, and seeking blame rather than solutions.

This situation seems funny in retrospect, but it’s all too common how conclusions are made without all the facts, false blame is laid on an entire group of outsiders, and just how angry someone can become when they perceive that they have lost control in a situation. This type of response is evident in our daily politicking, voting behavior, and medical decision making. As physicians, we often feel we believe rationally, and evidence-based, yet we know that the art of medicine and the gut decisions play a role in our daily decision making as much as the science and deliberate aspects of our thinking. We think fast and slow.

The most important lesson may simply be to recognize this type of thinking, and to discuss these lessons with our colleagues over some donuts.

Jordan Messler

Jordan is a hospitalist at Morton Plant Hospitalists in Clearwater, Florida. He currently chairs SHM’s Quality and Patient Safety Committee. In addition, he’s been active in several SHM mentoring programs, most recently with Project BOOST and Glycemic Control. He went to medical school at University of South Florida, in Tampa, and completed his residency at Emory University.

He recognizes the challenges of working in a hospital that lines the intracostal waterways of a spring break mecca. Requests that if you want to be selected as a mentored site, you will have a similar location with palm trees and coastline nearby. He tries to find time to sit on the beach with his family to escape the hospital’s miasma. While there, he looks forward to reading about the history of hospitals/medicine, and how it relates to quality (Anti-UpToDate reading material). But inevitably will get a five year old dumping sand on him, and then has to explain why she is buried up to her neck.

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