What goes on at a real morbidity and mortality conference?

f you’ve read my reviews of the new medical TV show “Monday Mornings” [here, here and here], 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.