In 1996, two British hospital doctors, one a consultant, the other a junior, devised an odd but ingenious way of assessing how much time a hospital doctor spends on the wards. Fiona Cooke, a senior house officer at the Royal Brompton Hospital in London, and Rhian Morse, a consultant physician at the University Hospital of Wales, made use of one of the commonest gifts that grateful patients give to the nurses and doctors who have looked after them, a box of chocolates.
The boxes are traditionally kept on the wards where those who work there can help themselves. It’s a useful tradition. The caffeine in chocolate has a stimulant effect that can help the weary – a state that often afflicts staff on hospital wards, particularly the most junior doctors. As a result, say Drs Cooke and Morse, newly qualified housemen and women ‘have a massive exposure to a wide range and quantity of chocolates – one of the many early and challenging experiences for the new doctor’.
They decided to test the ability of doctors and nurses to recognise popular chocolates and to see if chocolate recognition was in any way related to the number of years a doctor had been qualified. A random selection of 76 nurses and doctors, senior and junior, at the Royal United Hospital, Bath, and the University Hospital of Wales, Cardiff, agreed to take part in the trial. Each volunteer was shown a grid containing twelve popular chocolates and asked to identify the flavour and make of each. Prodding, smelling and tasting were not allowed.
The research, published in the British Medical Journal, produced some clear-cut results. All the volunteers, except the consultants, turned out to be better at recognising the make of chocolates than the flavour. Consultants were equally bad at recognising both. Among junior doctors, the chocolate-recognition scores of those who had been qualified for more than a year were significantly higher than those of senior doctors and of fellow juniors in their first year after qualification. The nurses performed as well as the best of the junior doctors. The results also showed that the longer a doctor had been qualified, the lower the chocolate-recognition score. There was one exception to this general rule. Most nurses and doctors, regardless of how long they had been qualified, could recognise the coffee crème.
After analysing the statistical data, the researchers concluded that a doctor faced ‘a steep learning curve for chocolate recognition’ in the first year after she or he qualified, though they admitted that this is true of other medical skills. They found it difficult to determine whether the learning process with chocolate was an active or a passive one. Their results suggest it is a deeply personal accomplishment. Chocolate recognition is unlikely to be taught by senior colleagues, or even acquired from them, because the skill appears to deteriorate with increasing seniority.
Despite the poor recognition skills of senior staff, they certainly knew which chocolates they liked and which they did not, even if they couldn’t recognise them. Senior registrars and consultants commonly used phrases such as ‘the yucky one’ or ‘the yummy one’ to indicate their preference. Drs Cooke and Morse suggest that this behaviour is in line with the more instinctive approach that doctors take to medical problems as they become more senior. Many consultants, they point out, have been heard to say, ‘I don’t know what’s wrong with this patient, but he’s definitely sick.’
The most significant finding of the research was the near universal recognition – and dislike – of the coffee crème. The researchers’ comment on this finding was the traditional, ‘The reason for this is unclear.’
The bad news for consultants was that, even before the results were published, NHS managers had expressed interest in the chocolate-recognition score as a surrogate measure of time spent on the wards.