Cut to the Chase: 100 Matrix Pearls for Doctors

Abstract

This is a fascinating book. Unfortunately, for the UK reader the title is misleading and does not clearly reflect the content of the book. ‘Matrix Pearls for Doctors’ would better be described as ‘pearls of wisdom’. The author is a general surgeon from Los Angeles who is one of America's leading medical educators. He is the originator of the M+M Matrix, which is an error and complication-reducing curriculum generated from the morbidity and mortality conference, which become lessons in patient safety. The book describes 100 lessons to be learnt from these conferences. They are not listed in any particular order but each of them defines a ‘matrix pearl’. The author himself states that ‘true to surgical form they are personal and opinionated’. Matrix lesson 1 opens with an appropriate quote from Cicero – ‘Nihil est tam insigne, nec tam ad diurnitatem memoriae stabile, quam id, in quo aliquid offenderis’ [Nothing stands out so conspicuously, or remains so firmly fixed in the memory, as something in which you have blundered], and never has there been a truer aphorism! There are some wonderful learning opportunities in this book and to whet the potential readers' appetite, I will quote a few. Lesson 5: ‘A patient cannot sleep through peritonitis’; Lesson 7: ‘Never allow a patient near an interventional radiologist on a Friday afternoon, at night or during a weekend’; Lesson 14: ‘Never begin a comment at the Matrix Conference with ‘In my experience’ ’; Lesson 17: ‘The least essential operating room supplies are always overstocked’; Lesson 23: ‘If the scrub nurse mumbles during the sponge [sic] count, get a film’; Lesson 37: ‘If the nurses like you, you are not doing your job’; and Lesson 65: ‘Never refer to a patient as an organ or an operation’. Perhaps one of the most appropriate lessons, however, is lesson 98: ‘Beware the a.m. admit’. The author describes the admission of a patient on the day of surgery as financial brilliance but educational stupidity. He argues strongly for ‘day before surgery’ admission. This allows the patient to become familiar with the surroundings and staff and allows the surgical team to review the history, examine the patient and correlate this interview and examination with the operative findings of the following morning. The author describes it as allowing the perfect synthesis of observation, examination and correlation. This is a beautifully written labour of love by an experienced surgeon and educator, full of good practical advice based on years of experience in the emergency room, the ward and the operating theatre. Although written very much for the American market, almost all of it applies anywhere in the world. I think this book should be compulsory reading for every surgical trainee and indeed for anyone who attends a mortality and morbidity meeting. It is a veritable gem – a pearl indeed.