Pop Culture Medical Mistakes

Grey’s Anatomy Via Wikimedia

As someone who works in medicine I find it difficult to be entertained by medical entertainments. From Grey’s Anatomy to Robin Cook’s novels I cannot suspend disbelief and live in the stories. This is mostly because I avoid conflating my work and my entertainment, but also at least partially because of the inaccuracies. Inaccuracies, falsehoods, and myths in medical fare jar me out of the moment. These aren’t the small technical errors you can see in any entertainment medium; I’m talking about convenient, often-repeated, easily fixed errors. I often wonder if experts in these field have their entertainment experience ruined like me. To me it is no different than watching the film Gladiator and seeing a helicopter fly over the Colosseum, or watching Sherlock and finding out “aliens did it.” Entertainment, for me, needs continuity—fine to stretch yourself out for comedy or artistic license, quite another for lazy plot contrivances.

I am sure airline pilots, police officers, astronauts, and others can be equally critical of their profession’s onscreen depictions. I hope that pointing out a few common foibles won’t ruin your experience, and perhaps they’ll teach a little and sharpen your critical thinking. Skeptoid is all about pop culture and myths; I will make a small attempt to purge the demons by sharing some of the most common or egregious medical errors seen in pop culture. Some are from TV, some from print, some are even from Skeptoid podcast. Hopefully I can enlighten some of us without ruining your favorite medical drama.

Problem 1: Doctors DO Everything. I am eternally dismayed by the common plot contrivance of physicians capable of performing every task that has to be done. It seems like it’s usually a means to provide them with dialogue. I will often see onscreen physicians pushing stretchers, making beds, answering call lights, and even, once on Chicago Hope, emptying a bedpan. Ridiculous! Although it is possible for them to do any of a large number of tasks that may have to be done in real life, their time is far too valuable. Physicians are there for their experience, knowledge, and skills. They have little or no time to be doing these menial things. If they were doing them, specialized tasks would go undone. It’s just a plot device to prolong dialogue and reduce extras. Your doctor will not bring your meal tray, just like the nurse won’t remove your tonsils.

Problem 2: Portrayal of Nurses. Nurses commonly fall into two characterizations in pop culture. They’re either Florence Nightingale or Nurse Ratched. This is more a cultural observation and it may be due to the more misogynistic aspect to the nursing profession’s portrayal. Nurses are easily slotted into the feminine archetypes of saint or sinner. I’m tired of the oft portrayed battle axe ER nurse or the lone nurse who gives all for the patient. Nurses are people—people who have skills, talents and failings. Many are women but not all. It grates on my sensibilities the two-dimensional portrayal.

Problem 3: Skeptoid Nitpick. Well, as Skeptoid host Brian Dunning is fond of saying, he loves to be proven wrong. Most of my objections are nits, minor and/or pedantic. So to be pedantic I will pick on the only medical-drama device he hasn’t corrected. It is technically misleading. In Skeptoid #78, Dunning says:

Well I’m sorry to burst your epicardium, but according to emergency room doctors, there is no actual medical treatment that involves the dramatic stabbing of a huge needle directly into the heart — certainly not through the breastbone or in any kind of violent or forceful manner. The way to get any medication into the heart is to simply inject it into a vein.

Yes for administration of medication there is no jabbing into the chest à la Pulp Fiction. However, there is an emergency condition where you do put a large needle through the chest into the heart. It is not for administration rather for decompression of the heart. In cases of blood or other fluid build-up in the pericardium you do stab a large need in between the ribs into the heart and withdraw fluid to save someone’s life. The heart is surrounded by a tough sack that has limited space called the pericardium. If it becomes filled up the heart will have no room to beat. To treat the condition, called “pulseless electrical activity,” you stab patients in the chest with a large needle into the pericardium in a attempt to relieve pressure from a condition called cardiac tamponade.

There are other scenarios that may require similar treatments, but bottom line there is a medical reason to do that. It’s technically wrong to say that large needles are never stabbed into hearts, but he is correct in respect to the movie scene. Notably, it is not used for medication administration, or through the breastbone which is the wrong spot to hit the heart anyway. Historically, so-called intracardiac epinephrine was used in cases of cardiac arrest from a time when information was scarce, CPR was new, and people weren’t sure that CPR could circulate blood well enough. This was mostly discontinued after 1960 when studies involving dogs showed that intravenous and endotracheal administration was just as effective. As an interesting anecdote, when I first started practicing you could still find large intracardiac needles on crash carts.

Problem 4: Bringing People Back to Life. You cannot defibrillate a patient who is flatlined, who has no blood flow (also called “asystole”). No matter how many times I see it in TV or movies, I still groan. People are not cars; you cannot jump start a dead person. It is all very visually dramatic to shout “Clear!” and make the patient’s heart start beating again. It is just plain, utter nonsense. Treating a flatline requires CPR and medication, period. Defibrillation is for arrhythmia, which means that the monitor is jumping all over the place, not flatlined. That scene is iconic and everybody knows what that beeeep sound means. But it’s just flat-out wrong.

The same goes with using aspiration of water or drowning. It’s another heckle fest for me and my wife every time they do CPR on a drowning victim, with the final climatic cough out some water and wake up everything is OK. No—this strategy is deadly wrong. First, you don’t treat someone with chest compressions unless their heart is stopped. Second, water is not an obstruction like a chunk of steak in your airway, an obstruction that you need to cough out before going back to life as normal. Near-drowning is a deadly, prolonged, risky recovery that has a 72-hour period of lethality. At no point is a mouthful of water being coughed up the crucial tipping point. If you don’t know CPR, get someone to help. Do not beat on their chest trying to get the water out of their lungs. It won’t help and it might make things worse. If you are trained in CPR then you already know all of this.

As an aside: my personal favorite worst Hollywood scene for this is James Cameron’s The Abyss, which manages to combine an asystole defibrillation and water cough-out all in the same scene. It’s a bad medical science double feature.

Next, there’s the 30-second CPR. I understand that no one can show a 45-minute resuscitation on a half-hour show, or even a 90-minute movie. Still, depending on the needs of plot, CPR and defibrillation scenes are way, way too short. Nobody, and I mean nobody, does five minutes of CPR and two shocks on a young kid and then “calls it.” The data is conflicting, but the average across all ages is about 16-25 minutes, which you won’t see even suggested in entertainment. Three minutes is a scene eternity.

The opposite is true of success from resuscitation. Cardiac arrest means you have about a 5% statistical chance of survival, though most people in Hollywood survive.

Problem 5: Removing or Pulling Out Penetrating Trauma. For example, John Rambo, in Rambo III, breaks off an arrow, removes it, and then uses gunpowder to cauterize the wound. The truth is, though, that removing any object larger than, let’s say, a splinter, can be deadly. Your body is damaged by the entry but also by the exit. Digging out a bullet fragment to save someone, as you often see in movies and television, will only cause more trauma bleeding and death. Some bullet fragments are left in people even when we have them in the operating room because it is safer to leave it in than try to remove it. If someone is impaled on rebar, firemen don’t pull them off the bars; they cut the rebar and leave it alone until you can get them to the hospital. Whenever I watch someone pull the arrow, knife, or bullet out, I think, He’s dead.

Logo francophone de la série Dr House Via Wikimedia

Problem 6: House M.D. and the Made-Up Disease. House M.D. has been off the air for three years, but its legacy lives on, as made-up or scientifically wrong diseases can still be found throughout TV and movies. There’s a preference for medical “zebras” over common ailments, just as much as there’s a love of the flawed genius character, such as Dr. House. Everyone thinks they need a Dr. House to properly identify their specific and unique ailment. But most medicine is run of the mill. You’re a unique individual with unique needs, but chances are that what you’re suffering from is what everyone else has. House, which was beloved by my colleagues for some unknown reason, to me was a study in scientific inaccuracy. In an attempt to put the record straight, one doctor has dedicated a website to catalog every single medical inaccuracy in the show. However, the program’s popularity has spawned almost a duplicate character in every medical drama. House and other medical dramas often make up a disease. It is, for me, the most painful dramatic license, and writers apparently love do it. There are plenty of good illness out there if you just look. Amazingly, these shows usually have a doctor on staff, consulting on technical issues. Just ask them and stop using made-up tripe!

Title logo for television series The X-Files via wikimedia

Problem #6 The Impossible Diagnosis. This is probably a personal annoyance because it does take some medical knowledge. I have no problem with extraordinary abilities as part of the story reality. For example, Supermans’ X-ray vision giving him the ability to diagnose a broken bone, or Dr. McCoy from Star Trek waiving a device over someone and proclaiming “He’s Dead Jim”. What jars me out of reality is when someone does something that is truly impossible outside of story continuity. Usually this is a short cut. A short cut that they are betting you won’t realize because it is a story and you’re not a doctor. My favorite example of this type of medical fail is found on the television show The X Files. Dr. Dana Scully MD is played by Gillian Anderson, according to lore she is an FBI agent “skeptic” and medical doctor. Dr. Scully runs into the hospital room sees someone thrashing around on the bed and proclaims “He’s in ventricular fibrillation get the crash cart!”. I literally laughed out loud the first time I saw that scene. Ventricular fibrillation is a heart arrhythmia that has no external cues. Symptoms that manifest in this condition are indistinguishable from any other heart issue.  Thrashing around is not one of the symptoms, and couldn’t tell you anything about the heart rhythm. You need a cardiac monitor to know someone is in Vfib arrest and this guy wasn’t on one. Killing an other wise compelling scene in the episode Excelsis Dei. That Xfile episode had both a miracle cure and ghosts yet that short cut made the medical scene the most unbelievable part of the episode. It would have been completely acceptable to say “he’s seizing get the crash cart!” and problem solved. Directors writers or script supervisors should consult a doctor or a nurse, even a medic on set, and get it right.

Medical fare is old standby for television and movies. More often than not, they get it wrong when it is so easy to get it right. Why am I upset? It is personally annoying, but more significantly it contributes to people’s overall gross misconception of medical science. Giving them unrealistic expectations of hospitals, doctors, nurses and medical care. The intellectual laziness contributes to the population’s overall growing deficit in science knowledge. The shows I picked on are beloved but the errors are not unique to those shows. People understand Dr. House MD is a show, they often fail to understand that the story surrounding the character is not ripped from real life it is just as fabricated as the characters names.

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You can follow me at Twitter @steveproacnp for a daily dose of skeptical nursing.

Disclaimer: This post is my personal opinion, it is not a substitute for medical care. It is for informational purposes only. The information on Skeptoid blog is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified healthcare professional regarding any medical questions or conditions. This post does not reflect the opinion of my partners, professional affiliates, or academic affiliations. I have no financial conflicts of interest to disclose.

About Stephen Propatier

Stephen Propatier is a board certified acute care nurse practitioner specializing in spine and sports medicine. He is a member of the Society for Science Based Medicine and is adjunct faculty for both Brown University Warren Alpert Medical School and Rhode Island College Graduate School of Nursing.
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50 Responses to Pop Culture Medical Mistakes

  1. Rob says:

    To be fair; in regards to #3 his point is still accurate – there’s no administration of *medication* via “stabbing though the sternum/heart” as seen in Pulp Fiction, etc… Yes there is a procedure to relieve cardiac tamponade but that’s not what is being represented in those movie/TV shows.

    • I am pretty sure that is what I wrote and was pointing out this part of Brian’s statement was technically untrue “there is no actual medical treatment that involves the dramatic stabbing of a huge needle directly into the heart”

  2. Chris says:

    How about the intubated patient, cuff just inside the lips, wide awake and calmly shaking their head yes or no?

    • gymgoki says:

      …..or talking while intubated….JR Ewing.

      • Well talking is very wrong. In the ICU you do wean aware patients off of the ventilator and you can ask them yes/no questions. My one thing I left off was the old style Bird ventilator they love in hospital scenes with the giant black rubber bellow and it is not connected to anything. It is used I think for the Hssss puft noise it makes. Unless your in an ICU you won’t notice those things for the most part

        • gymgoki says:

          Yeah…..I can forgive noise it makes …the hospital scenes with the giant black rubber bellow and it is not connected to anything. It is used I think for the Hssss puft….. because our new ventilators are way too boring. Flow-volume loops just don’t have the same appeal.
          ….but when I think archeologist, I think: Lara Croft Tomb Raider…
          ……And when I think Navy, I think: Petty Officer Cora ‘Weps’ Raikes (Rihanna in Battleship)

      • William J Granger says:

        I thought that was Cliff Barnes, not JR Ewing.

  3. Tom says:

    After 20+ years in the Navy, I feel exactly the same way about how the military is portrayed on TV and the movies. I can overlook a lot of it–like ribbons and uniform badges being out of sequence, from the wrong service, or just impossible for the character to have (ribbons, especially campaign ribbons, are like a resume you wear on your chest, and you can easily spot the improbable ones). More jarring for me is the constant saluting and standing at attention, or when the characters inexplicably show up in dress uniforms in working environments (this would be like a surgeon showing up for an operation dressed in a tuxedo).

    But oddly, the one that really makes me grit my teeth is when characters use the prefix “oh” for time, e.g., “oh-nine-hundred” for 9:00 a.m. “Zero” replaced the “oh” prefix decades ago–which is why the movie is called Zero Dark Thirty, which is slang for too damned early in the morning. Yes, it’s a small detail, but it kicks me out of the story every time.

    • Noah Dillon says:

      Ha! That’s great. I wish I could pick out that stuff. I’m sure it’s grating, but I always find it fun to catch movie mistakes, like an airplane in the background of “Troy,” a fuel tank on a chariot in “Gladiator,” or a guy in a t-shirt and sunglasses and cowboy hat in “Pirates of the Caribbean.”

    • I am learning just how often other professions run into this as well.

    • BobM says:

      I hate the “that’s an order” I don’t know about the US, but in the British Army when officers tell someone to do something it’s assumed it’s an order rather than a suggestion. So the phrase is entirely unnecessary.

      • Tom says:

        Exactly. I’ve only ever used “that’s an order” as a joke. If you have to say it for real, then you’ve already lost the authority that the phrase implies.

        • Tom says:

          …which maybe is why the character is using it, to show that they’re losing control. Like saying “but I’m in charge here!”

  4. Brian Wall says:

    I can emphasise with the author. I used to work in television many years ago and now can’t watch a movie without the illusion being punctured by becoming aware of the cinematic tricks of the trade. Nor can I watch a tv drama without wondering if it was a multi-camera setup or not and if not how do the actors like having to repeat a scene umpteen times to allow for different camera angles?

    • Brian I did 4 days on a video shoot and was the script supervisor. That one experience ruined TV and movies for me for about 6 months, I can imagine how it affects someone with your history.

  5. Henry Ballon says:

    Just a nit-pick: perhaps have someone or a computer program spell-check/grammar-check this otherwise fine article.

  6. bandit, Albuquerque says:

    I am an engineer – I do embedded systems (like medical devices).

    Tony Stark might be a genius, but he is not going to build an Ironman suit from scratch in one night.

    In NCIS, they get attacked by a computer virus. Two characters start typing – on the *same* keyboard. Nope.

    There are many more examples. But .. the blog post is spot on.

  7. Morgan says:

    I think you are wrong about rescitation with drowning victims

    • Morgan says:

      I confess to rushing through this on a mini break at work. I was wrong. You do not say that CPR shouldn’t be used for a drowning victim. My bad.

      Are you sure that chest compressions should only be used of the heart has stopped?

      • gymgoki says:

        CPR is used when the heart is not perfusing the body. That is, it may still be beating electrically but if there is no palpable pulse then CPR is indicated as in “Pulseless Electrical Activity” or PEA

    • Morgan CPR is always ABC assess breathing compression. If a person is not breathing but has a pulse you do not so compression you do rescue breathing. CPR is a whole process that said chest compression until they spit out water is wrong.

  8. Nobody says:

    Honestly, I think you are lucky. I am an archaeologist. Try having a whole network making “documentaries” about your field.

    • gymgoki says:

      A “network” devoted to making “documentaries”….! That must be painful. Thanks for the heads-up. I find it sadly hilarious too (Another man’s pain is easily borne). Whenever I want information on the latest ghost, conspiracy or alien (the outerspace kind) research I tune in to the History Channel.

  9. gymgoki says:

    The TV show “House” is almost 100% wrong (medically speaking). The wrongness could be graded on a scale.
    No institution would tolerate Dr. House’s behaviors. I don’t care if he was Albert Einstein or Kim Kardashian.
    Those residents or fellows or whatever….. are not going to have the expertise to do all those procedures. They can order them and interpret the results, but they aren’t going to do them. The reality is that people that do biopsies, look at pathological specimens and do complicated radiological studies, do that kind of stuff multiple times every day…that’s why they are experts…no dabblers allowed.
    One of the worst examples (that I personally watched) was the show with the 600 pound guy that ended up having small cell cancer. There was about 10 minutes left in the show when House noticed the man’s clubbed fingers. That is why we invented “physical exam” about 3000 (or more) years ago. This should have been done in the first five minutes of the show…….hmmm….but of course, then we would not have had that show.
    One of the worst shows of all time for “medically things” is (was?) “Person of Interest”. Whereas I actually love the show for its mix of a nerd, psychopath, sentient computer, corrupt government and a guy that could beat up Chuck Norris….I always had to leave the viewing area when a medical issue was depicted. The worst was when a cardiac surgeon slips into the pharmacy and draws up a small amount of deadly heparin. Then, while fully gowned, somehow pulls the syringe out of pocket or something and injects it into an IV line when nobody was looking (maybe they don’t use heparin in robotic heart surgery-which was implied- I think). Old fashion cardiac bypass surgery typically requires a very large dose of heparin. Probably 10x the amount that the surgeon secretly obtained. And don’t get me started on the breaches of sterile technique that she violated, that, despite her last minute change of heart, is still going to kill the patient.
    …..whew…….I could go on………Thanks for ‘grouping’ with me….I feel better

  10. Brian,

    Thank you for looking beyond the usual MD initials behind a name to get your medical support and factoids, as my son calls them.

    Nurse Practitioners Rock and are an integral part of treating acute and chronic healthcare needs.

    Thank you again. Nancy Nadolski, Nurse Practitioner, and Mitsuko Stoddard’s grandmom.

  11. As an editor with many years ‘ experience, I feel like the author must Feel when he sees egregious medical errors on television. Errors jump out at me and spoil the article. My suggestion is that someone hire a good line editor. There are simply too many spelling, grammatical and punctuation errors in the article to overlook. The copy editor you have may be overworked.

    • Lisa M says:

      One of my best friends is pretty much a genius, with two Master’s degrees, but she simply cannot rectify homophones and chooses the wrong one 99% of the time. (She’s gotten better with “your” and “you’re” and “to” and “too,” but everything else stumps her.) A good many of the errors in this article are of that nature, which a spell-checker won’t identify.

  12. Pam Newbury says:

    I am a hypnotherapist. All completely evidence based – no mysticism, trance states or swinging watches whatsoever.

    I DREAM of one day being misrepresented as little as doctors 😉 !!! I really wouldn’t know where to start about hypnosis being incorrectly portrayed! It’s such a pity, too, as learning to relax and let go (which is 95% of what we do) is invaluable to help those with anxiety – but it’s the anxious who are most likely to be put off by the ludicrous myths.

  13. Kate Rauner says:

    Problem #1 is all over – do you remember how many crew are on the Starship Enterprise? Me neither because the 6 main characters do everything. But then, standard “how to” writing advice tells authors to combine characters to get more drama.

  14. ausGeoff says:

    What a sad, banal, unimaginative life so many skeptics must lead that they’re unable to maintain their suspension of disbelief for an hour’s TV show. Of course the average-educated viewer will—if he or she looks diligently enough—find many technical faux pas committed by alleged professionals in their respective fields.

    Do these folks really watch these sorts of shows perched on the edge of their seats in anticipation, pen or TV remote in hand, and with an eagle eye just waiting for any technical boo-boos? Do they then turn in smug victory to their partners and shout; “Look at that willya? He’s supposedly an orthopaedic surgeon, and yet he just diagnosed CMV retinitis!” And as a result totally destroy the moment for his less pedantic co-viewers. Please take a chill-pill all you nit-pickers, and enjoy these TV shows for what they are—and which are not broadcast as scientific or criminal treatises—but rather as ENTERTAINMENT.

    • There is no reason a medical show can’t present medicine as it is in reality. Such productions go out of their way to get other things right, why not the gist of the story? This seems like pure laziness and sloppiness to me. There is more drama in reality than in fiction.

      • gymgoki says:

        “This seems like pure laziness and sloppiness to me.”
        Louise,
        I agree….I just want them to try….I wrote to “Person of Interest” and offered to be their medical consultant for free. I over look little things all the time but there are so many egregious things….Anyway, an example of a show that “tries” is “Grimm”. They must have a real medical consultant. When you are torn up by a monster……you are realistically (or close enough for TV) torn up. They even add details that a layperson would miss.

    • Despite the article AusGeoff, most things I am perfectly able to let go. What bothers me is the repetitive nature of the mistakes listed in the article. In star trek everyone gets it is fantasy. People watch ER and think they know how emergency medicine works. If you are striving for a reality based medical show spend a little thought on reality. Otherwise why not just have bobby wake up and make the whole season a dream sequence, or only make a simpsons episode where there is no pretense of reality.

    • louise says:

      What a sad, banal, unimaginative life you must lead that you are unable to maintain a rational mind for an hour’s TV show. Most of us know very well how to suspend disbelief insofar as plot devices go, but we aren’t willing to suspend disbelief–or common sense–when it comes to medical details that are known even to laymen. The same is true when it comes to courtroom dramas. If the writers can’t present a story within the confines of how the law works, I completely lose interest. I am neither a doctor nor a lawyer but I know enough about both to know when serious errors are being made in a story. The story becomes useless when such errors are made.

  15. J. Christina Hodgson says:

    I wish the site’s curator would edit for misspelling and grammar mistakes. It’s “medical fare” not “fair.” It’s “you’re not a doctor,” not “your not a doctor.” I was very distracted the many instances of incorrect written English.

  16. J. Christina Hodgson says:

    “by” the many instances …

    (See? Errors are easy for the writer to post. It takes an editor to spot and fix the flubs.)

  17. Amanda says:

    The one that gets me EVERY TIME is stabbing a needle into a patient’s neck and injecting them with…usually something to put them to sleep. I think this idea of stabbing someone in the neck came from original Star Trek, but Dr McCoy didn’t use a hypodermic, he used some kind of air compressor thingy (and just as often injected them right through the fabric of their uniforms). I can forgive it of Bones, because it was different technology, and anyway he was my hero. I CANNOT excuse any 20th or 21st century doctor. Have asked a doctor friend about this, and he agrees that there is no medical reason to stab someone in the neck to deliver a chemical (although I have had a doctor go in through the jugular in order to deliver an anaesthetic. Believe me, there was no stabbing, things were done slowly and with a great, great deal of care).

    • gymgoki says:

      HAHAHAHA…LOL….whew….I forgot that one too.
      When I see that, I always think : “Those writers were influenced by ‘Dr Who'”. I can’t remember such a maneuver being done outside a live action “cartoon”. “Realistic” medical gaffs are the equivalent of Dirty Harry saying: “Listen Mack, don’t try anything funny. I’ve got you covered”.

      Remember: Dr. Who is not a doctor…he is THE doctor.

  18. William J Granger says:

    As a medical doctor, I think the near-drowning scenarios are the most frustrating. I don’t believe it was mentioned about the latest Mission Impossible movie scene where Tom Cruise almost drowned but was shocked and brought back to life, aside from the water in his lungs, and ready for action again. In real life, he would probably be in the hospital for a couple weeks.

    • I didn’t see that one William but I am not surprised

    • ausGeoff says:

      William, I think as a medical doctor you need to fine tune your suspension of disbelief in order to enable you to “escape” the real world, and better enjoy the movies or TV shows you view. In fact, most people describe their viewing of fictionalised stories as escapism; they don’t sit there continually examining every little detail in order to check its credibility—which is a great way to ruin the story.

      From any practical perspective, how could the movie have worked if Ethan Hunt had to spend a couple of weeks in hospital? Being from an engineering background I too am well aware of many of the technical inconsistencies with various movie scenarios (on a viewing post mortem) but I never let that interfere with my temporary escapism. You need to lighten up William.

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