What's Your Coffee Order? - Four Eyed Medic

And why it should be a flat white!

There are certain questions which tell you a surprising amount about somebody.

What do you do for work?
What music do you listen to?
Would you rather fight one horse-sized goose or ten goose-sized horses?

And, perhaps most importantly
What’s your coffee order?

Mine? A flat white.
Always.

Well, almost always.
Occasionally I’ll have an espresso. Sometimes a frappe. And if somebody offers me coffee during a night shift, my standards generally fall somewhere around “Does it contain caffeine?”

But given the choice, there is only one correct answer. The flat white.
This isn't merely personal preference. I have evidence.
Well, I have opinions presented with enough confidence that they may initially resemble evidence. Which is basically the same thing on the internet.

The ABC of Anaesthetics

As an anaesthetics trainee, I have been taught from very early on that everything begins with the ABC approach.
A: Airway
B: Breathing
C: Coffee
Some textbooks apparently use Circulation for the final one. I can only assume this is a printing error.

Coffee and medicine have had a long and suspiciously codependent relationship. Hospitals contain coffee shops. Doctors own unnecessarily expensive reusable cups. Anaesthetic departments often have coffee making equipment with a complexity approaching that of the ventilator.

I have met anaesthetists capable of discussing espresso extraction with the sort of intensity normally reserved for a difficult airway.
Again: These are my people.

But even before anaesthetics, I was a coffee nerd.
And of all the many ways humanity has discovered to combine ground beans, water and milk, I firmly believe we peaked with the flat white.

A small confession

I should probably establish at this point that my interest in flat whites has gone slightly beyond simply ordering them.

A while ago, I did a Teaching Skills for Doctors course. As part of it, I had to prepare and deliver a teaching session to practise my teaching skills.

Sensible people might have chosen ECG interpretation. Or sepsis. Or perhaps something else vaguely relevant to being a doctor.
I chose: The Flat White: More than just a small latte

I created learning outcomes. I discussed its history. I taught coffee-to-milk ratios. I explained microfoam. At one point, grown adults were required to identify an incorrectly prepared flat white.
This all genuinely happened.

In my defence, the point of the course was to practise teaching, rather than demonstrate medical knowledge. And I actually think teaching something you're unnecessarily enthusiastic about is a brilliant way to learn how to explain things well.

It did, however, confirm something I already suspected, I take flat whites far too seriously.

So now that my conflict of interest has been declared, let me explain why.

First, we need to talk about the espresso

Every great flat white starts with espresso. Which seems obvious. But espresso deserves some respect. It's coffee concentrated into its most unapologetic form.

Hot water is forced through finely ground coffee under pressure, producing a small, concentrated drink with an intense flavour profile. That espresso then forms the basis of an enormous number of coffee drinks.
Add water and you enter the world of Americanos and long blacks.
Add milk and suddenly you've got lattes, cappuccinos, cortados and a selection of other words that make ordering coffee feel like a GCSE language oral exam.
And then, obviously, The flat white.

A good flat white retains enough espresso that you can actually taste the coffee. This is important.
I like milk. Milk is lovely.
But if I wanted to drink 400 mL of warm milk, I'd have developed an entirely different personality.

The coffee should still be the star. The milk is there to make it smoother, sweeter and more luxurious.
It is a supporting actor. A very good supporting actor. Perhaps Olivia Colman. But still supporting.

So who invented it?

Ah.
Here we enter dangerous territory.

The history of the flat white appears to be the caffeinated equivalent of an international border dispute.
Australia claims it.
New Zealand claims it.
And, because Britain is apparently incapable of seeing another country's cultural argument without wandering over and asking whether we might somehow be involved too, there are also claims of earlier UK origins.

Competing claims involve Australian barista Alan Preston, New Zealand's Derek Townsend and coffee historian Ian Bersten suggesting something similar existed in Britain considerably earlier.

Who actually invented it?
I have absolutely no intention of resolving this dispute.
I'm Welsh. I have enough historical arguments to worry about.

What matters is that at some point, somebody looked at an espresso and thought 'You know what this needs? Exactly the right amount of silky milk'.
And history was made.
Probably.
Somewhere.

But isn't it just a small latte?

No.
No.
I'm glad we could clear that up.

A flat white is not simply a latte that somebody has forgotten to fill to the top. Yes, both contain espresso and steamed milk.
By that logic, a lasagne and a pizza are the same because they both contain tomato, cheese and carbohydrates.

Ratios matter. And this is where the flat white becomes particularly appealing to me.
Because finally, coffee has maths.

The Golden Ratio*

*A term I have bestowed upon it with no authority whatsoever.

Coffee. Maths. Happiness.
This ratio is one of the reasons a flat white tastes so much more coffee-forward than a latte.
Add progressively more milk and you progressively dilute the espresso flavour.

This isn't inherently wrong.

People are allowed to enjoy lattes. People are also allowed to put pineapple on pizza. We live in a free society.
But choices have consequences.

Size matters

Sort of.

Traditionally, I'd expect a flat white to arrive in a relatively small cup. Somewhere around the 180–210 mL region.
This is important because the small cup helps preserve that coffee-to-milk relationship.

If somebody hands you something the approximate volume of a Sports Direct mug and tells you it's a flat white, I have questions.
Mainly, where is the rest of the espresso?
You can make a larger drink while preserving the ratio. Just add more coffee.
This has the secondary advantage of adding more caffeine. So everybody wins.

It’s not the size of the cup that matters… it’s what you do with it.
I remain proud and slightly ashamed of that sentence in equal measure.

Now we need to talk about foam

This is where reputations are made.

A flat white should not have a giant mountain of bubbly froth sitting on top of it.
That is not a flat white. That is a coffee wearing a hat.

What we want is microfoam.
Tiny bubbles incorporated into steamed milk to give it a silky, glossy, almost paint-like texture. Not a thick layer of bubbly froth perched on top. A flat white should be smooth and velvety rather than requiring exploratory excavation with a teaspoon.

When done properly, the milk and espresso integrate rather than sitting in obvious layers. And, ideally, somebody far more artistically talented than me will pour a beautiful rosetta into the top.
Whenever I attempt latte art, I tend to produce something resembling either:
1) an onion
2) an anatomically questionable heart
3) an ultrasound image
So I have learned to appreciate rather than participate.

For example:
I call this design 'the injured poodle'

The three commandments of the flat white

If I had to reduce this entire unnecessarily passionate post into three rules, they would be:

1) Respect the ratio
Enough espresso to actually taste the coffee.
Approximately 1:2 coffee to milk is my happy place.

2) Don't drown it
Keep the drink relatively small, or increase the coffee if you increase the cup size.
A flat white should not be a latte that has lied on its CV.

3) Microfoam. Not froth.
Silky. Smooth. Tiny bubbles.
If I need a spoon to excavate my way through the foam before reaching the coffee, something has gone terribly wrong.

Why do I actually care this much?

This is probably the point at which I should acknowledge that we are talking about coffee.

Nobody has died because their flat white contained slightly too much milk.
As far as I'm aware.
But this is also exactly why I enjoy it.

I spend a large part of my working life thinking about things that matter enormously.
Airways. Drugs. Physiology. Critically unwell patients. Small decisions which sometimes have very significant consequences.
Coffee is completely different.

I can obsess over espresso extraction. Ratios. Bean origins. Milk texture. Cup size.
And ultimately, if I get it wrong... I've made a slightly disappointing coffee.
That's it.
Nobody needs a Datix.

There is something wonderfully low stakes about having something completely unnecessary to be nerdy about.
And I think everyone needs at least one thing like that.
One of mine just happens to contain caffeine.

So what should you order?

A flat white.
Obviously.

You get the strength and flavour of espresso.
You get silky steamed milk.
You get enough milk to soften the coffee without drowning it.
You get maths.
You occasionally get a little fern drawn on top.
What more could you possibly want?

Will I judge you if you order something else?
Of course not. That would be ridiculous.
I'll simply quietly note it.
And remember.

So, the next time somebody asks "What's your coffee order?"
You know the correct answer.

Four Eyed love,
Dr Steff