Morbidity & Mortality

In her book, Dr. Pauline Chen discusses the role Morbidity & Mortality workshops play in doctors’ professional and personal lives. She discusses first her reactions at the ironic futility of it all—the emptiness that is left when a patient’s life and death are concisely summarized in such a workshop, then dismissed from conversation for eternity. She talks about the realistic mindsets of surgeons presenting in these sessions, defendants in a covert tribunal to decide where blame, if any, should be allocated. But then, later along in the book, Dr. Chen states that she finds such formalities to be potentially powerful, as long as their limitations are always kept in mind. I agree that there must be such formal avenues for doctors to discuss the morbidity and mortality of patients. By nature, these workshops can seem largely bureaucratic, or overly simplifying. However, as with Dr. Chen, these can and should play a role in stimulating often uncomfortable sentiments and further thinking for physicians at the individual level. Human words can sometimes play the role of gross and ironic understatement, especially in genuinely grave situations, I believe that formally set-up efforts to discuss or explore death is useful in helping physicians re-see the irony of how little words can account for human life and death.

Something that has been discussed during class throughout the semester is the morbidity and mortality of doctors themselves. Hacib Aoun, whom Dr. Chen writes about, experiences this first-hand when he is transmitted with HIV from the blood of one of his patients. In his lecture in published in Annals of Internal Medicine, he writes of seeing the artwork created by one of his patients: “It hit me violently that I had lost sight of my patients as human beings and had begun to see them as a different species: the patient species… The process of becoming a doctor is so protracted and arduous that it is easy to forget along the way the initial reasons and ideals for wanting to become a doctor, especially because the current medical curriculum is disease-oriented, not patient-oriented.” Dr. Chen discusses recent re-structuring of the currently Flexner-based medical curriculum around sessions that resemble M & M workshops. I also wonder if the medical curriculum could additionally incorporate opportunities for medical students and residents to reflect on and discuss their own vulnerabilities. This might prove to be a potent angle from which to develop more compassionate doctor-patient relationships that can deal more maturely with the morbidity and mortality of future patients.