Have any of you had to face the M&M committee?

[Bring It On]

It was intimidating😀, frustrating and I was a nervous wreck😳.....any pointers from anyone whose been there? Any help would be appreciated, thanks

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[southerndoc]

The M&M committee? Our M&M's are relaxed. No name calling. In fact, there is a great deal of effort to ensure people's privacy so that the residents and attendings involved aren't named. Of course there are some people that know who was involved in the care, and more often than not the attending or resident present at the M&M will speak up.

It's for education, not for blame. M&M is a learning experience for all. We all mess up, and we can all learn from each others' mistakes. That's how we view M&M and that's why my program doesn't play the blame and shame game during our monthly M&M's.

 

[Annette]

I agree with Southerndoc. An M&M should be about finding out what went wrong and how to prevent it from happening again, not about who screwed up.

 

[WallowaWanderer]

Not that I've ever been behind the podium during one of these, but I can imagine it would be pretty intimidating no matter how understanding the audience was - I mean you're talking about something that didn't go well on your watch in front of all your colleagues and mentors. That's one experience I don't mind being shielded from in medical school, although I'm sure it will make me a better doctor when I eventually am faced with this "opportunity."

 

[deuist]

It's for education, not for blame. M&M is a learning experience for all. We all mess up, and we can all learn from each others' mistakes. That's how we view M&M and that's why my program doesn't play the blame and shame game during our monthly M&M's.

Huh? Maybe the surgeons could learn this point. Every M&M conference I had to sit through earlier this year involved loads of hostility coming from the chief of surgery. He and a few other attendings would call out residents and attendings involved with the case and pummel them with insults for the entire hour. I'm surprised that no one has thrown a punch yet.

 

[southerndoc]

Not that I've ever been behind the podium during one of these, but I can imagine it would be pretty intimidating no matter how understanding the audience was - I mean you're talking about something that didn't go well on your watch in front of all your colleagues and mentors. That's one experience I don't mind being shielded from in medical school, although I'm sure it will make me a better doctor when I eventually am faced with this "opportunity."

Our "clinical chief" (the 4th year resident rotating through the administrative month) presents the cases.

It's very collegial here and not adversarial at all. Yet another reason I am incredibly happy I matched here.

 

[dowiattp]

I had heard that from a legal standpoint it is best if you are not present during M and M if your case is being presented- I can't exactly remember the reason why, but it had something to do with being asked in court if you had discussed your case with other professionals and/or being present for 'standard of care' type discussions.

 

[backrow]

I had heard that from a legal standpoint it is best if you are not present during M and M if your case is being presented- I can't exactly remember the reason why, but it had something to do with being asked in court if you had discussed your case with other professionals and/or being present for 'standard of care' type discussions.

I believe M&M discussions are exempt from being revealed in court. This only applies during official M&M sessions and has some limitations which require certain steps to be taken to make sure the session is an "official" session.

 

[dowiattp]

I believe M&M discussions are exempt from being revealed in court. This only applies during official M&M sessions and has some limitations which require certain steps to be taken to make sure the session is an "official" session.

That definitely jogs my memory a little bit. It all had to do with the 'discovery' process. Though I don't know what measures prevent an M and M session from becoming discoverable, the legal counsel for the hospital I was at in NY felt that more likely than not their M and M sessions could be discovered. It could have been instituition specific or just overly safe.

 

[Seaglass]

I had heard that from a legal standpoint it is best if you are not present during M and M if your case is being presented- I can't exactly remember the reason why, but it had something to do with being asked in court if you had discussed your case with other professionals and/or being present for 'standard of care' type discussions.

Usually these fall under "quality assurance" and are protected from discovery.

 

[WilcoWorld]

I agree with Southerndoc. At Christ we have someone else present the cases, and it's universally been a rewarding and non-threatening process. Aviation industry models of error prevention have shown that creating a safe environment for error analysis / admission reduces errors. The blame game that has been the norm in medicine for too long promotes covering up errors which thus impedes learning from them, and worse, ensures they'll be repeated.

 

[southerndoc]

I agree with Southerndoc. At Christ we have someone else present the cases, and it's universally been a rewarding and non-threatening process. Aviation industry models of error prevention have shown that creating a safe environment for error analysis / admission reduces errors. The blame game that has been the norm in medicine for too long promotes covering up errors which thus impedes learning from them, and worse, ensures they'll be repeated.

People who play the blame game are usually the ones who are the most insecure when they make a mistake. We all make mistakes, and it's best if we learn from both our own mistakes and those of our colleagues. That missed MI could have easily been missed by me, and it's important that I know the key features of a case that were missed because it will remind me to look for them next time. This is why M&M should be collegial, not adversarial.

 

[deuist]

This is why M&M should be collegial, not adversarial.

One of my surgical attending's patients suffered a pulmonary embolism during the hospital stay and ended up as the topic of an M&M. The chief of surgery spent half an hour blasting the resident and the attending on the case. The next morning, one of the chief's patients suffered a PE.

 

[PeepshowJohnny]

I agree with Southerndoc. At Christ we have someone else present the cases, and it's universally been a rewarding and non-threatening process. Aviation industry models of error prevention have shown that creating a safe environment for error analysis / admission reduces errors. The blame game that has been the norm in medicine for too long promotes covering up errors which thus impedes learning from them, and worse, ensures they'll be repeated.

Has anyone seen some of those studies comparing pilots to surgeons on quality assurance? It's almost comical. I believe the vast majority of airline pilots stated they would encourage someone working under them to raise any concerns about safety. The majority of surgeons considered underlings raising concerns disrespectful. Another good one is when they asked surgeons to rate how they rated the teamwork in the OR. Surgeons tended to rate it "excellent." But as you moved down "the ladder" to the anesthesiologist, the residents, nurses/techs, medical students, their ratings of the "teamwork" fell off precipitously.

 

[WallowaWanderer]

One of my surgical attending's patients suffered a pulmonary embolism during the hospital stay and ended up as the topic of an M&M. The chief of surgery spent half an hour blasting the resident and the attending on the case. The next morning, one of the chief's patients suffered a PE.

Wow. That's karma.

 

[novastorm]

Take it as a learning experience. Where I'm from we have a much more formal very very confidential review process if you have it you may not even know it exists, I would worry about my name coming up in that one.

 

[zinjanthropus]

M&M *may* not be exempt from being discoverable any longer in Florida due to a Supreme Court ruling last week. No one is really sure how to interpret this but everyone is talking about how to potentially handle M&M and other adverse event discussions.

=== Florida Medical Association ===

Yesterday the Florida Supreme Court issued an opinion on two cases involving the effect of Amendment 7 on the confidentiality of peer review and medical incident reports. Amendment 7, cleverly labeled as the "Patient's Right to Know About Adverse Medical Incidents," was the trial bar's way to obtain state-sanctioned confidential peer review information for use in medical malpractice lawsuits. To lessen the effect of this amendment, legislation was enacted providing that the Amendment was not applicable to documents created prior to the Amendment's passage. This legislation also placed restrictions on the documents that could be obtained under this Amendment and who could obtain them. Finally, the legislation made it clear that the Amendment had no effect on existing privilege statutes.

In a decision that Justice Wells in dissent described as "contrary to the law and fundamental fairness," a sharply divided Supreme Court ruled that Amendment 7 is self-executing and retroactive, and its provisions apply to records existing prior to its passage. In addition, the Supreme Court ruled that several of the key provisions of the implementing legislation are unconstitutional.

The Court's ruling effectively ignores over twenty years of statutory protection for peer review records and opens these documents up to access by the public, clearly in contravention of the expectations of the physicians who participated in the peer review process. While hospitals will have to continue to provide peer review as mandated by law and report adverse incidents, this opinion will likely have disastrous consequences on the effectiveness of such review.

The FMA has studied the Court's opinion in depth and is in consultation with the Florida Hospital Association to determine what avenues, if any, are open to address this unfortunate ruling. The FMA encourages each physician who participates in hospital peer review to consult with their medical staff attorney as well as the hospital administration to determine how best to proceed with peer review given the new legal landscape produced by the Supreme Court's decision.

 

[roja]

where I am currently, all seniors do an M&M. they are benign, open, and very educational.

 

[deuist]

I thought that discussion from M&M had never been allowed into evidence. Up until now, I wasn't aware of any states that permitted them into a court room.

 

[Fah-Q]

IMHO, part of the learning that comes from M&M discussions includes being able to get up in front of your colleagues and admit your mistake. The person who had the complication or made the error should be the one who presents the case as they are the one person who knows the case best and can explain the situation, state of mind and reasoning for the critical decisions.

I think anonymous discussions "water down" the process. I've been at the podium...several times. Whenever I make a tough decision, I still think to myself, "How could I explain this in M&M if things go bad?"

The standard of care is established by your colleagues and that is the standard you must measure your decisions against.

 

[roja]

We have a saying in our residency: if you haven't had an 'm&m' case, you haven't done enough follow ups.

the point of M&M's is to learn from mistakes. Or discuss things that happen in care. To educate and build knowledge. Not to point fingers and try and establish dominance.

 

[deleted109597]

I did as a medical student.
It was fairly benign though.

 

[zinjanthropus]

putting one person up at a podium to "admit" their "mistakes" goes against the data - these are system breakdowns, not individual negligence. Thus, anonymous discussions about quality improvement probably work best.

 

[Fah-Q]

putting one person up at a podium to "admit" their "mistakes" goes against the data - these are system breakdowns, not individual negligence. Thus, anonymous discussions about quality improvement probably work best.

"System breakdown" is another way of passing blame around and not accepting responsibility for what an individual did or did not do correctly.

I'm not sure what M&M's you attend but our complications (surgical subspecialty) usually are individual (or small group of individuals) negligence.

 

[zinjanthropus]

"System breakdown" is another way of passing blame around and not accepting responsibility for what an individual did or did not do correctly.

I'm not sure what M&M's you attend but our complications (surgical subspecialty) usually are individual (or small group of individuals) negligence.

nope, the data says otherwise. that wasn't an opinion I was posting.

 

[Janders]

nope, the data says otherwise. that wasn't an opinion I was posting.

What data? I agree that a ton of medical errors are due to systems errors. However, some medical errors are very much one (or two) individual's fault. That is OK, we are all human, and we can learn from both types of errors.

 

[Fah-Q]

nope, the data says otherwise. that wasn't an opinion I was posting.

Yes, please post the data.

And yes, that was an opinion.