notes from the M&M Conference

1st case: 18 year old woman presented with neck lump and pain in right hip

-panelists seem to consider diagnoses from their own specialty perspectives (infectious disease doc says mono, IBS possibly, “HIV is always a possibility, however much you believe someone’s sexual history”; oncologist says diffuse lymphoma).

-How much does specialized knowledge help/hurt the differential?

-although the patient didn’t present all the symptoms of LeMierre’s disease, the point of M&M is to find foolproof ways of diagnosing it next time. This is a learning experience. Quantifying symptoms, putting them in a checklist, and teaching doctors to recognize them next time.

-detective novels!

2nd case: 80 year old British man presented with shortness of breath, dyspnea, hoarseness

-panel members should and can ask questions

-the multiple lab data bits, EKG, types of scans, were all standard procedure.

-How do we actually know what a “disease” is? Just an accumulation of lots and lots of cases that have the same/similar pathology and we extrapolate from there/continue to add new symptoms/subdivide and name it after the “discoverer”

-if you sit up there on the panel and say nothing, you don’t look so good. Or when you say things like, “Lifespan doesn’t cover chimney sweeps.” Seriously? Apropro?

-the docs discuss the mechanism of death, not the emotional experience per se, though I suspect that it means something to these people, to know what it “feels like” when you have a certain biological condition

-they constantly compare patient to the available literature. Staying up to date with research and clinical cases is important!

-“it would be crazy” to aggressively treat someone in such poor condition. This man was resuscitated instead of being allowed to die in his sleep, but to what avail? Dr. Flanigan (!) makes the point of “delivering bad news” and the presenter said that he “made no bones” about telling him that it looked bad… discussion with wife and the patient was made CMO.