The psychosocial M & M: a tool in reinterpreting problematic medical situations

This article explores the concept of a psychosocial morbidity and mortality (M & M) conference as a useful adjunct to the traditional M & M in physician education. It argues that understanding significantly unexpected and disturbing patient outcomes often requires a shift in the analytic paradigm used and offers an interpretive and relational perspective as a way to deepen the understanding of physicians-in-training. In particular, it is argued that the psychosocial M & M can highlight previously missed or trivialized dimensions of patient, family, and physician interactions which affect care and, simultaneously, can help address the affective distress of the physician-in-training which results from a difficult and painful case. Definition, goals, and a theoretical formulation are provided, as well as a detailed description of how a psychosocial M & M might be conducted. A discussion of potential difficulties and anecdotal positive outcomes are also included.