Pulse
Relic or Relevant?
The doctors’ lounge isn’t what it used to be. In some cases, it’s better.
It’s no accident that the physicians’ lounge at Abbott Northwestern Hospital in Minneapolis has the feel of a men’s club. The room’s dark paneling, crown molding, and cabinetry were salvaged from the old Abbott Hospital after it merged with Northwestern Hospital for Women and Children in 1970. The woodwork literally is a vestige of the days when mostly male doctors went to the lounge to consult about a patient, smoke, or just hobnob with other practitioners.
The woodwork is about the only thing in the lounge that still feels old-world. Today, computer monitors flank several of the walls, as many women as men are seated at the dining tables, Starbucks coffee is the vice of choice, and CNN plays on the flat-screen televisions in the corners of the dining area. “It’s still a communal spot,” says Richard Sturgeon, M.D., vice president of operations for the hospital, explaining that the noon meal is especially popular but that the lounge is not the “old men’s club it used to be.”
For generations of physicians, the doctors’ lounge was the place to make and maintain the professional contacts that not only provided them with a social network but also with the referrals that paid the bills. As email and cell phones eroded the need for face-to-face communications, as managed care reduced the need for referrals, and as hospitalists usurped the inpatient work once done by private practitioners, the interactions that used to occur in the lounge seemed less and less essential. As a result, many proclaimed the lounge was as obsolete as the black bag. Articles in the medical journals have described it as “going the way of the dinosaur” and called it a tradition that’s slowly dying.
But is the doctors’ lounge truly a relic of the past? Although most now agree it is no longer the hub of hospital medicine it once was, the rumors of its demise might be exaggerated. A surprising number of hospitals in Minnesota have recently remodeled or even reinvented their venerable lounges. In many, the old hub has not yet gasped its last. But it has changed.
New and Improved
When Robert Moravec, M.D., started practicing medicine 25 years ago, nearly all members of the medical staff at Bethesda Lutheran Hospital in St. Paul gathered in the doctors’ lounge. The place, as Moravec recalls it, was crowded, noisy, smoke-filled, and even grimy. “It’s amazing to think back on that now,” he says.
The doctors’ lounge at St. Joseph’s Hospital in St. Paul, where he is now medical director, is a far cry from that. The brand new lounge is light-filled—sliding glass doors lead out to a patio—and immaculate. It contains a half-dozen computer workstations where physicians can access the hospital’s electronic medical record (EMR) system, several monitors where they can track the hospitals’ patient census, a spic and span dining area (a hot lunch is served on weekdays and a brunch on weekends), and a small sitting area furnished with a leather sofa and chairs and a flat-screen television. But at 9 a.m. on a Tuesday morning, the lounge is nearly empty, save for a lone physician reading the paper at one of the dining tables.
Moravec admits the number of physicians who use the lounge at St. Joseph’s is smaller than it was a few years ago. He explains that fewer physicians are rounding at hospitals because hospitalists and intensivists now do much of the inpatient care, and that many of the doctors who are making rounds are checking on their own patients as well as those of their partners. As a result, those doctors who do come to the hospital to round have to see more patients. “You don’t have the luxury to attend grand rounds in the morning or hang out for an hour on a break before you go to clinic,” he says.
Still Moravec says the new lounge is very much appreciated and there was no question about whether to keep it when St. Joseph’s was making space-planning decisions during its recent hospitalwide remodeling. It’s the place where physicians who come from outside clinics start their day and where a core group, a combination of hospital-based staff and physicians from nearby clinics, gathers between 11:30 a.m. and 1:30 p.m., Moravec says. “If I need somebody, I find them at lunch.”
Like the lounge at St. Joseph’s, the one at Fairview Southdale Hospital in Edina is also a popular lunch spot. That’s because a couple of years ago Fairview hired a chef to prepare meals for physicians on demand. John R. Schaefer, M.D., an emergency physician and past chief of staff at the hospital who dines there weekly, says the noon meal attracts both hospital-based physicians (including, he adds, “emergency physicians and hospitalists used to eating on the run”) and doctors from nearby clinics.
This year, the hospital has added a fitness room adjacent to the lounge. Fairview built the room and the medical staff funded the equipment including a treadmill, free weights, a stationary bicycle, and an elliptical trainer. The fitness room has only been open for a couple of months, but Schaefer estimates it’s used a dozen times a day, primarily by hospital-based physicians. He thinks of the room as a logical extension of the improved food: “We need some way to work it off,” he says.
Something Gained, Something Lost
The physicians’ lounge at St. Mary’s Medical Center in Duluth is not the place it was during the 1980s, when Hugh Renier, M.D., was a resident. Then, he says, the doctors’ lounge was the locus of communication. “We had a separate mailbox for every physician. You had to come by the lounge to pick up communications because there was nothing electronic in those days,” says Renier, now vice president of medical affairs for both St. Mary’s and Miller-Dwan Medical Center.
When the hospital remodeled the space in 2007, it took out the mailboxes, installed computers, stocked journals, and renamed the space the medical staff resource center. “Now, of course, [hospital administrators] communicate by email,” Renier says, “and the discussions [between physicians] really occur more on wards or on floors or in offices or are done electronically.” The lounge functions more like a library than the living room it once was, Renier says.
Physicians have mixed feelings about such changes. Some say medicine itself has changed so much that socializing during a work day is no longer feasible or desirable. Internist Richard Adair, M.D., who sees patients at Abbott Northwestern, is one who thinks the changes are for the best and that the interactions that truly are necessary still occur—either through the EMR or in person during the course of the work day. He says when he arrives at the hospital, he goes to the lounge to use a computer to check on his patients’ schedules so that he can plan his day. “We come to work, get our work done, and go home,” says Adair, who has been practicing for three decades. He admits he is not nostalgic for what he calls the “clubby” atmosphere of the doctors’ lounge of years’ past. “It’s much more efficient the way it is now,” he says, comparing communicating electronically with trying to catch physicians in the lounge when he needs to talk to them, which he did years ago.
Others, however, think the communicating done through EMRs, emails, and quick conversations on a ward can’t replace the kind of relaxed, face-to-face conversations that used to occur in the lounge.
Robert Moravec says there used to be a “huge” amount of medical information exchanged in the doctors’ lounge. “It was the place where the surgeons would talk to the primary care doctor about the consultation, the gastroenterologist would let the internist know what they found on the colonoscopy, where a difficult or challenging diagnosis or interesting story was shared,” he says. “Now, with the electronic health record and the ability to look at
X-rays on line, a lot of that is lost.”
Moravec laments that these more personal exchanges aren’t all that’s vanished. Also lost, he says, is “some of the spirit and camaraderie of medicine.”—Carmen Peota