07 February 2010

A very French proposal

From time to time comments appear on this blog saying how much better healthcare is in other countries. France is often claimed to be the best country. How people know is unclear. Most of us do not have that much experience as patients in other countries. Dr Grumble does occasionally interact with French doctors. He has visited parts of France which excel in his particular specialty. Are they better than us? The honest answer is that they are. It's not a marginal thing. They are head and shoulders above us.

As it happens Dr Grumble has recently been working alongside a French consultant. Getting locums with the right expertise can be difficult so the Grumble hospital recruited one from France. What would he think of the NHS? Dr Grumble tentatively asked. He shrugged in a typically French way. "It's the same," was all that he would say. The French doctor was a good one. The decisions he made were much the same as Dr Grumble would have made. From a distance French medicine can seem rather different from English medicine but the similarities are greater than the differences.

French doctors, junior and senior, are unusual in the UK. Dr Grumble has had the occasional medical student from Paris. He remembers one particularly well. Towards the end of her stay she beckoned Dr Grumble and told him she had a good idea for an improvement. Dr Grumble was all ears. What was this innovation going to be? If you know anything at all about France, what she had to say will not be a great surprise. But like all simple improvements that those from outside the NHS think would be easy to implement, the French student's proposal was a complete non-starter. Dr Grumble just laughed. He didn't mean to. But her proposal was so very French.

So what was the proposal from Grumble's Parisian student? Dr Grumble sat down to listen. She began by saying that we were leading unhealthy lives. All we had for lunch was a rushed sandwich. And that was on a good day. She was shocked that we did not do what they did in the French hospitals where they took an hour or so's break for lunch. They had a proper sit-down meal and the hospital paid for the wine! Dr Grumble didn't really laugh. He did inside but it is not good to laugh at serious suggestions made by students and she was serious. She was unable to grasp that nothing like that was ever going to happen in today's NHS and she looked visibly disappointed that Grumble was not going to make an immediate appointment with his masters to sort out the wine supply.

Believe it or not, this is an absolutely true story and while the student's suggestion does seem today to be absurd, Dr Grumble can remember times when we did sit down to lunch. And it was a healthy thing to do. It was healthy for the well being of the hospital and our patients. We met our colleagues. We learnt what was going on by chatting instead of by reading propaganda news sheets from the management. We learnt who to refer to. We discussed cases with colleagues that would otherwise not have been discussed. A lot of work was done in a painless way. But the world moves on - not always in the right direction.


Anonymous said...

I'm an FY2 doctor in a small, but busy, hospital. We all try to go for lunch together, at least for half an hour. At first I thought it was weird with the students, juniors and consultants from throughout the hospital all sitting down to eat together, but actually it's really worthwhile. We do all pay for ourselves though! Many an informal second opinion or referral has happened over lunch in between all the gossip and local news. It's also good for learning what to do and see in a new area, because you're socialising with long term residents. When visiting consultants come for clinic they join us and comment on how much they enjoy it. It'll be strange going back to big hospitals and all that anonymity again.

Dr Grumble said...

Small hospitals are nicer than big ones for this sort of thing. I well remember visiting one district general hospital when I was a student where the doctors were provided with free beer. A grateful patient had left money in his will to pay for the doctors' ale. That anyway is what I was told. The good news was that medical students were included.

As you say, F2 doctor, sitting down to lunch is really worthwhile for all the reasons you have given. If I was a manager I would be inclined to try and encourage people to sit down to lunch together. Perhaps that will be the management's next initiative to cheer up the staff of the Grumble hospital. We can but hope.

Years ago our clinics were punctuated by coffee with the consultant. This was also an opportunity to discuss cases and sort out any problems. And in days gone by it we used to punctuate wards rounds with a cup of tea when we would sort out problems with the social workers. Now we just don't stop. I am inclined to think that we were more efficient when we used to take breaks. As my French colleague says: C'est la vie.

Yoav said...

You can summerise this in one line:

The French live to eat while the British eat to live.

It's a cultural thing, and nothing to do with the health service per se.

Sam said...

Actually, I like this post very much Dr G - and I think you have a VERY valid point here.

Having lunch together with peers, managers, colleagues and students, etc - not only encourages the feeling of togetherness, hence, sense of belonging, responsibility and ownership, it also encourages debate and therefore, finding best solutions for 'any' problems .. and therefore aids best practice ..

It is also 'The' most proper way to encourage innovation and the creation of new quick but worthy ideas too!

If you google 'Google' and see how they allow their staff free lunches, so that they can sit together and precisly do just that!

They also allow their IT engineers a whole day to do whatever they want, providing it is to do with work! That's how that staff came up with the 'Google mail' idea .. etc

The NHS can not afford to allow one whole day 'at liberty' per week to encourage innovation .. but it can allow for that lunch hour together .. surely!


Andy Cowper said...

The timing of this post is uncanny. Last week, I saw a friend at the Kings Fund - someone who has good reason to know a lot about patient safety.

This person worked in NHS hospitals back in the day where everything stopped for lunch and dinner and there was wine. This person was clear that a significant problem used to exist with a substantial minority of consultants who attempted to carry on their lists after having had too much to drink. The culture of deference meant that they were usually not challenged, despite this being a fairly open secret.

The basic idea of getting the workforce to have lunch together is excellent, and should definitely be supported.

You're also right that working non-stop and without 'water cooler breaks' is unquestionably not more efficient way to work (see also very high rates of bed occupancy ...).

But given how British people drink (and how medics drink), I think wine might have to stay off-duty

Dr Grumble said...

You are right, of course, Andy. But it's surprising to find a journalist impugning medics when it comes to drink. Isn't that the pot calling the kettle black? :-)

Seymour Clearly said...

I am as bad an offender as yourself, Dr Grumble, and usually eat a sandwich on the run. The exception is Friday lunchtime, when I treat my secretary to fish and chips in the canteen. Many an issue is sorted out there, but mostly we make a point of avoiding talk about work.

Breaks with other doctors and staff are an excellent opportunity for informal second opinions and feedback, and a major contribution to team working. In theory they are an EWTD requirement, but like so much in practise do not occur.

The Friday night pub early doors, is also a thing of the past. 20 years ago a major part of team bonding. These were rarely heavy sessions, more a post working week drink for an hour. This no longer happens partly due to cultural reasons. Half our dept are female, half Muslim for example.

There are two substitutes for this in that we have departmental nights out in a local curry house, one both with beer and halal meats, so all tastes covered! The other one is departmental facebooking, with consultants and auxillaries in one network. Work is not discussed by principal.

Andy Cowper said...

Is stating a 'factoid' (AKA popular cliche) really impugning the profession, Dr G? Yours or mine?

; - )

I did after all make my main point about British people (and I suppose on a good day, journalists can be people too).

Anyway, as Chaucer, Shakespeare, Hogarth and many others show, Le Binge-Drinking N'Est Pas Nouveau.

Dr Grumble said...

There are actually some serious issues here. While binge drinking may go back to Chaucer's time I do think that amongst the general population it has got worse recently not, perhaps, helped by the latest government initiatives. (Tony Blair the culprit again, I think.)

Doctors may be relatively better than they were. And, to be fair, journalists too. I do remember in the past having quite a few journalists who regularly drank too much and as a result became my patients. It did seem to be a hazard of the job. One of the keys to helping them out was to learn about their lifestyle and what habits they needed to break. It became fairly clear to me that in those days journalists used to work in the morning and then go to the pub at lunch time (which I suppose might just have been part of the job). I remember being impressed that they could earn enough by working half days when I was working the whole week. (I wanted to be a journalist once.) Talking to the journalists I now have as patients it seems to me that their lives are very different. They work very much longer. Some work all night updating web pages. Even those who work more wholesome hours no longer have time for the pub. You must be one of those, Andy. Didn't I hear you on the radio recently burning the candle at both ends?

Dr Aust said...

Mrs Dr Aust well remembers sit-down staff lunch with wine from doing an elective stint at a French hospital nigh-on 20 years back. But we had assumed that by now it would be a thing of the past in France too. Does anyone know if les Francais still have wine at lunchtime in the hospitals? German hospitals don't have wine, though in an interesting cultural quirk the hospital shop does sell cigarettes.

So far, UK Universities still run at a pace (just about) where you can escape for 30-60 min for lunch most days. We even have a half-decent cafe (outsourced, natch). It is fair to say, though, that you don't see as many Professors lunching in there compared to sub-Professorial ranks. So perhaps they are too busy. Or perhaps my friends and I can only find time for lunch because we are the underachievers of the system.

I would agree, though, that seeing people over lunch is a good part of keeping the whole operation running smoothly in Universities too. Apart from the reasons mentioned, people are far more likely to tell you what they really think over lunch (and even more so in the pub) than in a formal meeting - especially one with forty people, including the big bosses, all sat there eyeing one another suspiciously.

Andy Cowper said...

You did, Dr G, chuntering on about Conservative public health policy for The World Tonight.

Young children and prices are the reasons I'm not in the pub much these days, but it remains a decent place to make and consolidate contacts.

More broadly, I think mainstream journalism is a soberer business these days. I'm not sure the end product is much better as a result, but that may be to do with the mainstream media being essentially insular and homogenous in its approach and intake of staff.