Reality check for drama

PUBLISHED : Tuesday, 10 April, 2012, 12:00am
UPDATED : Tuesday, 10 April, 2012, 12:00am


The patient lies immobile, and the droning beep from the heart monitor and the flat line across its screen suggest there's only one possible course of action left. The defibrillator paddles are fired up, someone shouts 'Clear!' and the patient is given a jolt of juice.

Nothing happens. Another jolt. Still nothing. The paramedic gives it one last, despairing try - and, miraculously, the screen flickers into life, the heart monitor's beeping becomes rhythmic again, and the patient splutters back into consciousness.

We've all seen it a thousand times, on every TV medical drama from ER to Grey's Anatomy. But there's one problem: it doesn't reflect reality. Defibrillation works on hearts that aren't beating properly, but not on hearts that have stopped.

People love medical dramas. Besides being entertaining, they often do a good job of educating people about medical conditions and the inner workings of hospitals. But these dramas also make an awful lot of mistakes and, in doing so, help to perpetuate some of the most common medical myths.

Some of these myths are ethical, some procedural. Many are just silly, and infuriate medical professionals who see their difficult jobs being misrepresented. People tend to believe what they see on television, and some myths, if applied to real life, could have alarming consequences.

Here are a few of the most common medical misconceptions.

Myth: doctors do everything in a hospital

Television routinely shows doctors performing every task from taking X-rays to analysing laboratory samples, to putting patients to sleep and dispensing medicines. In reality, hospitals have different staff - such as radiologists, lab technicians, anaesthetists and pharmacists - who do these things. And in contrast to what you see on television, nurses not doctors perform the overwhelming majority of bedside patient care. Plus, real-world doctors are rarely experts in every single type of surgery.

'In the modern hospital, the division of labour is very well defined, and there is typically a specialist for every aspect of care,' says Schiffman. 'Part of the reason for this has to do with reducing errors and legal liability. For example, although most internists and surgeons are capable of interpreting imaging studies like X-rays, radiologists will still provide a reading so that it is less likely something is missed.'

Myth: doctors can usually diagnose patients straight away

House is offender No1, given its focus on the diagnostic process, and the need to inject what is often a very dull and drawn-out process with a bit of dramatic pep.

'On TV, doctors often arrive at a diagnosis by doing a quick examination and ordering a few tests. This sometimes happens in real life. But more often, it takes some work to figure out what is going on,' says Dr Jason Schiffman of the medical school at the University of California, Los Angeles. 'Doctors create what's called a 'differential diagnosis', which is a list of all of the diagnoses that are consistent with the available information about the patient. Then tests are ordered to rule out diagnoses. The unrealistic aspect of House is that patients typically have very rare conditions.'

Myth: a person having a fit should be held down and something put in their mouth

'It is not advisable practice to either restrain a person having a seizure or insert anything in their mouth,' says Sarah Walker from Matilda . It's better to move objects away to prevent self-injury, put something like a sweater or blanket under the victim's head, and gently roll them on their side. 'Do not restrict limb movement; instead, hold the body loosely and gently in the side-lying position,' she says. Any object in the mouth may cause choking.

Myth: CPR always revives patients

Cardiopulmonary resuscitation regularly brings cardiac patients back to life on television. 'CPR does not restart the heart,' says Schiffman. 'The purpose of CPR is to keep oxygenated blood flowing to the brain to prevent brain damage.'

Walker adds the chances of reviving someone who's suffered a cardiac arrest are low - though much higher if CPR is initiated immediately.

Myth: you can defibrillate someone who's flatlining

As mentioned, you can't. 'Often on TV, a patient will be defibrillated after their heart has stopped beating, and this is unrealistic,' says Dr Jason Schiffman of the medical school at the University of California, Los Angeles. 'For defibrillation to work, the heart must still be beating, and beating in a certain pattern called a shockable rhythm.'

Specifically, says Sarah Walker, certified first aid instructor at Matilda International Hospital, 'defibrillation can only be used in cases of ventricular fibrillation or pulseless ventricular tachycardia - heart rhythms that are erratic, fast and unco-ordinated'.

Myth: doctors are omniscient

Watch enough television and you'll get the idea that the right doctor can cure anything, and there's a medicine to treat every condition. 'This is pretty unrealistic,' says Schiffman. 'Modern medicine is capable of amazing things, but there are often cases where the doctors aren't able to figure out what the problem is while the patient is in the hospital and just end up treating their symptoms. Similarly, doctors are human beings, and even the best are capable of making mistakes.'

Myth: hospitals are hotbeds of romantic and sexual intrigue

Exhibit A here is, without a doubt, Grey's Anatomy, a series in which the fictional Seattle Grace Mercy West Hospital spends more time as a place of romantic and sexual intrigue than it does treating people. In most places, there's no specific prohibition against relationships between medical staff. Romantic relationships between doctor and patient, though? Really not good for the medico's career.