The doctor's lounge is going the way of the dinosaur

By Christina Schallenberg, Clinical Editor, Parkhurst Exchange
Exclusive to Canadian Medicine

The Canadian doctor's lounge is on the road to extinction.

These days, when hospitals go through renovations, the doctor's lounge is often one of the first things on the chopping block. "It's no longer a priority," laments Dr Louise Nasmith, co-chair of the Collaborative Action Committee on Intra-professionalism (CACI), which works to improve collaboration between physicians. A similar complaint comes from Dr Preston Smith, head and academic leader of the Maritime Network of Family Medicine at Dalhousie University: "The doctor's lounge is disappearing in a lot of places," he says, citing a number of reasons, including space considerations and hospital authorities' failure to appreciate the benefits of the lounge. "The main value of the doctor's lounge," says Dr Smith, "is the promotion of intra-professional collegiality."

As doctor's lounges vanish, physicians aren't the only ones who will suffer: aside from good old socializing, lounge conversations have been known to speed up many a case. "I certainly have witnessed it in my career that a patient was on a wait list for six months, and after a conversation in the doctor's lounge the specialist said, 'I'll do that tomorrow,'" recounts Dr Smith.

Then there's the aspect of continuing medical education that takes place and, finally, the efficiency of face-to-face communication that allows for shortcuts. But as doctor's lounges dwindle in numbers, this kind of collegiality is bound to take a beating.

COMMUNICATION CATALYST
There still is a lounge at the Moncton, New Brunswick, hospital where Dr Smith practises once a week, and he believes that patient care -- and possibly even cost effectiveness -- are the better for it. A chat in the lounge is a great opportunity to be your patients' advocate without having to deal with faxes, emails or secretaries. It streamlines communication and promotes social interaction.

Without the lounge, physicians are more prone to working in isolation, without knowing the faces, names or specialties of some of their colleagues -- even if they're treating the same patients. Such simple "deficiencies" are among the major factors hampering an informal information exchange between physicians, according to the University of Toronto-based authors of the Structuring communication relationships for interprofessional teamwork (SCRIPT) study, published last year in the Journal of Interprofessional Care. As a result, collaboration suffers.

Dr Nasmith's Collaborative Action Committee on Intra-professionalism, established in 2007, was formed to address intra-professional issues such as the communication between doctors. It may not be a coincidence that such a group was deemed necessary at a time when the doctor's lounge has all but disappeared. And even in places where the lounge still exists, its character has changed.

Twenty-five years ago, the doctor's lounge was frequented regularly by two-thirds of the physicians at his Moncton hospital, Dr Smith recalls. But it's a different story today: "They're skipping coffee, skipping lunch, working right through the day," he says. Thanks to an exploding workload, there simply isn't time to hang out and have a coffee break with your colleagues.

GENERATION GAP
Younger doctors, more so than older ones, seem to avoid the lounge, Dr Smith observes. They may be worried that if they show their faces, a colleague will seize the opportunity to put even more work on their plates. With doctor's lounges vanishing across the country, it's also possible they've never seen one from the inside during their training, so they may not know what they're missing.

Doctor's lounges are disappearing from hospitals, yes -- but, this being the always-plugged-in 21st century, virtual doctor's lounges are ascendant. Social-networking has taken off on the internet, and the medical community has taken note: Asklepios, a Canadian Medical Association website, and Sermo, a private American firm, among other sites, offer doctors the opportunity to communicate with one another online, without having to worry about patients listening in. The content of the websites is similar to what you find in a real doctor's lounge: clinical queries, jokes, complaints and even a little bit of flirting.

The internet, however, doesn't make a good doctor's lounge -- a real-world one -- redundant. Dr Smith counts off some of the features that he appreciates in Moncton: a central location and comfortable seats, access to electronic health records to facilitate discussions about specific cases and -- last but not least -- good coffee.

So would he protest if his lounge were to close? "Definitely. And I wouldn't be alone."

Photo: Shutterstock

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