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Morbidity and Mortality conferences


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  #1  
June 13th, 2010, 06:13 PM
Quantum_Leap's Avatar frequent flier
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I'm reading an interesting book called Complications: A Surgeon's Notes on an Imperfect Science, by Atul Gawande. It's basically a memoir of his time doing residency as part of his training to become a surgeon, but it's also got a lot of commentary about the state of modern medicine, how amazing it is what surgery can do but also what the limits of modern medicine are, profiles of bizarre medical cases that science isn't fully able to explain, etc. etc. It's a good book. Highly recommend it.

One of the interesting things he describes in this book is something called a Morbidity and Mortality conference, which are meetings that are held on a fairly regularly basis (usually weekly) at almost all major hospitals. During these meetings the doctors/surgeons meet to discuss all of the things that went wrong that week and how they could have been prevented. Gawande's perspective is that errors are an unavoidable part of medicine, since doctors are human, and even the best-meaning, most highly trained doctors are going to screw up on occasion. But these meetings are meant to help them continuously approve, and to avoid screwing up in the same way more than once. Here's some general info on the conferences: Morbidity and Mortality - Wikipedia, the free encyclopedia

Anyway, one of the interesting facts that Gawande points out is that in the majority of states, these conferences are legally protected. In other words, any information that is discussed in these meetings cannot be subpoenaed and used in a criminal or civil trial against a doctor accused of medical malpractice. The purpose of this protection is to allow doctors to speak with one another freely, so that they can continuously improve. If they were self-censoring due to fear of prosecution, they might never get a chance to learn from their own mistakes.

How do you feel about this? Do you think that it's right that the proceedings of these meetings are kept secret? How would you feel if you were a family member of someone who had died under a surgeon's blade due to medical error, and you knew that the doctor might be admitting his guilt before his peers but be protected from doing so before a court of law?
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  #2  
June 14th, 2010, 07:57 AM
(.Y.)mom2dd(.Y.)
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I was hoping others would post in this first but since no one is...

Quote:
Originally Posted by brui77 View Post
How do you feel about this? Do you think that it's right that the proceedings of these meetings are kept secret? How would you feel if you were a family member of someone who had died under a surgeon's blade due to medical error, and you knew that the doctor might be admitting his guilt before his peers but be protected from doing so before a court of law?
This is nothing new to me but when I talk about things my birth, vaccines reactions, lack of bfing knowledge in pediatrics, etc. if it doesn't fall on deaf ears completely, it's met with anger, resentment and assumed to be isolated incidents instead of realizing this is the state of our heath care. And it's not just the western world: Medical Double Standards in the Third World : Inside Vaccines
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  #3  
June 14th, 2010, 12:29 PM
glasscandie's Avatar What I make is what I am
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I read that book awhile back, it was pretty decent.

In regards to the original topic, I don't see anything wrong with it. I assume that if a family member or someone dies wrongfully it would be investigated anyway and likely the truth would come out. And if the conferences weren't confidential, how would doctors learn anything from their mistakes?
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  #4  
June 14th, 2010, 05:56 PM
(.Y.)mom2dd(.Y.)
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Quote:
Originally Posted by glasscandie View Post
I read that book awhile back, it was pretty decent.

In regards to the original topic, I don't see anything wrong with it. I assume that if a family member or someone dies wrongfully it would be investigated anyway and likely the truth would come out. And if the conferences weren't confidential, how would doctors learn anything from their mistakes?
Why can't it just be transparent though? “An ounce of prevention is worth a pound of
cure” -Henry de Bracton

Recently my dd's little friend went in for a tooth pull. She had to be put under so the anesthesiologist asked the mother a bunch of questions. My friend is a non-vaxer after her dd had a severe vaccine reaction. Her dd did not have her flu shot, H1N1 shot nor MMR. Had she, they would cancelled the surgery. It turns out there are chemicals in the vaccines that mixed with the anesthetic causes death. Our local health region found this out after a child died from this complication. Had this case been confidential and not widely spread within the medical system, how many other kids locally would have died?

When doctor's are not open, they appear deceptive even if that isn't their intention. Think 2000 Simpsonwood CDC conference - Wikipedia, the free encyclopedia as an example.
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  #5  
June 14th, 2010, 06:24 PM
glasscandie's Avatar What I make is what I am
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I don't think that's the same thing, that's a public health concern. Pretend I have any knowledge about medical stuff, and say you're doing heart surgery and for whatever reason something heart-related starts hemorrhaging. The doc does the best he can, but in the end the patient dies. At the M+M, the docs would discuss what he could have done better to in the future possibly better handle that exact crisis, if it could have been handled better, KWIM? He did the best he could, doctors can't be psychic or flawless - had that convo not been protected, the doctor wouldn't have learned something from the unforeseeable circumstance and the hospital would have been sued for the "what ifs".
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  #6  
June 14th, 2010, 07:52 PM
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Quote:
Originally Posted by glasscandie View Post
I don't think that's the same thing, that's a public health concern. Pretend I have any knowledge about medical stuff, and say you're doing heart surgery and for whatever reason something heart-related starts hemorrhaging. The doc does the best he can, but in the end the patient dies. At the M+M, the docs would discuss what he could have done better to in the future possibly better handle that exact crisis, if it could have been handled better, KWIM? He did the best he could, doctors can't be psychic or flawless - had that convo not been protected, the doctor wouldn't have learned something from the unforeseeable circumstance and the hospital would have been sued for the "what ifs".
Agreed. The idea of M&M conferences, as I understand it, is to discuss preventable mistakes made by doctors, not actual medical issues. And it can't be transparent because doctors would be opening themselves, their practices, their hospitals, their universities, and so on up to devastating lawsuits. Having a protected forum in which medical professionals can learn from mistakes in order to improve procedures and protocols is important, IMO. The fear of lawsuits and judgments isn't a sign of a flawed medical system, IMO. It's a sign of a flawed system, in general.
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  #7  
June 15th, 2010, 01:35 AM
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I work an RN, but I have never worked anywhere that the RNs participate in M&M. We do something similar after cases that we, as a team, feel needed to be reviewed. We look at what went well, what didn't go well, and discuss what we could have done to prevent/change the part that didn't go well.

These discussions are essential to improving our practice. But, the only to get a true and honest discussion is if those participating know that they can safely discuss what happened without being penalized. In fact, the staff isn't normally disiplined from what comes out in these discussions (I said normally - yes, there are time when errors do require disiplinary follow up).

I think M&M rounds should continue. Patients should participate in their care. Also, if they have any questions about what happened, they should request sopies of their records.
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  #8  
June 15th, 2010, 04:59 AM
WineKeepsMeSane's Avatar Platinum Supermommy
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I think it's reasonable that the first discussions with the doctors involved are protected, so that they feel safe enough to actually discuss the problems. After that, the information should be made public by a third party such as the medical association, without names.
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  #9  
June 15th, 2010, 06:18 AM
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I attend weekly M&M conferences during my rotations and there is no information such as name or social security number of the patient, so I am not sure a lawsuit could be filed off the info given. If push comes to shove they can always state it may not be "the" patient the lawyer is talking about.

Sometimes we actually find a way to improve the situation but most times the end result was unavoidable regardless of medical intervention. For instance, we had an older gentleman come in the ER with flu-like symptoms and vague weakness. He had a blood test and other investigations but nothing of serious note was noticed...if I recall he didn't even have a fever. He was sent home and later returned (I think 2 days later) to the ER with now coplaints of myalgia and bone pain. At this point his blood tests came back abnormal....I think H&H and platelets. They began a total workup but within 12 hours this man was dead. What killed him? Dengue fever. We call this a zebra diagnosis because those the hoofbeats sounded like horses we ended up with a zebra.

Unlike HouseMD we don't aways beat the disease before the clock runs out. M&M conferences help docs hone in on a diagnosis faster and also allows for a free flow of ideas from docs who have more experience on their side. But it also can be pretty brutal sometimes as it can turn into a residency smack down by the Attendings...part of the hazing process I guess.

If there is a wrongful death then the same information is available to the lawyers that is available at the M&M. I've never heard a doc say "I did this wrong." They basically give a breakdown of the order and way things occured and how they handled it at the time, it's very dry. Though I have seen surgeons almost come to blows over disagreements on what kind of blade to use...no kidding...7 am and they were practically frothing at the mouth.
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  #10  
June 15th, 2010, 06:41 AM
(.Y.)mom2dd(.Y.)
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Thank you cudabear and BigGrin for weighing in.
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