M&M's

[Parietal Lobe]

Can someone help me understand what these meetings are? Mortality and something? What does it mean, who attends, and what happens?

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[Isoprop]

Can someone help me understand what these meetings are? Mortality and something? What does it mean, who attends, and what happens?

morbidity and mortality.

http://ifinding.blogspot.com/2006/01/mm.html

 

[alwaysaangel]

Can someone help me understand what these meetings are? Mortality and something? What does it mean, who attends, and what happens?

Morbidity and Mortality. Basically a conference to review cases with bad outcomes and discuss what could/should have been done differently to get a better outcome.

Who goes depends on what specialty it is. Surgery programs tend to have intense (often scary) M&Ms every week. Whereas maybe an IM program will only have it monthly.

Some programs will have interdisciplinary M&Ms. For example, I was just at a hospital that tapes their traumas and will do M&Ms with the EM docs, nurses, trauma techs and trauma surgeons.

 

[Gabby]

I just read the blog. Is the surgery M&M really brutal like that? Is it just attendings/chiefs or are residents and med students there too?

It must be horrible to be criticized like that by your colleagues/peers. How do these people have relationships after these meetings? What's the purpose of it overall anyway? Is action taken against the person that attendees feel was in charge?

 

[alwaysaangel]

I just read the blog. Is the surgery M&M really brutal like that? Is it just attendings/chiefs or are residents and med students there too?

It must be horrible to be criticized like that by your colleagues/peers. How do these people have relationships after these meetings? What's the purpose of it overall anyway? Is action taken against the person that attendees feel was in charge?

Medical students are often there - usually sleeping or studying in the back.

Its purpose is to learn. Surgery just has a mindset that being brutal makes for good learning.

Unless there was gross negligence no action is taken.

You are supposed to learn from mistakes or missed diagnoses to improve patient outcomes.

 

[Gabby]

Thanks Always Angel. That was very helpful.

 

[xanthomondo]

Obligatory pic:

In all seriousness though M&Ms can be interesting - they usually end up in some pretty heated arguments.

 

[Cruzinman]

The equivalent of M&M's for fourth year medical students, I'm told is the notorious Saturday morning "Surgical Bullpen". It is, or used to be performed in an amphitheater similar to the one in pictures where you see Vesalius dissecting a human body while it is still alive. The analogy is appropriate. The student about to be "dissected" is given 30 minutes to work up a brand new surgical patient. The student is then required to stand in the well of the amphitheater and present the patient to the Chief of Surgery, with the surgical faculty, house staff, and students on surgery block all in attendance, followed by being pimped in front of 150 spectators. I'm told that one year even the student that won the Golden Scalpel Award was reduced to an incoherent mass of stammering, blubbering jelly.

A "right of passage" at TMS.

 

[Cruzinman]

Sorry, I forgot the most important part: surgical bullpen is the right of passage at Tulane Medical School. Most other med schools would probably not do it because it violates the US treaties on torture.

 

[2012mdc]

Sorry, I forgot the most important part: surgical bullpen is the right of passage at Tulane Medical School. Most other med schools would probably not do it because it violates the US treaties on torture.

That sounds brutal but good preparation for a gsurg residency

 

[Gunneria]

http://www.youtube.com/watch?v=kZs88WWGDoo

 

[ACSurgeon]

It is confidential. Nothing said in M&M can be used in a court of law. This is important because anything said outside of M&M can be subpoenaed. For example, if you're a surgeon and you make a mistake, go home and tell your wife about it, and later you get sued, your wife might be brought as a witness against you. Then, she either lies under oath, or says what you told her. Instead of wife, you can substitute nurse, student, resident, fellow attending, etc. So, M&M is a safe environment for everyone to learn.

As a side note: M&M at some [even surgery]programs are completely benign; others are brutal.

 

[HHML]

Wow, that's not what I thought this post was going to be about ... Now, I'm hungry.

Can someone help me understand what these meetings are? Mortality and something? What does it mean, who attends, and what happens?

 

[Isoprop]

It is confidential. Nothing said in M&M can be used in a court of law. This is important because anything said outside of M&M can be subpoenaed. For example, if you're a surgeon and you make a mistake, go home and tell your wife about it, and later you get sued, your wife might be brought as a witness against you. Then, she either lies under oath, or says what you told her. Instead of wife, you can substitute nurse, student, resident, fellow attending, etc. So, M&M is a safe environment for everyone to learn.

As a side note: M&M at some [even surgery]programs are completely benign; others are brutal.

wouldnt spousal privilege apply in that case?

 

[Dwindlin]

wouldnt spousal privilege apply in that case?

Yes it would. Spousal privilege does apply to civil courts.

 

[ACSurgeon]

Yes it would. Spousal privilege does apply to civil courts.

You know, I'm not sure of the details (e.g. if medical-legal cases count as civil cases, etc) but several attendings explained it that way to me.

 

[hrandani]

The time I heard someone explain the wife thing, they said (pissed) ex-wife.

Which sadly is not that uncommon with surgical types.

 

[Dwindlin]

You know, I'm not sure of the details (e.g. if medical-legal cases count as civil cases, etc) but several attendings explained it that way to me.

Med-mal is a civil tort, so yes they are civil cases and spousal privilege applies. Spousal privilege is just as powerful as attorney/client, physician/patient privileges. Anything discussed (long as a 3rd party is not present) is considered privilege, and that privilege survives a divorce. Meaning if your ex was called as a witness because of a conversation that was had during the marriage, you can invoke privilege and block them from testifying.

Now I have been told told that privilege can suspended by a judge, but I am not sure as to how/why that may happen...maybe L2D will see this topic and add his expertise.

 

[Smurfette]

Hmmm...I think it depends on the state.

In some states, the spouse (or ex) has the option of invoking privilege, NOT you yourself. Thus, if the spouse wants to testify against you, they can. At least where I grew up, this was the case. You couldn't prevent the spouse from talking if they were willing to do so.

I have never heard of someone's spouse becoming involved in a malpractice case. That being said, I was always taught that you are not supposed to discuss case specifics or patient identifying info with a spouse or S.O. due to HIPAA laws. Maybe it's a little bit of both reasons?

 

[Dwindlin]

Hmmm...I think it depends on the state.

In some states, the spouse (or ex) has the option of invoking privilege, NOT you yourself. Thus, if the spouse wants to testify against you, they can. At least where I grew up, this was the case. You couldn't prevent the spouse from talking if they were willing to do so.

I have never heard of someone's spouse becoming involved in a malpractice case. That being said, I was always taught that you are not supposed to discuss case specifics or patient identifying info with a spouse or S.O. due to HIPAA laws. Maybe it's a little bit of both reasons?

Spousal privilege is common law, so I think it is applicable in all states. And I was also under the impression that privilege is held by the one who made the communication, thus can only be waived by that person. The whole point of spousal privilege is to protect the confidence of marriage. If the one person in the partnership can just ignore it why bother at all. I really hope L2D comes by this thread. . .

 

[Law2Doc]

...
Now I have been told told that privilege can suspended by a judge, but I am not sure as to how/why that may happen......

Um no..

 

[Law2Doc]

Spousal privilege is common law, so I think it is applicable in all states. ... I really hope L2D comes by this thread. . .

Also no. Common law is court made law and thus it varies state by state -- it's not generally national.

Here's the scoop:

1. M&M is deemed important peer review for patient safety reasons and thus is given some form of privilege in every state. The ACGME also deems it a very valuable residency training format and thus it is required of hospitals with accredited residency programs.

2. Spousal privilege exists in most states, and in many states it survives the marriage, so things said in the marriage may still be privileged after a divorce. In most states it applies to both civil and criminal cases. In some states a spouse can waive the privilege.

3. There is a hearsay rule that significantly limits what someone can offer into evidence in terms of what you told people. Unless you fall within an exception to the hearsay rule, stuff you tell people outside of M&M conferences probably don't make it into court. Ignore TV shows where this kind of testimony comes in regularly, and fabricated war stories where someone's ex comes out of the woodwork to burn them. It generally doesn't happen.

4. The judge has no power to suspend established privileges. His job is to apply the law.

 

[Dwindlin]

Also no. Common law is court made law and thus it varies state by state -- it's not generally national.

Here's the scoop:

1. M&M is deemed important peer review for patient safety reasons and thus is given some form of privilege in every state. The ACGME also deems it a very valuable residency training format and thus it is required of hospitals with accredited residency programs.

2. Spousal privilege exists in most states, and in many states it survives the marriage, so things said in the marriage may still be privileged after a divorce. In most states it applies to both civil and criminal cases. In some states a spouse can waive the privilege.

3. There is a hearsay rule that significantly limits what someone can offer into evidence in terms of what you told people. Unless you fall within an exception to the hearsay rule, stuff you tell people outside of M&M conferences probably don't make it into court. Ignore TV shows where this kind of testimony comes in regularly, and fabricated war stories where someone's ex comes out of the woodwork to burn them. It generally doesn't happen.

4. The judge has no power to suspend established privileges. His job is to apply the law.

Thanks!

 

[cbrons]

Also no. Common law is court made law and thus it varies state by state -- it's not generally national.

Here's the scoop:

1. M&M is deemed important peer review for patient safety reasons and thus is given some form of privilege in every state. The ACGME also deems it a very valuable residency training format and thus it is required of hospitals with accredited residency programs.

2. Spousal privilege exists in most states, and in many states it survives the marriage, so things said in the marriage may still be privileged after a divorce. In most states it applies to both civil and criminal cases. In some states a spouse can waive the privilege.

3. There is a hearsay rule that significantly limits what someone can offer into evidence in terms of what you told people. Unless you fall within an exception to the hearsay rule, stuff you tell people outside of M&M conferences probably don't make it into court. Ignore TV shows where this kind of testimony comes in regularly, and fabricated war stories where someone's ex comes out of the woodwork to burn them. It generally doesn't happen.

4. The judge has no power to suspend established privileges. His job is to apply the law.

Are there any states where what what is said in M&Ms is "subpeonable" (if I am even wording this correctly...)?

 

[Law2Doc]

Are there any states where what what is said in M&Ms is "subpeonable" (if I am even wording this correctly...)?

There are limited exceptions to every rule, but in general, things said and documents produced for the purpose of a physician "peer review" morbidity and mortality conference are privileged (and thus not subject to subpoena) to some extent in every state. The legislatures have made clear that candid exchange in such conferences aids the goal of correcting systemic hospital errors, and thus are protected and encouraged as a matter of public policy.

 

[45408]

Are there any states where what what is said in M&Ms is "subpeonable" (if I am even wording this correctly...)?

That would be horribly counterproductive, because it would just neuter the M&M discussion. Nobody would say what they were thinking, and it would be pointless to discuss mistakes.