By Lochy Cupit
Love them or hate them, medical dramas (and sitcoms) are something of a TV institution. Whether it's Grey's Anatomy, House, The Good Doctor, Scrubs, or even old episodes of All Saints, we've all seen scenes from a hospital played out on TV. But how realistic are some of those scenes? If you go to a hospital, will you see Grey's Anatomy played out with different characters, or is the real thing very different?
We talked to a range of doctors, nurses and other medical professionals about hospitals on TV, and how they're different from the real thing. And we certainly got some strong opinions. So, where does the TV get things wrong?
In the ED
Lots of TV drama happens as the patient is coming into the hospital - either in the ambulance, the ED, or as an urgent, heated conversation over a patient on a rolling bed being moved around the hospital. So what are some of the common mistakes from those critical few minutes arriving at the hospital?
You can't zap someone without a heartbeat
This one gets under the skin of a lot of medical professionals. The TV cliché is pretty well known - the heart-rate monitor stops beeping and makes an annoying flat tone, and everyone gets frantic. Someone grabs out the defibrillator paddles, yells "clear" and then zaps the patient, restarting the heart and saving their life.
Except, it doesn't work like that. Because if someone's heart has stopped, a defibrillator can't help them much.
See, part of the problem is that everyone thinks of a defibrillator like jump-starting a car - giving someone an electrical jolt to restart their motor. But in reality, a defibrillator doesn't start the heart. It stops it. If the heart is behaving erratically, the Defibrillator's job is to stop the heart for a moment and then allow it to restart itself naturally. So it's less like a jump-start and more like turning the computer off and on.
Fortunately, as anyone who's done recent first aid training can probably tell you, you don't generally need to worry. Modern automated defibrillators (usually called AEDs) are designed to assess the patient and decide whether to administer the jolt themselves if required.
It is possible to restart a stopped heart with the right drugs and medical expertise. But let's face it - giving someone an injection and then doing CPR is far less interesting television than someone getting zapped.
Patients don't flatline like that
While we're on the topic, that iconic flat line on the monitor doesn't really happen - that generally means someone's accidentally yanked out a cable. "Stopped" hearts still have fluctuations on the monitor for some time.
That dose would kill them!
It's probably best to never use one of those TV hospital dramas as a guideline for taking medications. Apparently, the writers don't always make a point of checking their dosages, and TV doctors and nurses often give people dangerous or even lethal doses of some medications.
Not everything goes quickly
On TV, stuff at a hospital happens at a breakneck pace. Unless there's a plot point about the ED being overcrowded, there's always a lot of hustle as people come into the ED, are dosed with vital medicines, and are promptly sent off to surgery.
In reality, with the exception of particularly urgent cases, things are often a lot slower. Anyone who's been to an ED recently can probably tell you that it's not always a quick process. But even when you are getting help, many things - like scans, tests, and surgery - don't happen right away. Those machines and experts are quite often in use elsewhere, and you may need to wait a while. Likewise, most medicines take a while to work - so don't expect instant relief moments after your injection.
Things aren't much better in the operating theatre. Many doctors told us they have trouble watching medical shows because the actors are doing things they'd personally get fired for. So how is the real O.R. different to the TV version?
Operating theatres are very well-lit
For starters, one issue that bugs a lot of doctors is the dramatically gloomy night-time operating room with just a handful of lights directly over the patient. It's a good way to make the scene more moody and dramatic. But in reality, O.R.s are absurdly well lit - surgeons do incredibly intricate work with lives in the balance, so nobody wants them struggling to see what they're doing.
Staying sterile is a BIG deal!
Surgeons do not muck about when it comes to staying sterile for an operation. Masks go on first, and once you're scrubbed up, there's no answering phones, adjusting masks, or even shifting your glasses. You don't touch anything that's not sterilised!
Surgeons don't run the whole show
On TV, the operating theatre is generally presented with one heroic doctor in charge - doing the operation, keeping an eye on the monitors, and making all the decisions. Everyone else is there to either advise (in the case of other named doctors), or to hand them tools, mop their brow, and generally just watch in awe. In reality, there's much more of a team effort going on.
The surgeon is generally focussing on the task at hand and doing the operation - which is probably a good thing, given lives are on the line. And although they don't often get much air-time on TV, in a real O.R. there's an Anaesthetist there throughout the whole operation. They'll generally be the one watching the monitors and making sure you stay in that halfway state where you're still alive but deeply unconscious. They'll also be the one who notices if the patient starts to "crash" and decides what steps to take - and what drugs you need administered.
Around the hospital
So what about the stuff that's not in the ED or the operating theatre - the everyday parts of hospital life? Is that more realistic on TV, or are nurses still rolling their eyes at the television in those parts? Where does TV get that stuff wrong?
The equipment isn't hooked up right
A lot of nurses had opinions about this one! It seems that many medical dramas have access to either medical equipment or pretty good replicas of it. But unfortunately, what they don't seem to have is the people who know how to hook it all up. So it's not unusual to see unnecessary equipment, hoses connected the wrong way, wrong machines, and an abundance of plugs in all the wrong sockets.
Apparently, a common mistake is to use a urinary catheter as an oxygen cannula. Which, if you're not a doctor or nurse, doesn't sound too bad - until someone explains that it means using a tube for weeing through as a breathing tube.
You don't grill the intern in front of the patient
Although it's a pretty standard feature of medical dramas, apparently it's frowned upon to drill a young intern with questions while you're standing at the patient's bedside. Apart from being potentially humiliating for the intern, it doesn't exactly inspire confidence in the patient. We can't say it never happens, but it's certainly strongly discouraged in many modern hospitals.
SOOOOOO much paperwork!
One thing that very rarely gets highlighted in medical shows is the sheer mountain of admin involved. The TV focuses on the exciting stuff like bedside interactions, diagnosis, surgery and emergency first aid, but we rarely see the paperwork going on behind the scenes, which in many cases can add up to more than half of a doctor's workload. So much so that many doctors starting out in the industry feel like they're more administrators than doctors.
So next time you're in a hospital and you feel like things aren't quite how you'd expect them to be, it's probably worth assuming that it's the hospital that's got it right - not the TV show you've been watching!