Wednesday, October 13, 2010

m & m & m

I had to present at our monthly departmental M & M conference today, which unfortunately in medical shorthand stands for Morbidity and Mortality rather than whatever else M & M stands for in the real world. (DID YOU KNOW? The candy name M&M is taken from the first letter of the inventors' last names, Forrest Mars and Bruce Murries. Now go impress your friends, of which you probably don't have very many if you routinely try to impress them with your formidable bank of candy-related trivia.) My case involved no mortality and no detectable morbidity, but it still was sort of excruciating to stand up and present it because it was one of those cases where the only thing that caused a deviation from the charted course was straight up human error. The worst kind of adverse event, in my opinion. Sometimes bad things happen because the patient is sick or because of some catastrophic event or because who knows why, and sometimes there are bad cases that you can talk about for days, because they're just so complex and nuanced and what if we had done this? Or what if we had done that?

And then there are cases where just just flat out make a mistake, and let me tell you, that is much, much harder to talk about. Because it's embarrassing, that's why. Not sure why that's the case--after all, I'm pretty sure that the only way that a human being can not make a mistake is when there is only one possible outcome to any particular action, and even then, I'm sure someone somewhere would find a way to screw that up. I know that we all like to think that we're infallible, but the truth of it is that the sooner that we realize how easy it is to make mistakes, the less likely we'll be to make them. Probably.

So that's why I like M & M, though I admit to liking it slightly more when I'm not actually presenting.

I know that physicians historically have a terrible record of admitting when mistakes have been made, and to my credit, I told the patient in this case immediately when I realized that we had gone off course. As bad as it is to make mistakes, hiding or ignoring mistakes that you know you made is infinitely worse--it's simply a matter of intent. Just take responsibility for what's yours. Own up. I didn't intend for this to happen, but here's how we're going to try to make things right. Mending. Which, I guess, could make for the third "M."

And now for no particular reason, pictures of my kids in the bathtub. Don't worry, no indecent bits, you perverts.


  1. Yeah, I had to do an m and m for my department this a fellow moonlighting in the er...and we had some actual morbidity and a real chance of mortality. And I got to sit there and say, you are right. I screwed up. Weirdly, people complimented me for my LACK of defensiveness. Well, what else was there to do, really? Lie? Boy, that sucked. So, in short, kids in bathtubs! Yay!

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  3. The sooner that everyone in medicine realizes that we are HUMAN and we WILL make mistakes, the better. We can try and devise better systems to help us not make mistakes or to help us catch them early before there is an adverse event, but we will always be infallible and make mistakes sometimes. That is why they called that landmark report, 'To Err is Human.'

    Good for you for standing up and admitting it. Hopefully you and all those who attended learned from it and this may help someone not make the same mistake in the future. (They can make different ones, instead).

    Trust me, we have all been there and have a huge amount of empathy (though, knowing us doctors, there were probably at least a few in the crowd who were just so happy that it wasn't them!)

  4. Anonymous12:29 AM

    Every time I see a new picture if Cal, I think about what a heartbreaker he's going to be when he gets older. He's just so adorable.

  5. Anonymous5:32 AM

    are these pictures taken on your iphone again? because they're awesome. why dont my iphone pics ever look like this??

  6. Anonymous10:37 PM

    You've totally sold me on the Hipstamatic app...beautiful pictures of your boys, as always

  7. Anonymous9:39 AM

    You overlooked one other way that humans can avoid making mistakes. It is very simple. Just don't do anything or make any decisions.

    And if you do actually end up being forced to make a decision make sure that you have the approval of someone else in writing beforehand. That way if things don't go well you can just blame them. And if things DO go well then you can take the credit.

    It seems to work well for some people I know anyway. Lots of emails and meetings.


    PS: Love the blog and I have nothing to do with medicine (I'm in engineering), just always thought it was fascinating.

  8. New DVM10:00 AM

    Ugh. Hardest part of vet school was the day I had to go back into an exam room and tell the client about the mistake I just made on her dog. The day before graduation. She was very nice about it. Understandably upset. But very nice. Nicer than I deserved.

  9. Is Cal trying to do the Vulcan salute?! So cute.