Science-Based Medicine and the M&M Conference…..
Last week I attended a Morbidity and Mortality conference, or M&M, held by the group of hospitalist physicians I recently joined. For those of you unaware of the concept of the M&M, these recurring conferences serve as one of the cornerstones of science-based medicine and have been vital to improving patient care since first proposed a hundred ears ago by Dr. Ernest Codman at Massachusetts General Hospital. And though typically associated with academic medical centers and community hospitals, most large medical and surgical practices engage in similar group discussions as well.
Much like the peer-review process which is so integral in the publication of new studies in medical journals, the M&M allows for critique of how a particular patient’s medical or surgical case was handled. Cases selected for review usually are those in which some kind of complication or medical error took place. Those involved in the patient’s care discuss the particulars, not with the intent to ridicule or shame into compliance, but with a focus on discovering how to avoid these problems in the future. Not every presentation involves issues with medical decision-making, however. Many are useful in uncovering problems with the system itself, such as miscommunication between doctors and nurses or between the floor and the pharmacy. A host of potential stumbling blocks to providing the best care possible for patients can be rooted out and dealt with.
Because of repeated and invaluable efforts like the M&M conference, which was initially rejected by colleagues of Dr. Codman, science-based physicians have become increasingly aware of the importance of laying out medical errors for all to see and to learn from. Medicine based on the principles of science, such as the importance of taking into account just how easily we can fool ourselves into thinking a particular therapy is effective, or how personal biases can lead to the dismissal of poor outcomes, is the best approach to patient care. It is also the best approach to the education of future generations of physicians, which is why accredited residency programs are required to hold M&M conferences.
Of course, not every physician takes part in such a review process. Many, who are a part of small group or single doctor practices simply don’t have the opportunity. With the widespread incorporation of computers and the internet into physician offices and homes over the past decade, there are resources for self-education available at all times for motivated physicians. These don’t require a thorough scouring of the current literature and an answer can be found sometimes in minutes. But not every physician takes the time to avail themselves of up-to-date recommendations based on the best evidence available. There are thousands of doctors across the full spectrum of legitimate medical specialties that fall heavily into the practice of what I like to call experience-based medicine.
As Mark Crislip, a frequent contributor to Science-Based Medicine, likes to point out, the three most dangerous words in medicine are “In my experience,…..”. Doctors who subscribe to the principles of experience-based medicine are significantly more open to being effected adversely by myriad well-described and inherent weaknesses in the way the human brain interprets the natural world. And those who claim the title of alternative medical practitioner, or promote therapies which fall under that umbrella term, base their worldview entirely on them.
More to come.