M&Ms in your T&Cs – are you 
nuts, or just being a smartie?

So what can the backstage antics of a hard rock band from Pasadena teach us about practicing safely? Quite a lot, actually.

We’ve all heard stories about rock bands and their rather excessive tour riders. In her tour rider, Madonna, for example, requires a brand new loo seat at every venue, whereas Iggy Pop’s stipulates “a copy of USA Today that’s got a story about morbidly obese people in it”. Some of these stories have the added flavour of being associated with dressing-room tantrums, like Van Halen’s, who’s rider demanded “a bowl of M&Ms, with all the brown ones taken out”. On at least one occasion, the band’s lead singer, David Lee Roth, trashed his dressing room on going back stage and finding a brown M&M.

So does any of this type of behaviour have an impact on being a GP, and why would this be something I’m about to recommend all GPs do?

Firstly, I’m not in any way going to suggest that trashing our consultation rooms on finding a used speculum is something that any of us should do, but I am going to recommend we adopt Roth’s approach to what in the tech industry is often referred to as operations signaling or, in our field, patient and professional safety.

So how can Roth’s behaviour be explained, let alone justified? Back in the day - we’re talking the 70s here - bands would often go on a 30-gig tour, with around three or so 18-wheel articulated lorries. But Van Halen’s tour would have up to 100 gigs in the space of a year, using nine such lorries to carry the sort of equipment they needed to put on all the lights and pyrotechnics they were famous for. After each gig, finishing in the early hours, the crew would have to load all their equipment back into the lorries, drive all the way to the next venue, unload, and set everything up all over again. Owing to this gruelling schedule, with so much equipment, and much of it highly dangerous (remember when Michael Jackson caught on fire?), Van Halen published a comprehensive instruction manual for each venue, reportedly the thickness of a telephone directory, detailing in minute detail all the technical specifications they’d need for the show: where each power outlet needed to be placed, its amperage, length, capacity etc. So on arrival, the band could just plug in everything, do the soundcheck, and start the performance.

"Although no one could condone the precious antics of smashing up a dressing room, it’s perhaps a lot easier to justify both the rider and the sheer frustration that Roth must have felt each time he saw a brown M&M."

But how could Van Halen trust that the venue’s operators had fulfilled their contract by making sure everything was in place, reducing or even eliminating any risk that could lead to a serious injury or even death? Hidden within that instruction manual, Roth had a clause called Article 126 that read “There will be no brown M&M’s in the backstage area, upon pain of forfeiture of the show, with full compensation.”

On arrival at each venue, the first thing Roth did was to check the bowl of M&Ms; on the odd occasion when brown M&Ms were discovered, his immediate conclusion was that the venue’s operators had not properly read the band’s technical specifications, and so Roth would run a full safety audit of the venue and, in every case, would find a technical or safety issue that then needed to be fixed, causing delay and frustration, but greatly reducing risk.

Although no one could condone the precious antics of smashing up a dressing room, it’s perhaps a lot easier to justify both the rider and the sheer frustration that Roth must have felt each time he saw a brown M&M.

According to Dan and Chip Heath’s book Decisive, what Roth was demonstrating here was a mastery of operations signaling, laying down what they term a sensitive tripwire that then alludes to a much greater, hidden problem.

[Tweet "But just like Van Halen, your T&Cs are pointless if they’re not read."]

So what can we as GPs take away from this, especially if turning up to work in an unfamiliar practice? Are we as GPs subject to the same sort of risks as a touring rock band? Although there will no doubt be official Health & Safety policies within the practice, both formal and informal, they don’t necessarily extend to how we perform as GPs. And although there are governing bodies like the GMC and the CQC, their operations don’t cover every eventuality. In fact, it’s possible that they lull us into a false sense of security, whereas in reality there has been no robust investigation or research done into the safe practice of locum GPs operating in multiple, unfamiliar settings.

So what sort of trip-wires can you set?

First impressions

  • What kind of welcome do you get when you arrive?
  • Are you met by a member of staff who seems familiar with locum induction and shows you to a pre-prepared fully-stocked room?
  • Do they give you a brief induction tour of the features of the room and building e.g where are the panic buttons, the toilet etc
  • Has the practice given you a secure (only you know the password) login?

Throw in some safety questions

  • ”Can only registered prescribers generate acute prescriptions?”
  • “What’s the policy if a patient DNAs for a follow-up appointment for an abnormal blood test?”
  • “Do the nursing team speak to a GP with allocated time if they have a query, or do they have to catch a GP in between patients?”
  • Does the practice have an up-to-date, indexed and searchable locum pack?

Several of these are already baked into NASGP’s online model locum T&C generator, which is accessible through our online invoicing and booking platform, and it allows you to add your own too.

But just like Van Halen, your T&Cs are pointless if they’re not read. So although we’re not in any way even suggesting you should place a brown M&M clause in your T&Cs, we are suggesting you apply your own ‘operations signaling’ questions whenever you arrive at a new practice.

Richard Fieldhouse

Freelance GP locum since 1995, living and working in West Sussex. NASGP chairman.

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