Here are the top five myths about being a doctor perpetuated by television medical dramas:
Number 5: Surgeons scrub their hands with their masks down.
The operating room is supposed to be a sterile enclosure because exposing people’s insides to the environment renders them highly susceptible to infection. The pathogens can come from any number of sources including the circulating air, the moisture within the surgeon’s exhalations, the surgical team’s skin, or the instruments used to perform the operation. While it is impossible to eliminate all germs from contaminating the wound, operating room personnel take every reasonable precaution to prevent infection. Included in these practices are wearing a mask and washing our hands.
Every time I see two actors playing doctors standing at the sink, preparing for what is certain to be a dramatic and life-saving breakthrough in the annals surgery, they are scrubbing away, chatting about who is sleeping with whom, and doing so with their masks hanging uselessly around their necks. Now, consider if you will their next move. Into the operating theater they go where, lo and behold, they place their masks over their mouths with the dramatic grace of their profession, hence contaminating the hands they just spent an entire scene sterilizing. I realize that this happens on T.V. so that the audience can understand the dialogue and because the network isn’t paying George Clooney and Patrick Dempsey hundreds of thousands of dollars per episode to hide their faces; but it still irritates me.
Number 4: When running a code in the I.C.U., no nurses are present.
A typical such scene on television depicts the handsome trauma surgeon patiently, yet with conviction and a touch of masculine dominance, teaching the bodacious twenty-something intern how to intubate a dying patient, while the grizzled veteran chief-of-staff administers epinephrine and other cool sounding drugs into the patient’s arm through an intravenous line that he placed himself in about one second.
This is so far from reality I don’t even know where to begin. First of all, with the exception of anesthesiologists in the O.R., doctors almost never administer medication; nurses do. I don’t have access to drugs; not even benign ones like lidocaine, which I use to numb people’s skin before stitching them up in the E.R., or over-the-counter ones like aspirin. I must ask a nurse to unlock a door to a special room and use a secret code to unlock a medicine cabinet, and then tell him or her which patient I need the lidocaine for so it can be added to the bill.
Additionally, doctors don’t hang around the I.C.U. waiting for a patient’s heart to stop beating, nurses do. Certainly, as soon as something serious like that occurs, the appropriate doctor is called, but the nurses don’t just sit there in helpless anticipation of the almighty doctor’s arrival, they start saving the patient’s life. When I was an intern working in the I.C.U., I never once saved anyone’s life. I nodded and verbally approved the orders that the nurses told me to give, while staying out of the way of the experienced R.N.s who were busy doing the saving. Maybe I did chest compressions. Yet, in every I.C.U. code on House or Grey’s Anatomy, there are like five physicians running the code without a nurse in sight. Ridiculous.
Number 3: Residents want more patients.
The residents on these shows are always depicted in fierce competition, desperately vying for the next E.R. patient or surgical case. Please. Residents are so overworked and inundated with patients, the exact opposite is true. Every time my pager went off as the consulting intern or resident, signaling that I was getting a new patient, I died a little.
When I was a first-year resident serving my penance on the trauma surgery service, at any given time, my counterpart and I were responsible for the care of up to 90 patients. These were not patients coming into the clinic for a checkup or recovering from an uncomplicated appendectomy. I’m talking about 90 of the most fragile and damaged people in the hospital. These were victims of motor vehicle accidents, falls, gunshot and stab wounds, and just about any other trauma you can imagine (and some you surely cannot), with ruptured organs, head injuries, and blood filling their lungs. In addition to managing this battalion of patients – being at a level one trauma center – every half hour or so the trauma pager would shriek and we would have to drop what we were doing, scurry to the E.R., get gowned up, and grab our trauma scissors so we could rapidly disrobe the next victim and assess him for various injuries. We were so efficient that by the time we were done introducing ourselves, we were already probing for hidden injuries. The conversation would go something like:
“I’mDrMcDonaldWhathappened?TellmeifthishurtsJustholdonwearegoingtorollyou. Squeezedownandtellmeifyoucanfeelmetouchingyou…Sorry.” The “sorry” I usually threw in as a certainly inadequate apology for the uncomfortable, not really consented for, and always shocking rectal exam that preceded the order to squeeze down – an important test to check for internal bleeding and a spinal cord injury. Then we’d stitch up or splint any obvious injuries, check the CT scans, and hope the patient needed surgery right away because if so, it meant we could go back to what we were doing and the third-year resident would get called to prep the patient for the O.R., meaning that he or she would have to write the admission orders and do the rest of the paperwork instead of us. Sound callous and self-centered? To an exhausted intern in survival mode, passing off any of the work is considered a huge victory.
Number 2: A doctor only has one patient at a time.
This one drives me crazier than any of the others. Dr. House and his team of physicians are geniuses, right? Give me an entire episode to manage only one patient and I’ll cure cancer and still have time for romance in the storage closet. Doctors perpetually juggle multiple patients, often in multiple locations. Unlike on television, once a surgeon operates on someone, he or she remains a patient until healed. This can be a couple of days or a couple of years depending upon the disease, type of surgery, and the individual. Primary care doctors never shake anyone.
When I am in the O.R., my phone rings on a regular basis because nurses, therapists, mothers-in-law, receptionists, coders, schedulers, other physicians, and the goddamn milkman require my focus to, at that very moment, be on someone other than the guy I am cutting open. And heaven forbid a surgeon display the slightest disapproval at being interrupted while clamping an aorta, removing a tumor, or repairing a tiny nerve under a microscope. Any tone other than welcoming and unmitigated enthusiasm will invariably be interpreted as “rude” or “intimidating,” landing that surgeon in an administrator’s office for a lecture on “disruptive physician behavior.” Disruptive? I’m the one who was disrupted!
And the Number 1 stereotypical television medical drama plotline that has no basis in reality is: doctors and nurses spend a considerable amount of their shift gossiping, arguing, and making out in storage closets.
Of course, maybe this was just my experience, but I never once engaged in a romantic interlude in a storage closet despite this being an almost ubiquitous part of a T.V. doctor’s workday. First of all, we are too busy to stop and get busy. Also, the dim, romantic lighting and tight spaces depicted on ER and other shows are nothing like a real storage closet. Think about it, their purpose is to provide hospital staff convenient access to instruments, blankets, bandages, bed pans, and a thousand other items required for patient care. To meet these requirements, the rooms must be well lit and spacious, and anyone and everyone involved in patient care needs to go there on a regular basis. There is a constant stream of traffic in and out, day and night, precluding any opportunity for privacy.
Additionally, given the current legal environment, the Human Resources Department – concerned as they must be about the threat of sexual harassment lawsuits – frowns upon such crossing of professional boundaries. Still, I am young and maybe, just maybe, I will someday discover that this one isn’t a myth after all. Good thing my wife works at the hospital with me.