Table 3 MDTM dynamics. Significant quotations from the qualitative interviews. The respondent’s identifications (referring to Table 2) are in brackets

“When there are too many participants, (…) I am not sure that it is useful, we waste time, because people who don’t know anything about the pathology are going to intervene… It is true that it may have an interest in medical training, but the main objective is to reach a medical decision” [ID 16]

Quality of discussions

“I know that the recording is compulsory, but I think that MDTM loses some of its meaning by taking time for registration because we need more time for complex situations” [ID 22]

“When the patient is beyond the therapeutic resources, the discussions can be stormy” [ID 22]

“At first, we need a good knowledge of the files, but generally, the files are presented very quickly and this is problematic! (…) I think it would be better to postpone the non-urgent files to the week after, rather than trying to present everything” [ID 9]

Team’s dynamics

“It is really a kind of mini concentration of the team’s life, with people who speak systematically, while others never speak and put themselves in the background, and some who even may show some hostility” [ID 8]

“We realize that the MDTM is a place of exchange, I do not think that it is to score-settling meeting in our Department. But it doesn’t mean that there is no conflict…” [ID 13]

Taking part on the decisions

“Globally, we feel comfortable to speak as long as we have an area of competence” [ID 11]

“There are two categories of people in MDTM: there are the people who speak on one side and who express an opinion which holds place of standard, in the name of an expertise, and the others, who listen…” [ID 19]

« Atmosphere»

“Each one is free to express an opinion, (…) even the residents, biologist takes their place, everybody manages to discuss the files. MDTM are a moment of exchanges that we appreciate all because it is also a training setting” [ID 7]

“There were hostilities within the team, which led to stuck discussions, to peremptory decisions, the debates were immediately closed, there was no possible exchanges”. [ID 3]

“I find that MDTM tends to function in a partial way: there are one or two people who impose their decisions on others. I think that the listening is not always open…the decision-making process is not really collegial…” [ID 5]

Participants’ involvement

“Personally, I try to be active in these meetings, participative, and my colleagues also: each participant can express his/her opinion about the decision to be taken” [ID 18]

“A physician presents his/her file, some colleagues don’t pay any attention and continue to mind their own business: we make the MDTM in front of our computers, and sometimes you have the impression that some colleagues are looking at their e-mail…” [ID 8]

The role of the moderator

“In this Department, it is the Department head who decides, so, when he is not there, we don’t make choices because we know that he will send an email the next day changing the MDTM’s decision” [ID 22]

“I attended MDTM in different Departments where the Department head was being is a little bit dictatorial, someone who imposed his point of view: this attitude blocked any word, there was a sort of judgment on the person presenting the file and others don’t dare to speak… it is very difficult” [ID 19]

“In our Department, it is the Department Head who is the moderator; he has the intelligence to encourage everyone to participate, and he has the modesty to say that if there is another expert of this disease in the room, "it is not me who is necessarily right” [ID 1]

The « final word»

“There is a technical aspect (the bibliography, the protocols) and the experience aspect and it is true that for me, the Department Head, because of his experience and his knowledge of the specialty, should have the final word.” [ID 6]

“It is the referent hematologist (RH) who has the final word. I am the Department head and I often lead the MDTM but even when I don’t agree with the RH’s point of view, I maintain that it is the RH who has the final word” [ID 16]

“I think that between what is decided in MDTM and what is really implemented, there may be gaps… and if it is the RH who decides, it is not necessarily a standardized choice, thus, there is a subjective bias…” [ID 20]