PM Pediatrics
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Dr. Christina Johns
Senior Medical Advisor, PM Pediatrics

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Doctor wheeling patient in Emergency Department

As Seen on TV…or not. Medical Shows Deconstructed

“Get me an ECG, Chest X-ray, (6 other unrelated things), and 2mg Epinephrine STAT”  

…is a phrase I have never said, unlike nearly every physician on every medical show that I’ve ever watched. Anyone who randomly barks out an extensive list of orders like that is probably either:

  1. Not a real doctor but might be an actor on one of those medical shows, or
  2. A pompous jerk, because most actively employed medical staff understand that good team function is critical for delivering effective patient care and depends on respect, collaboration, and 2 way communication. (And for the record, the nurses are often one or ten steps ahead of the physician team leader in a resuscitation and therefore do not require the laundry list of orders delivered in a stern tone.)

I can’t claim to watch or have watched any of the medical shows regularly. Actually, other than “ER” (back in the day before I really knew what was up in the Emergency Department), I don’t think I have ever watched a single episode of any series more than once. I’ve often wondered if police or attorneys feel similarly about programs that center on their chosen field, but I feel fairly comfortable speaking for much of the medical community in saying that those shows really don’t even loosely depict the sequence of events in healthcare life day to day. That just wouldn’t make good entertainment. I fundamentally like the idea of highlighting the compassion, humanity, grace, and detective skills of clinicians as well as acknowledging their flaws and foibles, but I just can’t even with the medical shows. Here’s why (my opinion).

1. Not enough airtime time spent on waiting for return calls or charting.

With the documentation requirements and amount of time spent charting in electronic health records, if these shows wanted to have a brief encounter with reality then they’d need to spend about 2/3 of the air time depicting the clinical staff either on the phone or sitting in front of a computer. For added drama some of the doctors could be speaking into slick voice-dictation programs, but they’d need to use a robotic extreme enunciation voice so that might not be real good for ratings. The true story is that documentation requirements for medical-legal accuracy as well as for insurance verification/billing/coding purposes have increased over time and as such the healthcare team can spend an excessive time working in front of a screen until the completion of all charts is achieved.

Who wants to watch that? (-Crickets-)

2. IT issues aren’t highlighted.

There are pluses and minuses to this. I usually have to call IT to get at least one of my passwords reset each week, so multiply that times the number of people working in an office or hospital and at least ¼ of any side plot would need to include this riveting aspect. One upside is that the IT folks are often pretty nice, patient, and lovely individuals, so at least some character development could happen, but no medical show I’ve seen or read about seems to include this common, everyday experience throughout healthcare worldwide so accuracy is really at issue here.

3. At least in pediatrics, not many kids get shocked with the paddles (defibrillator). Hence, “clear!” doesn’t get yelled very often.

It looks so dramatic and cool, doesn’t it, when there’s a bevy of healthcare providers standing tensely around the bedside as they get ready to shock their patient into wellness. In reality, there aren’t that many shockable cardiac rhythms, especially in children, and especially especially we do not typically defibrillate for “flatlining,” which we actually call by its appropriate medical term, “asystole” (25 cent word). IV or central access medicines, oxygen, and fluids are most often the key interventions during a resuscitation.  Electricity is not, but it does stir up a good bit of anxiety when it happens, so I can see why it would be effective for tv so long as authentic depiction of therapy is not an actual goal.

4. As much as I like to think of emergency doctors as renaissance physicians who cover in depth every single specialty (not biased or anything), physicians mostly stay in their lane.

It cracks me up how the doctors on medical shows seem to show up involved in work activities ALL AROUND THE HOSPITAL at ALL HOURS OF THE DAY. Certainly with the evolving encyclopedia of advancing medical knowledge, specialties and subspecialties exist for a reason and no one doctor is quickly thinking up blood cancer protocols right after they emerge from the operating room where they swiftly handled a significant traumatic great vessel hemorrhage. There is indeed collaboration between specialists, and I’ve been known to field trip up to the ICU to check on some patients I’ve treated in the Emergency Department and vice versa from the inpatient crowd, but the medical shows over exaggerate in ridiculous fashion the ubiquity of physician scope of work.

5. It’s highly unusual for anyone to wake right up after CPR.

This one is just plain fiction, and requires, as my 10th grade English teacher used to say, “willing suspension of disbelief.” One immediate way to get me to check out completely from any medical drama is for a patient to be getting chest compressions one minute and then struggling to make the right choice on the selections from dietary the next. Patients who truly need CPR usually require much more recovery time before they are back to any kind of food consumption.

6. All staff isn’t working all together at the same time.

Everyone knows that hospitals never close and that people have to leave and get a little sleep at some point. That’s why there are different shifts, hello! So I’m not really sure why everyone is always working together all the time in these hospital shows. You never see a sequence of events unfold where that non-emergent test that might help make the diagnosis but we’re not really sure waits until the next day when the rest of the relevant team comes in for work. No, on these medical shows stuff can happen instantaneously because EVERYONE’S THERE AND NOT TIED UP WITH ANY OTHER PATIENTS. And lab tests that need to incubate for days in reality, just seem to come back immediately. Recently there was an awfully quick diagnosis of Ebola on TV- 30 minute lab turnaround time!  I know I don’t have to tell you just how absurd that is. Someone needed to tell that medicine team that that particular lab is a send-out to the CDC and never done in-house!

I’m not trying to ruin your weeknight viewing experience, I promise. I want you to enjoy the stories that show families coming together during difficult times, and about healthcare teams supporting each other through stressful situations. That’s the stuff that is quite representative of what really happens in medicine on a daily basis, and I’m proud to be part of it. “Clear!”

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