What this physician learned from being a doughnut waitress

I wrote this essay for KevinMD

In high school and college, I waitressed in a Dunkin’ Donuts shop that sat between Boston Common and the Combat Zone’s porn shops, strip clubs, and bars. The wages paid for school, clothes, rent, and food. At the time, I didn’t realize this job would provide useful skills for my later medical career, an early pre-med training of sorts.

Look the part. I donned the bubblegum pink polyester uniform that clearly identified me as the girl who’d bring coffee and doughnuts. Customers called me “Hey you” or “Honey.” In medicine, I wore a white coat, stethoscope, and nametag that branded me as a knowledgeable healer. When some patients called me Hey You or Honey, I internally rolled my eyes and got on with the job, as I had done as a waitress.

A smile goes a long way. In waitressing, a smile can mean the difference between poverty-level wages and a decent working-class income. That friendly face means a full tip jar at the end of your shift. In clinical work, a smile shows your patients that you care about them and their problems.

Keep the counters clean. Spilled coffee or doughnut crumbs lingering more than five minutes would provoke a rebuke from the store manager. But doctors also are expected to keep a clean worksite. Near the end of my first emergency room night shift, a nurse told us to straighten out our patient charts. It had been a busy night full of screaming alcoholics, gunshot victims, and cardiac arrests. As the nurse disposed of syringes, tubing, and bandages, and wiped the doctors’ work surfaces with industrial-level solvent, she explained that dirt or disorder enraged the director. He arrived exactly on time, read chart notes, and barked questions as we stood to attention. Annoyed at the time, I later appreciated the efforts. By keeping our physical surroundings orderly, our thinking could proceed logically, and we would provide better care to the patients.

Wash your hands. No one wants germs served with their coffee and doughnuts, and employers put state-required signs in lavatories in the hopes that staff will comply with hand-washing rules. According to the United States Centers for Disease Control, contamination by hands of healthcare providers is a major cause of most healthcare-associated infections.

Listen to what the client wants, deliver the goods, and don’t mix up the orders. If my customer asked for the typical Bostonian order of coffee “regular” (i.e., with cream and sugar), but I delivered black coffee, he’d be rightfully annoyed. Similarly, I quickly learned that if a patient came to my clinic about the hip pain that kept her awake at night, I’d have to address her pain during the visit. If I focused only on that day’s blood pressure reading of 210/105, she might not listen to my advice and might not return at all.

Memorization skills are important. The more doughnut and coffee orders you could remember at one time, the faster you could feed the hungry masses, and the fuller the tip jar would become.  My personal best was memorizing orders for thirty customers at one time. To practice medicine efficiently, the ability to memorize facts and retain a depth and breadth of knowledge is essential.

It’s a money transaction. My doughnut waitress job was pretty simple: take orders, deliver coffee and doughnuts, and collect money. Clients knew the costs up front—the menu clearly listed the prices. In medicine, the focus is on the patient, the diagnosis, and the treatment, but cost is rarely mentioned. Think of how refreshing it would be if you were handed a menu with prices when you sign in for your next doctor’s visit: “Hmm, I’ll have the primary care check-up, a glucose test, and a vitamin D blood level. But the bone density scan doesn’t look that good to me, especially at that price.”

Take care of yourself. A sneezed-on doughnut loses much of its appeal; however, we waitresses didn’t have paid sick leave, so too many of us arrived for our shifts even when quite ill. Likewise, many physicians don’t have adequate backup for sick time and show up for work all too often. This puts patients at serious risk.

Treat the client with respect. The Dunkin’ Donuts shop attracted customers from all walks of life, and we provided the same service to the Boston Brahmins in furs and diamonds as to the unfortunates in rags and grime. The same applies in medicine for the physician-patient interaction: all patients look the same during an examination, and all deserve the same care.

Watch your coworkers’ backs. Don’t steal from the tip jar. Help others when they are overwhelmed on the job. Enough said.

Take the perks when you can get them. During an emotionally trying college semester, I made liberal use of the free doughnut policy and packed on several unwanted pounds. On call nights during my medical training, I was often too busy to eat until the cafeteria was closed. I adored the pharmaceutical reps who supplied us with free pizza.

Much has been written about what makes a good doctor, and how to prepare for a career in medicine. Schools advise potential applicants to take specific science courses, maximize grades and MCAT scores, volunteer in a clinic or hospital, and work in a lab. Many institutions now offer courses in communication for physicians, and some even require attendance. But there’s scant attention to real-world experiences that can prepare a person for a job that involves customer service on a daily basis.

Looking back, I can see that being a doughnut waitress didn’t promise a life of riches, but it did provide an enduring education. The length of training differed between becoming a waitress and becoming a physician — seven days versus seven years, in my case — and the pay scales didn’t overlap. But, both jobs involved hard work and long hours. They both required excellent listening skills and putting customers first. And they both provided comfort to persons in need.

Anne McTiernan is a cancer prevention researcher and the author of Starved: A Nutrition Doctor’s Journey from Empty to Full.