When I was a resident, we had a weekly Morbidity and Mortality Conference.
That was the euphemism for what most called it, Death and Donuts.
That moniker was not meant to be disrespectful. It was merely an acknowledgement that death did happen at the hospital. High risk procedures were indeed risky.
And a normal part of learning, getting better, and promoting quality included routine, open, honest conversations about what went wrong. What could we learn from the outcome? What could we do better? How do we prevent such errors from happening again, if even avoidable?
The conversations were tough.
I remember a resident delivering his narrative.
The attending asked the resident. “Was your patient sleeping with your wife?”
The resident looked bewildered, not understanding what this had to do with the operative mishap.
The attending asked the resident the same question. “Was your patient sleeping with your wife?”
The resident still didn’t know what to say. He said “No. Of course not.”
The attending finished, “THEN WHY ARE YOU TRYING TO KILL HIM?”
Humiliation was often a part of the Death and Donuts experience.
When others heard about mistakes, they learned. They learned what to look for to prevent a mishap. They thought about patient safety. No doctor wanted to end up on center stage.
Unfortunately, humiliation makes it less likely a doctor will want to share his mistakes. Who wants to be humiliated?
I’m guessing the tone of Morbidity and Mortality Conferences has changed. I’m guessing they are less hostile. More about checking the boxes. I also know that some abuse such conferences to settle vendettas with competitors.
And donuts are no longer brought in by pharmaceutical reps.
What do you think?
Feeling the pressure? Learn how we can protect you…
We know your time is valuable. Spend a few minutes with us and discover how membership protects what’s important to good medical practice – and does away with what’s detrimental…
Morbidity and Mortality conferences were painful during surgical residency since they were brutal and all about humiliation. Humiliation has never been found to be a good teaching tool. Intimidation, threats, and humiliation, all part of ground rounds. Why did medical authorities permit this to continue other than to feed the egos of those who had previously been psychologically abused.
Please accept my humble thanks for this our Vital – Valuable Death Conference essential for both patient care and patient centered care.
Please accept my availability to tutor/mentor as a Volunteer Tutor/Mentor for our U.S.M.L.E. Step Three {III}
Please note my e-mail drjosh@embarqmail.com>
Please accept my humble apology for my meager and imperfect writing. Respectfully…Doctor Josh <editors, colleagues, students, allied nursing providers know me as Doctor Josh….Josh Grossman, Colonel {r} U.S.A.R. M.C. M.D. F.A.C.P.
I’ve been in several D&D venues: Pitt’s, MUSC’s, and national neurointerventional societies’. The caveat is that these were highly specialized, not general surgery–only neurosurgical. I can’t speak for other places, but none of these were allowed to be abusive. On the rare occasions that one of the national one became that way, the moderator yanked the chain on the criticized.
If we are going to improve, we have to admit mistakes. And if someone humilates you for doing that, you probably won’t spill the beans again–even when you need to do it most.
Interestingly, at one of the annual (national) ones, a group of lawyers showed up and demanded to be allowed in. Serious chutzpah. Needless to say, we showed them the door.
M&M conferences are more tame and less demeaning these days. The AMA’s guidelines for residents has made all conference areas Bully-Free Zones.