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…

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