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As seen on TV: Real-life health care workers say medical shows aren't telling the real story

By Julie Kirkwood , Staff Writer

The recent plotline on ABC's "Grey's Anatomy" is so far-fetched that registered nurse Cheryl Edwards couldn't believe it.

"(The main character) Meredith has her near-death (drowning) experience and was intubated and all of a sudden they put the breath of life into her," said Edwards, who used to work in the emergency department and now is program director of patient access at Caritas Holy Family Hospital in Methuen. "Next thing you know, they take the tubes out of her and she's talking. A drowning victim would be on the ventilator for days. It just doesn't happen that way."

Heather Moore, a nursing student on an internship at Holy Family, said Meredith wouldn't even have survived to be brought back to life.

"They were coding her for an hour and a half and all of a sudden she has a sustainable heart rhythm," Moore said.

"She would have been dead," said Cathy Simoes, nurse manager leader for the hospital's neuro/ortho service line.

The show is so far from reality it drives the nurses nuts, but they watch it anyway, just like the rest of America.

"Grey's Anatomy" is one of the most-watched television programs every week, drawing an audience of more than 20 million viewers. The show, in its third season, took home two Screen Actors Guild awards. It is just one of several successful fictional medical shows on the air, along with "House," "ER," "Scrubs" and "Nip/Tuck."

Entertaining as these shows may be, the nurses gladly shared some of the things that irk them most as they watch.

We invited local doctors to do the same, but got no takers. Andrew Holtz, author of "The Medical Science of House, M.D.," said that in reporting his book, he found a lot of doctors didn't watch television and were clueless about the show "House," even though at the time it was in its second season and was among the top 10 most-watched shows on TV.

Here are the inaccuracies in medical shows that the nurses said were the most annoying:

* Patient safety

"It's the safety stuff that bothered me, watching 'Grey's Anatomy,'" said Sue Uzdavinis, a nurse manager in the hospital's cardiovascular service line. "I was watching it last week, and they had brought back that physician. She had drowned. It was crazy."

What bothered her more than the unrealistic rescue, though, was how the fictional doctors apparently couldn't be bothered to monitor their patient adequately or to make sure she was secure in her bed.

"They left her alone," Uzdavinis said, "and the side rails were down."

r No nurses

Moore, who worked in an emergency department before going back to school, said she watches most of the current batch of popular medical shows.

"'Grey's Anatomy' depicts residents as being at the bedside and they really don't give any credit to the nurses," Moore said. "They're kind of like yelling orders to the nurses, and the nurses are subservient."

In real life, nurses tend to be supervised by nurses, not doctors. And while doctors make the high-level decisions regarding a patient's care, nurses have a lot of independence and responsibility for treating the patient, as well.

"ER" tends to be a little better in its depiction of nurses, Moore said, with some fairly independent nurse characters. Her problem with that show is the wardrobe.

"They've got a little bit of cleavage," she said. And the characters also always look as if they just walked out of a salon. "When you're in the middle of a trauma, your hair is up, you hope."

* No discipline

On "House," the main character is a doctor who is addicted to prescription painkillers. He's also sarcastic and rude to his patients. In real life, either of those things would be grounds for disciplinary action.

"I had to stop watching it," Moore said. "I really hope that people don't think this is how it is (in real hospitals)."

It's not that real-life doctors aren't occasionally rude, but in real life, there are consequences, Edwards said.

"If it was witnessed by a nurse, a nurse would write it up," she said. "It wouldn't be tolerated."

Myth vs. fact

Medical dramas on television certainly distort the truth, but not in the way you might expect.

The medical science is often based on reality, at least loosely. On the Fox show "House," for example, many of the bizarre cases diagnosed by Dr. House are based on real case studies in medical literature, said Andrew Holtz, author of "The Medical Science of House, M.D."

What's wildly inaccurate is the depiction of the health care system, Holtz said. Here are some examples.

Myth: Doctors spend hours or even days on one interesting patient.

Reality: Nowhere but in the fantasy world of Hollywood does a team of top-notch doctors have all the time in the world to spend on one case, Holtz said.

On "House," the fictional Dr. Gregory House leads a team of three expert diagnosticians. In each episode, they take on a strange case that has been referred to them and the whole team puts all its efforts into figuring out what's wrong with that one patient.

In real life, there is no such team of crack diagnosticians, Holtz said, nor even groups of ordinary doctors with that kind of time on their hands.

"There's nothing like that in the real world," he said. "That's pure fantasy."

The closest you get is when a regular doctor asks a specialist - perhaps a neurologist or an infectious disease doctor - to look over a patient's chart and suggest some ideas, Holtz said. The specialist doesn't take over the case and, in many cases, the specialist doesn't know what's wrong, either.

Myth: Doctors do everything.

Reality: Nurses are responsible for much of the care patients receive, and technologists and nurse aides do a lot of the work, too.

"Physicians (on television) are constantly doing the work that nurses do in real life," said Sandy Summers, executive director of the Center for Nursing Advocacy in Washington. "The majority of people who work in hospitals are nurses, not physicians."

Summers' organization is so infuriated by this that they've dissected episodes of "ER," "Scrubs," "Grey's Anatomy" and "House" to point out all the nursing work that television portrays as doctors' work.

For starters, nurses are the ones who typically use defibrillators to save a patient's life, not doctors, Summers said.

Nurses are also the ones who spend hours at the bedside getting to know the patient and the family, and investigating the factors that brought the patient to the hospital.

On "Grey's Anatomy," it is almost always the surgical interns who are portrayed as forming the relationships with patients and fighting higher-ranking doctors to get the right care. In real life, Summers said, that's what nurses do.

Television doctors also have a habit of running machinery, such as intra-aortic balloon pumps and dialysis machines, that in real life is the expertise of nurses.

"Nurses are trained for a very long time to be able to use those safely and effectively," Summers said. "We'd never let a physician near one."

In addition to nursing work, TV doctors also do the work of many other health care professionals. On "Grey's Anatomy," the young doctors put their own patients into an MRI machine. On "House," the doctors slave away in the laboratory, testing patient samples for viruses.

"(On television) there are no radiologists, no lab techs, basically no nurses," said Holtz. "(The doctors) do it all themselves. There is no sense of the complexity and the teamwork that's involved in real-world health care."

In real life, a doctor is just one of 15 to 20 health care professionals working the typical intensive-care patient, Holtz said.

"I don't know why they do that," Summers said, "unless they're under the delusion that only the work of the physicians matters."

Myth: Behind any storage room closet door there's probably a pair of doctors having a romantic moment.

Reality: Doctors would be punished for inappropriate behavior at work.

"Certainly these days a hospital is like any other workplace," Holtz said. "You've got a lot of rules about what sorts of relationships are appropriate and which aren't among co-workers."

That said, both Holtz and Summers said there surely are medical couples who meet on the job.

"I think they do have it right that in a hospital you do tend to work long hours and, especially younger physicians, they don't have much of a life outside of the hospitals," Holtz said. "It wouldn't be shocking for them to have relationships."

"Anywhere there's people there will be dating and sex," Summers said. "I think there just isn't so much going on in linen closets as television portrays."

The nurses at Caritas Holy Family Hospital in Methuen greeted the question, at first, with a humorous silence. The idea of medical professionals having relationships wasn't so far fetched, they agreed, but it's not a soap opera like on television.

Unlike what you see on TV, most health care professionals spend the majority of their time at work focused on patients, not on their personal lives, said nurse Cheryl Edwards.

"I don't think people are in supply closets," said Heather Moore, a nurse and student intern at the hospital. "People are certainly too busy to do that."

Myth: Plastic surgeons are superficial and unethical.

Reality: Though the FX series "Nip/Tuck" may make it appear that way, many plastic surgeons do have ethics - although some do admit "Nip/Tuck" is a guilty pleasure because the show is so outrageous, and the doctors are absurdly unethical.

On the show, two plastic surgeons have affairs with their patients and operate on patients who aren't good candidates in exchange for suitcases of cash.

The American Society of Plastic Surgeons objected to the show even before the first episode aired.

In a statement, the society said the show "in no way represents the way in which qualified, professional and ethical plastic surgeons manage their practices or care for their patients. ... The society takes great offense at the spurious depiction of its medical specialty, which is dedicated to restoring and reshaping the human body. While the FX 'drama' of the South Florida plastic surgery center is sensational, bordering on the absurd, it certainly is not realistic."

Myth: Most patients fully recover after a medical emergency.

Reality: Unfortunately it's much more common for a person to be left with a chronic and serious disability, even if his or her life was miraculously saved.

"In the real world of medical care, it rarely ends up happily ever after," Holtz said. "People don't come back perfect."

Real patients are generally older than the typical 19- to 39-year-old whose life is saved on television. They also have much more mundane illnesses, such as diabetes and heart failure, that are easy to diagnose but don't have miraculous cures.

"The mythology that there are some great shamans of medicine out there who can produce miracles I think is a potentially dangerous myth," Holtz said. "It gives that overinflated sense of what medicine can do."

Shows like "House" in particular reinforce the myth that a person can be cured of anything, if only they find the right doctor.

"That's just not true," Holtz said. "When you do get sick, it's not much of a mystery. It's pretty obvious what's going on and there are great limitations on what medicine can do."

Myth: Television viewers know the shows they're watching are fiction, so it doesn't matter if they're accurate.

Reality: Fictional medical shows do change public behavior.

Studies have shown that public awareness of such medical issues as emergency contraception, cervical cancer and the human papilloma virus spiked after these topics were woven into a television show plot. Public health researchers have also looked at the negative impact of the way organ donation is often portrayed and how the distortion of reality may discourage people from donating.

Summers, of the Center for Nursing Advocacy, said the way these shows distort the work of doctors and nurses can have serious consequences in real life, as well.

When people see doctors doing all the important work, nurses in the real world don't get the respect and public support they deserve, Summers said.

For example, she recently heard a news story about bird flu and concern over having enough doctors to deal with it.

"We're not really going to need that many doctors in a flu pandemic," Summers said. "It's going to take about three seconds to diagnose somebody with the flu. It's going to take weeks to help them recover. We're not going to be ready because we don't have enough nurses."

Yet when Summers and her colleagues have approached television networks and offered to consult on scripts and suggest dramatic plotlines involving more realistic nurses, they get little response.

"It's hard to get people to listen," she said. "They know very well that nurses don't do anything, and when you try to tell them that nursing work is very valuable they can't listen. ... They just can't believe it. Even nurses' own family members don't believe them. These same family members watch TV and they know what's what. They see this on 'ER' and 'Grey's Anatomy.' Only physicians matter."

In Holtz's opinion, the consequence of shows like "House" is that people get the impression that medicine is more powerful than it actually is.

The subtle message of these shows is that more medicine is better than less, new drugs are better than old, and experimental drugs offer the best hope. In fact, less medicine is often better than more, new drugs like Vioxx are often worse than old drugs and experimental drugs may or may not work, say the professionals.

"I really think there is a deep power to some of these stories," Holtz said, "and by reinforcing myths that people have about medicine and health care, the shows can interfere with how society deals with issues of health care that are facing us ... Even when people understand that it's fiction, I think it plays on a subconscious level to reinforce the beliefs about what health threats face us and what medicine is capable of doing to face those health threats."

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