Wednesday, January 30, 2013

Monday Mornings Quarterbacking: How does new TNT medical drama match reality?

Doctors are human. Humans screw up. What happens when doctors screw up?

The latest prime time TV series set in a hospital, TNT's "Monday Mornings", sets out to provide a dramatic answer.
As I write this post, the first episode has not yet aired, so I can't say how realistic (or entertaining) the new series is. But I have seen doctors scrutinize each other in the sort of morbidity and mortality meetings the new show purports to reflect. These examinations of cases that didn't turn out for the best trace their history back to the early days of modern medical practice.

It seems obvious that picking through cases of injuries and deaths would help doctors learn how to avoid harming patients in the future. But the early proponents of M&M (as Morbidity and Mortality meetings are generally called) were demonized by ohter physicians, according to a Grand Rounds presentation on the practice that I wrote about in "The Real Grey's Anatomy." In that lecture, Richard Mullins, MD at the Oregon Health & Science University (OHSU) argued that in addition to being a classroom where doctors can learn to do better next time, or a courtroom where they are judged by their peers, M&M has a third purpose... a ritual that tests how well doctors fit within the "tribe" of medicine.

“You realize that you are part of the tribe. Your participation confirms that you are part of the tribe of surgeons. It is a rite of passage, extremely unpleasant and difficult; but it makes you hardened and gets you ready to make difficult decisions of life and death. And you have to discuss your errors in front of your peers; it's a purification ceremony,” Mullins said.
And indeed, in that section of "The Real Grey's Anatomy," I went on to note how the performances of young surgeons seemed to reflect almost as much about their ability to fit in and act like the senior surgeons as they did about their grasp of the medical facts of the cases under examination:

The stress of M&M clearly affects some residents. They haltingly struggle through their case presentations, hesitatingly answering questions until the attendings cease asking more. One resident is chastised for not supplying a report in the format an attending expects. “I’m happy to jump through hoops. I just need to know where they are,” the resident responds testily.

But then a resident steps up with confidence. He projects his first slide with the list of recent cases and complications.

“Tell me about R.L.,” an attending asks, referring to one of the cases. One quick click and the resident is narrating a slide showing the key points of that case. Then back to the summary screen. “Why did you do an open procedure on that third case?” another attending asks. “I’m glad you asked,” the resident smiles and pops up a slide about that case.

As he continues through his presentation, he demonstrates not only a clear grasp of the facts that the attendings want to know about… he displays his mastery of the form of M&M. There’s no doubt he is a full member of the surgeon tribe.
Coincidentally, the new TNT series "Monday Mornings" is set in Portland, the home of OHSU and "The Real Grey's Anatomy" book. It'll be interesting to see if this new medical fiction captures any of the essence of real world M&Ms... or instead resembles two other Portland-set TV series: the fairy tale fantasy of "Grimm" and the over-the-top farce of "Portlandia."


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