What really happens in a morbidity and mortality conference

If you’ve read my reviews of the new medical TV show Monday Mornings, you’ll know I’ve been critical of many things about it. I was particularly disappointed with the way the show handled one of its central themes: the morbidity and mortality (M&M) conference.

I thought it might be useful to tell you how most real M&M conferences are run. M&M conferences generally take place at hospitals with residency training programs and are rather specific to surgical disciplines.

It is possible that they may be held in large non-teaching hospitals, but time constraints and the fact that direct attending surgeon to attending surgeon criticism in an open forum is difficult to do.

Unlike the TV version, real M&M conferences feature presentations by residents, not the attending staff. The resident who performed the operation prepares a summary of the case which these days is usually on PowerPoint. Pertinent history, physical exam findings, lab results and images are shown. A radiologist or pathologist may be on hand to help educate the attendees. The conduct of the surgical procedure and the patient’s hospital course are described.

The resident is asked questions about the way the case was managed and what she knows about the disease process and the surgical literature. The resident may have prepared a brief review of recent papers on the subject.

The attending surgeon who was involved with the case might add some more details. At least one person asks a question that was already addressed in the presentation. An attending surgeon or two will describe a similar case they had 10 years ago that went wrong and state that now he does things a different way, never mind the evidence to the contrary.

Comments from other surgeons and the chairman are made. Often a consensus may be reached about whether or not the complication or death was preventable. The idea is that the discussion informs the whole department, and everyone does not have to make the same mistake. In theory, the complication might be averted the next time.

However, not all complications or deaths are due to errors. Sometimes despite everything being done correctly, outcomes are bad.

In the old days, residents were blamed for everything that went wrong. Public humiliation was common. A famous chairman allegedly once said to a resident who presented a case that resulted in a patient’s death, “Why didn’t you just take a gun and shoot him?”

Although this is said to still happen in some hospitals, the conference is much more civil in most places.

Unlike the Monday Mornings version, M&M conference is not where attending surgeons are browbeaten, tricked or fired. Of course, the real conference is far less dramatic (most of the time).

There can be raised voices and sometimes arguments occur, but the focus of the conference is usually more on education and quality improvement.

It’s too bad about the show. It could have done a lot of good if it tried to realistically portray how self-critical we are. Unfortunately, it went all Hollywood on us, like every other medical TV show.

“Skeptical Scalpel” is a surgeon blogs at his self-titled site, Skeptical Scalpel.

Comments are moderated before they are published. Please read the comment policy.

  • Scott McGarvey

    Thank you for informing us about these conferences. I think you cleared up a lot of grey areas.

    • http://twitter.com/Skepticscalpel Skeptical Scalpel

      Thanks for commenting. I just found out the other day the show “Monday Mornings” was canceled. One article about the cancellation lamented the fact that the M&M portions of the show could have been more interesting if they had been more true to life.

      • FarianMD

        Actually if they were more true to life, they would be far less interesting. At least for laymen.
        As surgeons, it’s almost always painful to watch anything that comes on network with the prefix ‘medical drama’.

        Have you seen ‘Living in Emergency’?

        Or ‘History of Surgery’ a BBC documentary?

        • http://twitter.com/Skepticscalpel Skeptical Scalpel

          I have not seen those shows. I agree that a real M&M conference might not be as dramatic, but I think that intelligent viewers might find it very interesting and educational. It might also help people like Karen3 above, who seems quite disenchanted with doctors, to realize that some of us are actually trying to do some good.

  • karen3

    It’s too bad they don’t have the family of the patient present, as I suspect there might be some particularly fruitful questions from that quarter.

    • http://twitter.com/Skepticscalpel Skeptical Scalpel

      Yes, but then it wouldn’t be a peer-review conference. I suppose you could have the patient’s lawyer there too. But then it would be something else too.

    • azmd

      The purpose of the M&M conference is to allow for open and objective discussion of the management of a case that did not go well. Having family members there would obviously cause a loss of objectivity and would keep the discussion from being productive from a learning standpoint.

      • karen3

        I think it would add immensely to the objectivity. It is very common for medical records to be altered after an adverse event and doctors, without a doubt, usually lie through their teeth. Having the other witnesses present, to address sketchy recounts of the event, would improve the process to make sure that the learning process is based on what really happened. Not a self-serving recount of events. You cant change what you don’t acknowledge.

        A recent study showed the 70% of the time, when patients said a doctor caused harm, they were right. Based on the literature, patients’ version of events is more reliable than the doctor’s.

        • azmd

          Somehow I think you must know that it would be completely unproductive to have an academic conference in which a family member was present for the purpose of confronting doctors to accuse them of lying through their teeth and altering medical records.

          The correct venue for those sorts of accusations is, as mentioned above, a courtroom.

          • http://twitter.com/Skepticscalpel Skeptical Scalpel

            Karen3, please share the link that says that patients are right 70% of the time when they say doctors cause harm.

            You have a real problem if you think “doctors, without a doubt, usually lie through their teeth.” What makes you think that having a patient’s family at a conference would change that?

            This may reassure you. I recently blogged About the fact that electronic medical records mke it nearly impossible for a chart to be altered. If you want to read about it, here’s the link http://is.gd/1BYrIJ.

    • Mengles

      I think you missed what the purpose of M&M conference is with respect to resident education.

  • Guest

    I admit I never saw the show. However, both in medical school and residency I found M&Ms to be terrifying experiences. They were like inquisitions. Amazingly, no one was hung at the end. There was no great discussion about how we could improve care for the future. More often than not it was “why the f*@*$&$)* did you do THAT?”

    I’m hoping M&Ms are more civilized these days.

    • karen3

      In light of the 180,000+ patients a year in the US who die due to preventable medical error, I most certainly hope they are not “nicer.” “Nice” to your colleagues kills patients.

      • Guest

        You’re right – we should penalize, ostracize and humiliate rather than determine how to make things better for future patients.

Most Popular