What Happened to the Doctors' Lounge?

The lounge was once a place for physicians to regroup and congregate. Today, where lounges do exist, they are places for paperwork.
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Two senior physicians at a local hospital bump into each other in the hallway and realize they have not seen each another in years. Both are bewildered. Twenty years ago they saw each other at least weekly in the doctors’ lounge. There they would catch up on their personal lives, talk hospital politics, and compare notes on patients. In their hospital today, the doctors’ lounge no longer exists, eliminated in a recent renovation.

In hospitals that still have doctors’ lounges, they are often nearly deserted. On the infrequent occasions when more than a handful of physicians are found there, typically they are not engaged in conversation with one another, but tending to medical paperwork or dictating patient discharge summaries. Increasingly, the doctors’ lounge represents a place where physicians are alone.

What makes the doctors’ lounge so important?  It once provided a base of operations for physicians who came to the hospital to round on their patients or perform procedures. They would show up there at odd times throughout the day, pick up their white coat, grab a cup of coffee, or just rest for a few minutes. Most of all, they talked to one another. Many senior physicians recall the doctors’ lounge as the most important hub of medical collegiality in the hospital.

The reasons for the decline of the doctors’ lounge are not difficult to fathom. Physician workloads are growing from year to year. They are expected to see more patients in shorter periods of time, electronic paperwork has become more onerous than ever, and the sheer complexity of medical practice is always increasing. As the intensity and length of the workday increases, time for non-urgent interaction inevitably gets crowded out.

While hospital administrative staff members want to provide a hospitable environment for their medical staff, on whom they rely for patient referrals and admissions, the site of large numbers of physicians congregating on a daily basis can also engender anxiety. This is particularly true at a time when hospitals are trying to assume more control over how physicians practice medicine. 

Likewise, the managers of medical practices might be happy to see the doctors’ lounge fade. A manager monitoring what once transpired within its walls might conclude that it was a large productivity sink, a place where physicians who should be seeing patients, prescribing medicines, and performing procedures were instead engaged in idle conversation. By eliminating the spaces in which such wasteful interactions occur, they might suppose, medical productivity could be boosted.

But such an attitude betrays a superficial understanding of the role of the doctors’ lounge. One of the reasons many people, including physicians, enjoy their work is the collegiality it affords. From a psychological point of view, work is not just churning out widgets like a robot on an assembly line. It is also a matter of affiliation, of building relationships with colleagues, and of sharing professional and personal experiences.

The loss of such opportunities is one important though largely unrecognized contributor to the high rates of dissatisfaction and burnout among physicians today. Without a place in which to interact regularly with colleagues across specialties, the medical profession increasingly resembles a collection of silos. Under such conditions, competition can degenerate into turf wars and collegiality can melt into distrust and even antagonism. There is no substitute for face-to-face interaction.

As different medical specialties and physician groups interact less, physicians are less likely to see colleagues. Those they do see are likely to be much like themselves. This clustering of physicians decreases the frequency and diversity of physician-physician interactions. And this degradation of physician-physician interaction contributes to discontinuities in patient care and decreases the rate at which physicians gain new insights and produce new innovations.

Medicine needs to catch up with other organizations that have recognized the importance of promoting interdisciplinary interaction. Some of Silicon Valley’s most forward-thinking companies have gone out of their way to design environments where their staff members interact across such boundaries. For example, the volleyball pits that some companies have installed cut across departmental lines, promoting interactions between people who might otherwise never venture beyond their own silos.

If I were a patient choosing a hospital, I would want to know if it had a lively doctors’ lounge. Is it simply a bunch of doctors being alone together, or is it marked by fruitful conversations? If the doctor’s lounge were buzzing, I would take comfort from knowing that the medical staff is probably relatively vibrant, cohesive, and capable of providing better care.

                

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Richard Gunderman, MD, PhD, is a contributing writer for The Atlantic. He is a professor of radiology, pediatrics, medical education, philosophy, liberal arts, and philanthropy, and vice-chair of the Radiology Department, at Indiana University. Gunderman's most recent book is X-Ray Vision.

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