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SKEPTOID BLOG:

Pop Culture Medical Mistakes

by Stephen Propatier

December 4, 2015

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Donate 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 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.

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!

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.

by Stephen Propatier

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