5.18.2007

TV medicine

An asthmatic child presents to our ED the other day. After multiple nebulizer treatments and steroids, she continues to decompensate. I tell the mother...

"I'm going to have to intubate your child. Intubation means, I'm going to put a tube - "

The mom interrupts me with a sheepish grin "I know what intubation is...I watch Grey's Anatomy."

***

I love medical shows on TV. I've been watching ER since....I was a child. I think (or used to think) Scrubs was the best show on TV ever, bar none (the Cosby Show a close second). I love House MD...and really get a kick out of the way he kinda...just says what we're all thinking. And, Grey's Anatomy is (mostly) fun to watch. I like Trauma, Life in the ER. I like Untold Stories in the ER. I even TiVo Dr. G, Medical Examiner.

My husband often asks me "How can you do that all day...then come home and watch it on TV."

I don't know. I just love medicine. I just love seeing elements of my experience played out on TV.

That's why I fell in LOVE with Scrubs. The early episodes, with JD, Elliot, and Turk as interns....were the best. The interaction with the nurses, patients...even Janitor represents the various "Pencil Monitors" I talk about from time to time. We used to have Janitors sleep in our call rooms...and have attitude if you asked them to scoot over. It's like they took my experience, my thoughts, my emotions...and made it into a sitcom. Like a fly on the wall in the residents lounge. They even managed to have a diverse cast, and have them interact in a way that wasn't 'forced' or 'weird'. Excellent. It was the most realistic medical TV show made.

- but now, they're all done with training. The story lines are...kind of pointless. There are too many references to ethnicity (with the whole "Mexican thing" with Carla, or the whole "Black thing" between Turk and JD). They've made Elliot weak and...a dumb blond. The characters are no longer color-blind, and their interactions are 'weird.' They don't touch on the real issues in medicine like before (malpractice, uninsured, universal healthcare). And there's not enough actual medicine involved. Not my favorite show anymore. It's no wonder ratings are down, and the sitcom was almost canceled from the Fall line-up.

House was great. Plenty of times I'm like "oh no he didn't just say what I think he said." The time he told that mom that "just because she took a high school biology class, she's no expert in medicine." Sometimes, when parents are being difficult, and are not listening...I wish I could say something like that. The diseases, although weird zebras, actually required thought...and sometimes even helped me in real life clinical practice. I'd do it like House...white board....differential diagnosis....let's try this...let's consider that....

- but then, the disease processes became inaccurate, and outrageous. Every episode started looking the same. I didn't like the fact that House was a drug addict. He became mean, just to be mean...instead of being mean as a reaction to patient stupidity. But, I think recent episodes are better than last season.

Grey's Anatomy is a fun show. I like the diverse cast. I like the narration, and the way it captures the thoughts of interns and residents. I like the interaction between the cast members. My criticism from the beginning has been the medical inaccuracies. This is important because the public "learns about medicine" from these shows...and I feel that Shonda (the creator of the show) has a responsibility to *not* depict medicine as 'magical.' If people come into Seattle Grace in full traumatic arrest...and live. Or have a submersion accident, prolonged ACLS, and come back neurologically intact...it skews reality, and subsequently our real patient's expectations are out of the realm of actual possibility.

The interns would not be able to cut an LVAD wire, move a patient up on the transplant list, perform open heart surgery on an elevator, and get away with these things with no knowledge or input from the nurses, residents, and attendings. There would be no prom on the surgical floor (cafeteria perhaps).

My gripe is that...it's not difficult to make things medically accurate. The show would lose nothing by being more realistic. Actually, I think they'd have a wider audience...and would be doing more for the public (and for the doctors), by paying attention to medical detail.

And the finale...was horrible. After all that, Christina and Burke didn't even get married. After all that drama, breaking up a marriage, dumping McVet...Meridith can't commit? Then Izzie, after all that Denny stuff...and after knowing George for a year...now that he's married she decides to screw up his marriage? You go from actually liking her, to thinking she's a whore. Then the chief resident thing. Why is an ortho resident chief of general surgery? The Chief thing...why would an OB/Gyn even be in the running? The 'intern test' doesn't get you thrown out of any residency program (probation maybe). And I find it a bit offensive the way they refer to the ER...and the lack of ER participation on all levels. Incoming trauma, field medicine, and every procedure done in "the pit," is all surgery. That's not reality. How hard is it to squeeze in an EM resident or two? Maybe now that George is kicked out of the surgery program, he'll apply for ER?

I really liked this show....but I think it may have jumped the shark.

Then there's the all time classic - ER. I must admit, I love ER. To date, that is the most medically accurate show on TV. It educates the public well. It reveals difficultly with the healthcare system. Did you see the last couple of weeks, with the ED closed because of Joint Commission regulations? Classic. Or Lukas's malpractice fiasco with the crazy patient? Not sure I liked that whole Darfur thing...but it shined a light on a situation that we should all be aware of. And I'm okay with that. I like the diverse cast, and the snippets of 'life' we see them live outside of the hospital.


I like medical TV. I like Addison, and I'm looking forward to Private Practice in the fall.