Starring Emergency Medicine

I recently watched “Code Black” at the IFC Center in NYC. It’s a great documentary by an EM physician about emergency medicine and the challenges that we face in practicing medicine today. It focuses on LA County Hospital and the infamous C-Booth, which is the trauma bay where supposedly “more people have died and more people have been saved than in any other square footage in the United States.” It was especially enjoyable to watch this film at this early point in my training because I connected so strongly to the humanity and frustration of the young resident physicians who chose to train at a county hospital similar to my own. It was an accurate and sometimes disheartening depiction of emergency medicine, especially as it delved into the challenges of modern day regulations and paperwork as we work to provide excellent emergency care and also ultimately serve as a safety net for so many who have nowhere else to go.

A few months ago, I had also watched another documentary by EM physicians entitled “24/7/365: The Evolution of Emergency Medicine,” which is a more academic take on the history of our specialty. It’s actually really interesting and features many of the fathers of emergency medicine. As an EM doc, it’s great to watch the interviews with the “mavericks” who dared to forge a new field in medicine when everyone thought they were crazy.

With both of these films, emergency medicine as a field is starting to claim some control over how the future of EM will be portrayed not only in film but in society. EM is a relatively young specialty, and its perception as a specialty has always been shaped in part by its portrayals in media and film. The depiction of emergency medicine in the media has come a long way. I’m too young to have watched M.A.S.H. or Emergency!, which were both TV shows that were instrumental in EM’s development. I’m more of the ER, Scrubs, House, and unfortunately Grey’s Anatomy generation. ER in particular wins the award for not only introducing America to emergency medicine but also maintaining a fairly accurate portrayal of the pluses and minuses of the field.

Of course, there’s a new crop of medical dramas that premiere every season, and not surprisingly many of them will feature emergency departments because apparently the ED and the OR are the only interesting places in hospitals. Increasingly, many of these new shows often trade in realistic medical scenarios for ridiculous but dramatic life-saving interventions and of course sexy love triangles, the most egregious new offender being NBC’s The Night Shift. I understand it’s going to get big ratings, but it’s just painful to watch the wild inaccuracies as a medical provider.

Besides just misrepresenting our work in popular culture though, these inaccuracies do have an impact on patient care and perceptions. For example, surveys and studies have looked at what percentage of resuscitations depicted in media were successful. Some of these TV shows have shown success in as high as 75% of resuscitations depicted. Consequently, patients and the public believe the chances of successfully resuscitating someone are much higher than they actually are. In reality, the percent of cardiac arrest patients who are successfully resuscitated after CPR and survive to hospital discharge is less than 10%. If we keep this up, we’re just setting everyone up for disappointment.

Emergency medicine is a very cool specialty obviously. People’s interest in it will only grow, and there will be countless more TV dramas and films based out of the emergency department. That’s great for us, but we owe it to medicine, our patients, and ourselves to make sure that these depictions of our field in media maintain a respectable and responsible degree of accuracy. We can’t just let Hollywood run the show.

 

Finally, just for fun. Here’s my quick rundown of some popular TV shows ranked from more realistic to not.

NY Med and Boston Med – These were TV documentaries based on real doctors and patients, so I feel obligated to rate them as most realistic. However, it absolutely sensationalized and over-dramatized medicine and made you think there were no other doctors in the entire hospital besides surgeons and emergency medicine physicians. And of course, anything that features Dr. Oz these days is questionable.

Scrubs – My personal favorite. The most accurate depiction of residency and hospital medicine out there. As long as we completely just ignore that whole ninth season.

ER – Sometimes a little dramatic, but overall a faithful and honest depiction of our field. Maybe what happens in one episode actually happens over a whole week, but otherwise totally spot on. We’re pretty much all as good-looking as George Clooney and Noah Wyle, if not more.

House MD – I wish diagnostic medicine, House’s department on the show, was a real specialty because I would totally do that. You get to solve the most interesting cases and do everything from operating on your patient to interpreting all your own scans. No other specialties needed. Also, we all wish we could just do whatever we want like House and not get fired.

Grey’s Anatomy – I wish it was true, but not so at all. Nothing happens in the call rooms except unsatisfying sleep. Also, I’ve never seen surgeons hang out in the emergency department so much or respond to traumas as they come in. In fact, why are surgeons the only doctors in the entire hospital? Why are the chiefs of departments so young and good-looking? Why a million other things?

The Night Shift – This latest newcomer is probably pushing the field of emergency medicine backwards and actually doing a huge disservice to medicine in general. There’s so much wrong in every episode. Go check out EP Monthly and their live tweets for the best recaps on all that is wrong with this show. For doctors, that’s actually better entertainment than the show itself…

The Scions of Medicine?

I recently read some statistics that shocked me, but not really. In the US, 60 percent of medical students come from families with incomes in the top 20 percent of the nation. Meanwhile, only 3 percent come from families with incomes in the lowest 20 percent. Not much socioeconomic diversity in the house of medicine.

Now, I realized early on that I didn’t have a lot of company in this respect, but I didn’t think it was as lonely as a mere 3%. As a first generation college graduate, let alone doctor now, I know all too well that feeling that I had stumbled into an exclusive club to which I didn’t perfectly fit in. More often than not, it seemed like many of my classmates had parents who were physicians or at least some better sense of what a life in medicine was like. Looking back on my journey into medicine, I remember firsthand the challenges facing aspiring doctors from lower SES backgrounds.

If nothing else, my personal journey illustrates the importance of early recruitment and sustained mentorship in the field of medicine. It’s just more challenging for those without any prior exposure to higher academics to realize that a career in medicine is a possibility. To this day, I can’t say exactly what it was that first made me think that it was feasible for me. My father delivered takeout, and my mother was a seamstress in a factory. In my family, a high school diploma already made me a pioneer in education. I was very fortunate though. I got accepted into medical school at the age of 17 through a joint BA-MD program. While most would consider the greatest benefit of this set-up to be a guaranteed seat in medical school during undergraduate, I actually considered the greatest benefit to be the mentorship and guidance that I was connected to through the program. Even with a guaranteed seat in medical school, I would never have successfully made it to medical school without that added support, direction, and community.

Of course, the other large obstacle, perhaps the greatest impediment of all, is the exorbitant cost of medical education today. The AMA reports the average debt of medical students in 2013 to be around $170,000, and that amount can easily be as high as $250,000 or more, especially if you attended a private university for both your undergraduate and medical degrees, as I did. In my case, I consider myself very fortunate once again because I received a near-full ride scholarship from my generous alma mater for my undergraduate education. As for medical school, it was a combination of scholarships and loans that was pretty typical for many medical students. As a result, I still owe some people a lot of money, but perhaps not nearly as much as I could have for someone in my position. It’s hard to say how these things may have affected my choices in retrospect. If I didn’t get that scholarship in college, would I have dared to take on more debt by going to medical school? If I was in more debt, would I have felt more compelled to go for a more lucrative specialty?

The ramifications of a lack of socioeconomic diversity in medicine are great and significant to patient care. Looking back, it seems obvious how we can start to remedy the problem. We need more outreach to those from lower SES backgrounds early on and more learning opportunities for those interested. We need to provide sustained mentorship to those already on the medical track. And, most importantly, we need major reforms to the funding and costs of medical education today. It will take more than just 3% of us to improve this. As a profession, we must recognize increased diversity in our field as an important goal to strive towards.

The Next Chapter

They say the jump from medical student to intern, which is the infamous and grueling first year of residency, is the steepest. Of course, I heard that same thing about the jump from MS2 preclinical year to MS3 clinical year and from resident to attending and from young attending to seasoned attending. So who knows? By this point in my medical career, if nothing else, I am very comfortable with being uncomfortable. Or at least very used to it. Willingness to deal with uncertainty is must-have in emergency medicine after all.

What I do know is that MS4 year was awesome. This last year of medical school was truly wonderful and revitalizing. You can have dinner with your family and friends again; you can read a book just for fun; you can actually sleep the number of hours that you recommend to patients, and then some.

Now, with my very newly minted MD, I’m finally making the big jump from medical student to doctor. It took four years to reach the top of the medical student totem pole, and I enjoyed those good times while they lasted. Now, the reward for reaching the top is to start back at the bottom of the “real doctor” totem pole. It’s okay because, by this point, I’ve also grown very accustomed to perpetually being at the bottom of a totem pole.

So why would I choose to start a blog now? At the end of the most carefree period of my life/career and the beginning of what many have told me is the most challenging phase of my medical training? Well, that’s easy. For my sanity and my patients.

Once upon a time, I was a normal human being. I loved to read and write. I had interests and normal reactions to things.

Let me illustrate further what I mean with a simple example. Diarrhea. When people hear about diarrhea, they are generally grossed out, as normal people are, so I’m told. Now, after the brainwashing that is medical training, I’m intrigued about your diarrhea and have a million questions for you regarding it. I want to know the color, odor, consistency, presence of blood…something has happened to me.

I wish I had documented that change in myself more. I wish I wrote more in medical school. So that’s why I’m going to do a better job of it in residency. I want to be able to trace that gradual evolution and at least still recognize the individual in the white coat that I see in the mirror. Physicians are storytellers at heart; patients tell us stories; we present stories to one another. We collect and tell stories all day long. I think the best doctors are the still the ones who remind themselves and remember why they chose to don the white coat in first place.

Medicine is the best job in the world. The training and day to day work can be a little rough on your soul, creativity, and humanity. I have to do what I can to try to preserve and save them.