Years before I embarked on the road to becoming an emergency physician, one of my first exposures to the specialty was the television show ER. There are many reasons I ultimately chose this career path, but I'd be lying if I said ER didn't put the idea in my head. Even after all this time, the very first episode rings true and that cheesy, 1990s-style theme song brings a smile to my face. It's not perfect, but the world of Carter, Greene, and Benton gets a lot of the culture and the medicine right. Scrubs was also a big favorite of mine. While it doesn't claim to tackle the science accurately, it does a great job of representing the culture of medicine, especially the dark humor, hierarchy, pressure to succeed and the weight of responsibility for others. Ironically, both of these shows have been a source of comfort and a reminder of why I went into medicine during some of the more difficult periods of training.
But this post isn't about my favorite medical shows. Instead, it's about the ways the medical dramas so often get things wrong (ER and Scrubs included), those things that make doctors cringe and are sure to have me standing up and shouting at the television mid-episode. From emergency surgery to cardiac arrest, seizures to organ donation, there's a lot of the medical field that these shows misrepresent and misconceptions that they perpetuate. I’ll always love a good medical drama (or comedy), but here are my top ten medical missteps, mistakes and downright lies as seen on TV.
1. "We have to remove the bullet!"
Despite the compelling scenes enabled by this plot device, it still drives me crazy. A character is shot, oftentimes in the abdomen, and ultimately undergoes a painful extraction of the bullet fragment (whenever suits the plot). Sweat drips from the surgeon's face as he pulls it out, usually with the help of some liquor as an antiseptic, the patient screaming or perhaps gritting their teeth stoically. And with a few hours of rest, that same character is ready to go like nothing even happened (though he or she is obligated to wince from time to time just to remind us). As it turns out, you can still bleed to death from a vascular injury (in seconds) or liver laceration (in minutes to hours) or die a horrible painful death from a perforated bowel and sepsis (in hours to days). Taking the bullet out fixes none of these problems and has a reasonable chance of making things worse. After learning the anatomy and running real-life penetrating traumas, these scenes just demand too much suspension of disbelief.
It's true that we do say "clear" in the emergency department, though perhaps not as often as on ER or House. This inaccuracy lies more in the delivery. First of all, this doesn't happen nearly as often (which is good because it means someone is on the brink of death). And though it's often a tense moment, this phrase is about communication, not drama. More often, you're going to hear something like, "I'm clear, you're clear, everyone's clear," in a measured voice. Charging in with the paddles defeats the purpose, as 'clear' is about keeping everyone else safe from the electrical shock being delivered to the patient.
3. "We've placed him in an induced coma."
The concept of a coma is tremendously misunderstood, and television shares at least some of the blame. The term is used carelessly and imprecisely (with tragic consequences) for other types of conditions - such as persistent vegetative state and brain death - from which people do not recover. Some people - for example, those with traumatic brain injury (TBI) - can recover and eventually "wake up". But sadly many with severe underlying brain injury will never wake up and this television inaccuracy can create false hope, leading to suffering for patients and families.
"Stat", like many words in medicine, is derived from Latin (statim meaning 'instantly' or 'immediately'). Pretty much everything in the emergency department is STAT (especially in comparison with the rest of the hospital), so it's really not necessary to say it out loud, much less shout it. If you tell a seasoned ED nurse that something is STAT, you are guaranteed to get an eye roll as they go back to whatever they were doing. The only folks I know who still say stat without a hint of irony are neurosurgeons, and they are in a class of their own. After all, it literally is brain surgery.
5. "He's flatlining! Charging... clear!"
Sorry, this one is just wrong. Delivering an electronic shock via defibrillator is a method of converting someone from a non-perfusing, disorganized rhythm (ventricular tachycardia or ventricular fibrillation) and resetting their heart to a normal sinus rhythm. You cannot shock someone out of asystole (no rhythm or electrical activity) or pulseless electrical activity (electrical activity but no rhythm) because there is no mechanical rhythm to reset. All you can do is continue CPR, push epinephrine, and think about reversible causes (and cross your fingers). Put the paddles down, doctor. And speaking of which....
6. Those paddles
Maybe this one isn't so much of an inaccuracy as it is outdated. The television show ER was my first introduction into the field of emergency medicine. And, while I definitely didn't mention this in my residency interviews, at least some small percentage of my choice of speciality came directly from watching it. Gosh darn it, I just want to use those paddles one time, is that too much to ask?! But alas, as it turns out its safer and quicker to apply defibrillation through large sticky pads. Less badass, unfortunately, but in the end better for our patients and safer for the ED team. (Fortunately, the paddles do still exist, and I’ve had the chance to use them!)
7. Successful Resuscitation
Unfortunately, television shows and movies drastically overstate the success of resuscitation. If a patient becomes so ill that their heart stops, there are often forces at work that are irreversible, even with the very best medical care and high quality cardiopulmonary resuscitation (CPR). This is especially true in cardiac arrest due to causes like blunt trauma (e.g. a car accident), advanced infection or cancer. Successful resuscitation is more likely in situations such as respiratory arrest leading to cardiac arrest or in penetrating trauma, such as a stab wound, in which there is an isolated injury that can be temporized and then corrected surgically. But even in scenarios with better odds, the rate of survival is still quite low, at best about 1 in 3 and at worst about 1 in 100. The numbers are much worse when you exclude patients that suffer neurological injury even if their bodies survive. The television portrayal of CPR was even the subject of a 1996 New England Journal of Medicine article which catalogued medical television dramas and found that 75% of patients depicted were resuscitated and 67% left the hospital alive. Sadly, this just isn’t the case.
8. Spending time with McSteamy
I'm sure it does happen from time to time, but certainly not with the frequency portrayed on television. Though emotions can run high in the hospital setting, it is still our office. Plus the stained mattresses of shared call rooms, crowded supply closets and the blood, urine and vomit of the work day aren't exactly aphrodisiacs. That's not to say that relationships don't catch their spark and blossom in the hospital. They certainly do, especially given the seemingly endless hours of residency make your co-workers some of the only people you see on a regular basis. But the rest is better left for the bedroom, rather than the supply closet.
9. "He's seizing!"
Seizures tend to be a very misunderstood condition as well. They look very dramatic and this causes others to respond in dramatic fashion. The disconnect here has always bothered me. Even in this hospital setting, seizures tend to receive outsized attention. A patient who experiences a seizure that stops after a few minutes is almost certainly going to be fine. In contrast, someone with cardiac chest pain and EKG abnormalities has a very real chance of dying any minute even though they are awake and talking to you. Television has certainly contributed to some of the problematic treatment of seizures as well. Specifically 1) trying to restrain a seizing patient and 2) trying to put something in the patient’s mouth. In reality, these are the last things you should do. What someone should do if they witness a seizure is make sure that the patient is an a position and location where they are at minimal risk of harming themselves.
10. Organ donation
Last but not least: organ donation! Donation of organs after death is also a very misunderstood area that is perpetuated by depictions on television. In reality, donation is a very rigorous process that requires specific guidelines and permission in order to move forward. In particular cases, including donation of heart or lungs, which can only come from a brain-dead donor, this involves even further stringent medical testing to confirm brain death. Things that NEVER, EVER happen include 1) deciding whether to resuscitate someone based on their donor status, 2) deciding whether to ‘pull the plug’ based on their donor status, 3) reserving an organ for a specific person from a deceased or brain-dead donor. If you’ve ever come across these misconceptions, I encourage you to learn more about organ donation and become a donor yourself.
Joshua Feblowitz, MD, MS, is currently a PGY4 resident in the BWH/MGH Harvard-Affiliated Emergency Medicine Residency (HAEMR) Program and a freelance science writer.