How the public is misinformed about the outcomes of CPR

A survey of 1000 volunteer adults found 71% regularly watched medical television dramas, but only 12% said the shows “were a reliable source of health information.”

The participants were given some brief vignettes describing scenarios where CPR was administered—a 54-year-old who suffered a heart attack at home and received CPR by paramedics, an 80-year-old with a postoperative cardiac arrest in the hospital after surgery, and a post-traumatic arrest in an 8-year-old.

Those surveyed estimated CPR success rates at 57% to 72% and rates of long-term survival with neurologic recovery at 53% to 64%.

"The Resident"

A new medical drama with the same old characters.

The show opened with the chief of surgery in the middle of a rather bloody open, not laparoscopic, appendectomy.

The circulating nurse started taking selfies with her phone; the anesthesiologist was distracted; the patient started moving; blood spurted all over the surgeon.

According to a nurse, the patient lost 2 liters of blood in 20 seconds.

What artery, other than the aorta, could he possibly have cut that would bleed so much? The chief of surgery just stood there. I yelled at the TV, “Put pressure on it for God’s sake.“

Finally, they started CPR and the surgeon seemed to be packing the wound.

Review of TV show "The Good Doctor"

Just when you thought there could not be another bad medical show, ABC TV presents “The Good Doctor.” It’s about an autistic young man going to California to become a surgical resident.

Just after he lands at the airport in San Jose, an overhead sign breaks and causes the unluckiest 8-year-old boy on earth to suffer three life-threatening injuries. The Good Doctor gives a bystander, who sort of sounds like a doctor but is not too confident, an anatomy lesson about where to hold pressure on a bleeding internal jugular vein. He then notices bulging of the left arm veins and diagnoses a tension pneumothorax.

He looks for a knife “with a seven-inch blade” at a TSA checkpoint, grabs a lesser knife, makes a chest tube and underwater seal from various supplies he finds in the airport, dumps half a bottle of whiskey on the kid’s chest, and inserts the makeshift tube. All of this happens on the floor of the airport concourse.

Of course the kid wakes up and starts breathing normally.

Meanwhile the board of directors of the hospital is debating the hiring of an autistic surgical resident. In this hospital, its president, who met The Good Doctor when he was 14, hires the residents, and the chief of surgery has no input. [Matching? What matching?]

Yet another new medical TV drama

“'The Resident’ follows an idealistic young doctor who begins his first day under the supervision of a tough, brilliant senior resident who pulls the curtain back on all of the good and evil in modern day medicine.” So says the article announcing Fox’s pilot for a new medical TV show.

As opposed to all the other medical dramas, this one features an idealistic young doctor and a tough, brilliant supervisor. How original.

I tweeted the show's premise and got several humorous replies prompting me to write this post.

There is no such thing as an original medical show. Original would be a resident sitting in front of a computer 75 percent of the time and then leaving the hospital in the middle of a great case because of work hour restrictions. While at home he plays video games for five straight hours.

Someone wondered if “The Resident” would find romance—possibly in a convenient storage closet. I wouldn’t know about that because I trained at a Catholic hospital.

Another asked if there would be a tough staff with soft hearts, a hospital administrator who put profit before patients, a second-generation physician who cracks under pressure, and a renegade doctor who breaks all the rules but saves the day.

What about a show with overworked, stressed, but oh-so-average attending physicians and idealistic, but basically inept residents?

I’d like to pitch an idea. It’s called “The Administrator” and follows an idealistic young deputy assistant junior vice president who begins his first day under the supervision of a tough, brilliant hospital CEO who pulls the curtain back on all of the evil and none of the good in modern day medicine.

Think of all the dramatic meetings involving committees, ad hoc committees, lean, six sigma, budgets, root cause analyses, public relations, whether to buy a third robot, and so much more. True to life, the administrators never leave the C-suite*.

*C-suite (def): A widely-used slang term collectively referring to a corporation's most important senior executives. C-Suite gets its name because top senior executives' titles tend to start with the letter C, for chief, as in chief executive officer, chief operating officer and chief information officer. [From Investopedia]

Thanks to the Twitter folks who contributed: @smootholdfart, @DrDes1970, @geekpharm, @JessicaDeMost, @DrMikeSimpson, @jsekharan, @mjaeckel

"Code Black" is still on TV. Did it get any better?

Despite some recent ratings problems, the TV show "Code Black" somehow remains on the air. It has lost viewers after five of the last seven episodes including a whopping 23.8% drop in the all-important 18-49 year-old demographic after the 2/17/16 installment.

It's still viable because of fans like Sharon who said on the ratings website: "The best medical show on. I have been in the medical profession 30 years and it depicts the most true to life situations of any of the medical shows I have watched. Love the show." Sharon must work on the psych floor.

I decided to take another look at it. Having seen the 2/17/16 episode, my opinion hasn't changed. Here's why.

Code Black Part II: "It gets worse"

Last week, I reviewed the premier of the new medical television series "Code Black" and pointed out several flawed or impossible scenarios. I didn't think I'd watch another episode.

But I was alerted to a rather shocking error on last week's installment. I had to see it for myself.

On this typically chaotic day in the emergency department, a young woman was brought in after a car crash which occurred while she was in her way to the ED because of abdominal pain. A CT scan of her abdomen and pelvis was negative, but her serum lactate level was elevated. They then decided to examine her abdomen and noted tenderness. A bedside ultrasound done in the ED revealed a left ovarian torsion (twisting of the blood supply to the ovary which if not rapidly corrected, could cause irreversible damage). The patient had already had her right ovary removed. Further heightening the drama was that her husband died of lymphoma but had banked his sperm, and the patient wanted to have his baby.

She needed immediate surgery, but all of the hospital's operating rooms were busy. As the window of opportunity to correct the problem was closing, an operating room opened up. But alas, there was not a single gynecologist or surgeon available to do the case. According to the back story about Dr. Neil Hudson, he's a fully trained surgeon who decided to work in emergency medicine. One of the new ED residents begged Dr. Hudson to do the case, and he resisted for a while until it was almost too late.

“Code Black” should be pronounced dead

A new television series called “Code Black” debuted last night on CBS. The show’s name supposedly means the emergency department has too many patients and not enough staff. In my over 40 years in medicine, I’ve seen many busy, understaffed EDs but never heard anyone call it a "Code Black."

There is the usual array of standard medical characters—the inexperienced new residents on their first day at work, the savvy nurses, and the cocky, overconfident attendings. This one has a few twists. The world-weary head nurse is a Hispanic man, and the headstrong know-it-all attending is a woman, Dr. Leanne Rorish. She has early conflict with the handsome, more cautious Dr. Neal Hudson, but I see romance in the future should this show manage to stay on the air.

It takes 5 people to push an empty gurney at Angels Memorial

The show started off with a gunshot wound to the neck that the docs had to retrieve from a car which had been abandoned in the hospital parking lot. Although no one had been putting pressure on the damaged carotid artery for an undetermined period of time and blood was visibly spurting out of the wound, the patient pulled through the resuscitation thanks to Dr. Rorish who replaced all his blood with cold IV fluid. She spiced up the resuscitation by asking the new residents questions about what she was doing.

Oh, no. Not another medical TV drama

A show called "The Night Shift" has surfaced on NBC. The pilot is available for viewing on line. I'll post the link in a minute.

But first, let me warn you. Here's what happened in the first 13 minutes of the show.

The hero doctor, named TC, awakens in jail after a bad night, and while riding his motorcycle to work he comes across a roadside accident.

A man impaled by a tree branch is in shock. Paramedics are in attendance, but don't know what to do.

The doctor suggests removing the branch, which he promptly does. Blood pours out of the wound.

ED Doc clamps renal artery at accident scene

The medic says, "He's gonna bleed out."

TC says, "No, he's not. His renal artery is cut. I'm gonna clamp it." How he knows it's the renal artery I couldn't tell you. He places a clamp through the 3" long impalement wound and the bloody field.

Then he makes an incision at the umbilicus and puts in a peritoneal dialysis catheter, which fortunately the ambulance crew has handy. They also have an empty IV bag, which is used to collect the blood for auto-transfusion.

Did I tell you that this is all taking place on the ground by the highway?

On to the ED.

A two-week-old baby arrives in presumptive renal failure. Another ED doc subdues a large violent man with a "sleeper hold" reminiscent of Worldwide Wrestling. A man positioned on his hands and knees is having a scrotal laceration sutured.

Of course, there's a blossoming love affair between TC and a beautiful female colleague who both pretend they aren't hot for each other.

A new intern was juggling some things he picked out of the "lost and found" box to try to impress a woman doctor when he found out the box actually contained objects removed from people's rectums.

The hospital is having financial trouble. At a meeting, our hero insults a realistically smarmy administrator who told him a patient could have been transferred by pointing out that he wasn't a doctor.

While on break, the docs pass the time by playing basketball just outside the ED where a number of hospital personnel seem to be socializing. Perhaps this could be why the hospital is losing money.

TC puts the two-week-old baby on hemodialysis without consulting pediatrics or nephrology, mentioning how vascular access was obtained, or speaking to the parents, who apparently were not present.

That's about all I could take.

If after all that, you really must have the link, it is here.

The Midwife Delivers

The other day I reviewed a new medical reality television show called "Scrubbing In." I didn't like it very much.

A loyal reader, robertl39, commented that an antidote to "Scrubbing In" might be a show called "Call the Midwife."

It's about a midwife in the East End section of London in the 1950s. Fresh out of training, she joins a group of religious and lay midwives providing care for the indigent population.

The National Health Service had just been established, which led to improvements in the care of pregnant women.

I have watched the first two episodes. The show is everything that most medical TV shows are not. The story lines are compelling and tell a lot about the social climate of postwar England. The characters are interesting, engaging, and complex. You will laugh, and you will cry.

The midwives are heroic.

I can't say enough good things about this series. It's available online, and the first season is currently being rerun on PBS.

Since the episodes are in chronological order, it's best to start with Season 1, Episode 1.

Enjoy.

Review: "Scrubbing In," a new medical reality TV show

I don't watch much television except for some sports. But I feel it is my duty to comment on medical TV shows, which I generally hate. A few months ago, I reviewed two shows that, as I predicted, didn't last long. Their names were "Monday Mornings" and "Do No Harm."

A third show "Married to Medicine" is rumored to be coming back for a second season despite a storm of protests over the way it depicts black physicians and their spouses. You can read all of these reviews by entering "Medical TV shows" in the search field in my blog's upper right.

I should have known better, but something drove me to look at a new reality show on MTV called "Scrubbing In," which debuted last week.

A warning sign was that based upon only the show's trailer, both the American Nurses Association and the Canadian Nurses Association wrote to the network asking that the show be canceled because it depicts nurses in demeaning and unflattering ways.

I will spare you the details of the plot, such as it was. But here are a few highlights.

A group of travel nurses, mostly from Pittsburgh, to go to work at a hospital (which probably regrets its participation) in Orange County, California.

The cast features several extremely unlikable young women and a few equally unlikeable men. All are profane, unprofessional, and dishonor the nursing profession.

Most if not all of the women have had breast implant surgery and are not bashful about revealing that fact verbally and sartorially.

Two nurses, one male and one female, had to be removed from the orientation session at the hospital. Their California nursing licenses were held up because they both had prior arrests for DUI.

It's not clear what the show's title "Scrubbing In" has to do with anything, since all of the nurses who had licenses were working in the emergency department, not the operating room.

During the first 30 minutes of the show's premiere, which was all I could take, about 3 minutes took place in the hospital. The rest of the time was devoted to watching the ladies walk around in towels, swear, shower together (behind a curtain), and go on a "booze cruise" so they could all get acquainted.

There were some memorable lines however.

While taking off his shirt on the boat, one of the male nurses said, "Sun's out, guns out."

One of the nurses, discussing her prospects for the move to Orange County, said, "Nurses f--- doctors, and doctors f--- nurses."

And while in a car, one nurse says to the others, "Did you bring your vibrators?"

Not only is "Scrubbing In" the worst medical show I've ever seen, it might also be the worst television show in history.

It should be scrubbed.

Medical television hits a new low

Tipped off by a reader, I watched “Married to Medicine,” a reality program about doctors' wives and female doctors in Atlanta, which premiered on the cable network Bravo last night.

What a colossal embarrassment to the medical profession, women, black people, television and humanity.

In the beginning, some “highlights” were shown, which featured a pushing match between two of the characters. I should have stopped right there, but regrettably, I kept watching.

I hope the cast members were paid well because they could not have looked worse had they been on Jerry Springer.

What could they have been thinking?

They were portrayed as shallow, materialistic caricatures. And their husbands, the doctors, looked like fools. Two of them were emergency medicine physicians whose practices probably won't suffer. But the orthopedic surgeon—who would go to him after hearing his wife say surgeons bring home the cash?

After about five minutes, I couldn't take it any longer.

The reviews of the show have been mixed. But the New York Times, an organization that should know better actually had a favorable slant. Its reviewer said, A confederation of mostly black women, some of them doctors’ wives and some of them doctors, enacts scenes of petty jealousy and scorched-earth class warfare that reinforce every pernicious cliché about female treachery and the shallowness of buppie culture and that are also, as it happens, reliably entertaining. 

Entertaining if you are a moron.

Black women of Howard University Medical School, who petitioned the network to cancel the show before it ever aired, have different views.

Comments on the petition's website at Change.org were decidedly negative. Here are some excerpts:

Another show depicting black women as shallow, angry, weave wearing, sassy women that can't get along with each other. The bigger issue here is that they are representing a serious community of professionals that have to fight really hard to be taken serious by their white peers.

As a young black woman in the medical field, I was excited about the show, foolishly thinking there would be some sort of mention of, well...medicine. Instead I was incredibly disappointed, disheartened & embarrassed for what I saw. It was a mockery of medicine, and a modern day minstrel show.

This show is not reality! I have many friends that are African American female physicians and I am also married to a surgeon and we are both African American. This is NOT how we live and this is NOT our reality! This is a very negative image and against ALL that we stand for.

Sadly, the petition has only a little over 2000 signatures.

The good news is that one can simply choose not to watch.

Monday Mornings: The second episode

Since my review of the first episode of the new medical drama “Monday Mornings” generated quite a few comments, some of which thought the show had promise, I thought I’d give it another chance.

Although I have started to like a couple of the characters, particularly Dr. Sung and the sassy Dr. Napur, the medical portions of the show continue to disappoint. Dr. Sung said his evolving catch-phrase “Not do—dead” at least four times and hit a milestone as he uttered a complete sentence during the show.

Dr. Villanueva, the trauma surgeon, managed to diagnose trichinosis after a brief (and I do mean brief) laying on of hands and two questions. Trichinosis is a roundworm disease caused by eating raw or undercooked pork. The CDC says there are fewer than 20 cases of trichinosis reported in the US yearly and most of those come from eating game such as wild boar. The domestic pork supply is virtually free of the problem. I am familiar with the trauma surgeon community. I doubt that many of them could have picked out that zebra.

Dr. Tina Ridgeway, the female neurosurgeon who is destined to hook up with the hunky neurosurgeon with nightmares (another Dr. Jekyll? See “Do No Harm”), presented a case at M&M conference. The patient, a chef, suffered olfactory nerve damage during a craniotomy for a meningioma. She acknowledged that she relied on the resident to obtain informed consent. This is not permitted in most hospitals. The chief of surgery then castigates her for allowing the resident to do the case. When I was a chief of surgery, I usually was faced with the opposite problem. Some of the attending staff were not letting the residents do enough.

By the way, Dr. Hooten calls himself “Chief of Staff” and he never takes care of any patients. While it is true to life that many administrators don’t actually treat patients, I know of no surgery department in which the chief does not operate. It is very easy to criticize others if you don’t ever have to get in the line of fire yourself.

The transplant scenes lacked realism. The doctor who wants the organs cannot go around and ask for them. Ethically, he must refrain from any hint of solicitation. When organs are donated, they are distributed by a network of organ banks. They rarely would stay at the procuring hospital. There are waiting lists and priorities. Donor families and recipient families would never be in the close proximity that was depicted in the show.

I liked it at M&M when the chief said to the evil transplant surgeon, “Tell us how you’ve been bad.” I wish I had thought of that one when I was running those conferences.

The story line about the girl with the brain tumor was good except for the part where the trauma surgeon helps talk her into agreeing to the operation. He’s a versatile guy. But really, a grand piano in the lounge?

Why is everything so dark at the hospital? Is there a problem with the power grid? I’m waiting for someone to ask for a flashlight.

The show is better at character development than medicine. Maybe they should stick to the former.

“Do No Harm” is “Down the Drain.”

Late yesterday, NBC canceled the series “Do No Harm” after just two episodes.

You may recall that I blogged on January 31^st about the comically inept medicine portrayed in the first three minutes of the show’s pilot. The show’s premise that a modern day Dr. Jekyll and Mr. Hyde who had nightly 12-hour blackouts could be a practicing neurosurgeon with what appeared to be the open knowledge and support of his colleagues and the hospital administration was far-fetched, to say the least.

The viewers voted with their feet—making “Do No Harm” the lowest rated debuting series in the history of the big four (NBC, CBS, ABC, Fox) networks.

The second episode, which I’m told featured the neurosurgeon drilling a burr hole (to alleviate pressure in the skull) on a man pinned in a car at the scene of an accident, drew even lower ratings than the first.

Perhaps having an inkling of what was to come, Steve Pasquale, the show’s leading man, told the Huffington Post before the premier “Ultimately in this scenario, I'm just the actor who's saying the words."

My question is who thought this was a good idea? I can try to imagine the meetings where the idea of a modern day Dr. Jekyll who had to be home by 8:25 every night and did medically impossible things during the day was pitched. People with money and experience in television apparently sat there and said “What a great premise.”

Are those who make TV shows and movies so far out of touch with reality?

H. L. Mencken said, “Nobody ever went broke underestimating the taste of the American public.” In this case, he may have been wrong. The American public apparently has its limits.

“Monday Mornings” Review Part 2

Yesterday I posted a review of the new medical drama Monday Mornings. I based it on a 5-minute preview that was available on line.

I was very critical of the way surgical M&M conference was portrayed. Then I thought maybe 5 minutes wasn’t enough. Against my better judgment (again), I watched the whole show.

I stand by my first impression. The show is a typical medical soap opera filled with the usual array of doctors—the arrogant one, the beautiful one, the arrogant and beautiful one, the black guy, the Asian guy, the devious one, the vulnerable one, etc.

Forgetting about the acting and the heavy handed directing (extreme close-ups, focusing back and forth, quick cuts) and the funereal music, I will just point out a few errors and implausible medical situations.

A child bumps his head playing soccer and appears fine. The ED docs order an MRI “as a precaution.” (And you wonder why the cost of medical care is so high?) It shows a large brain tumor which the arrogant neurosurgeon declares is an emergency that requires surgery that same morning. The patient has uncontrollable bleeding and his blood pressure drops accompanied by blood squirting out of his head, which I have never seen happen especially since the kid was hypotensive. No code is called, but the neurosurgeon without even applying pressure or packing the bleeding area, opens the chest and does internal cardiac massage. Since there was no chance that would work, it didn’t. He is understandably upset. (More about this later)

A woman is brought in as a possible “suicide by car” because there were no skid marks. She is intubated but moving. The chief of trauma walks by, shines a flashlight in her eyes and declares that it was not a suicide, but rather a bomb went off in her head. He means she had a hemorrhage. She then undergoes surgery for a brain aneurysm. There is no way that he could have made that diagnosis with a flashlight. The patient would have had a CT scan anyway since even kids who have no signs or symptoms of brain injury get MRIs in that hospital.

There is a Korean doctor who is one of the worst stereotypes I have seen in recent memory. His command of the English language is limited to 3-word sentences and his bedside manner calls to mind Donald Trump. When asked whether a procedure he recommended was really necessary, he replied, “Not do—dead.” He was told to improve his English by the chief of surgery in a hallway conversation. He also grilled the med students without mercy. However, he is a genius at deep brain stimulation.

At the end, the neurosurgeon who lost the child on the table (I will omit the part where he has a flashback to his own childhood) has to face the music at (da-da-da-dum) M&M conference. It comes to light that the tumor was much worse than anticipated and the kid would have died anyway, but the crafty chief of surgery was holding back a card. He somehow found out that the child’s estranged father had Von Willebrand’s disease, which the neurosurgeon was unaware of. It usually is a very mild bleeding disorder and would not cause fatal hemorrhaging. The type that does cause hemorrhaging would surely have come to light with easy bruising or other issues in at 10-year-old boy. And wouldn’t the mother have known about this and told the surgeon? After all, the chief of surgery knew. The neurosurgeon was appropriately beside himself about this and refused to be consoled by the pretty one who no doubt he will hook up with in a future episode despite the fact that she is married.

In the final scene, which is one of the few believable parts of the show, the chief of trauma tells the neurosurgeon that a trauma case is on the way in and he needs to pull himself together.

As we have all been in the position of feeling terrible about a complication or death but had to go back to work the next day, that scene at least rang quite true.

I categorically refuse to watch medical shows on television. Here's why.

Thanks to Karyn Traphagen who posted a link to the Grey’s Anatomy episode in which a surgeon tweeted while operating. Having just watched the 8 minute clip, my reservations about medical television shows are reinforced.[Updated on 1/31/13: I'm sorry to say the video has been taken down. Maybe it's available on Hulu.]

A surgeon is doing a Toupe procedure, an operation to prevent esophageal reflux, and [I guess] damages the colon and pancreas. A medical student is tweeting the progress of the surgery and taking questions from surgeons all over the country. The chief of surgery finds out about this because students who are ostensibly watching a case he is doing are following the tweeting case on their phones. During the surgery, the Twitter surgeon takes a break to have a milkshake and runs into the chief of surgery in the cafeteria. He tells her to stop tweeting during the procedure because he is worried about the medicolegal ramifications. She goes back to the OR and finds a leaking pseudoaneurysm of the splenic artery which necessitates a total pancreatectomy. She disobeys the order not to tweet and gets a number of helpful suggestions and insightful questions from the Twitterverse of surgeons. She realizes that removal of the entire pancreas will create a diabetes problem. To address that, she helicopters over to Tacoma Methodist to pick up the equipment to extract islet cells from the removed pancreas for injection into the portal vein. The chief of surgery receives a shout-out from a former resident via Twitter and is now converted to an avid Twitter supporter.

How the audience of Twitter surgeons found out that this case was ongoing was not stated.
I have never in my 40 years of surgery seen a surgeon take a milkshake break during a case.
Disobeying the chief of surgery’s orders is a good way to see what the job market is like.
In the world of fantasy which is television, there are surgeons at Mayo Clinic, Johns Hopkins and Emory who apparently have nothing else to do that day and are glued to their computers/smartphones breathlessly anticipating every twist and turn of the procedure.
Total pancreatectomy is rarely indicated even for gunshot wounds. She must have really screwed up the surgery to end up needing to do that.
It is not clear how the staff at Seattle Grace [the hospital of Grey’s Anatomy] is to be inserviced on islet cell extraction and transplantation.
Oh by the way, is there going to be a morbidity and mortality conference to discuss the colon and pancreas injuries during a simple procedure for esophageal reflux?

Other than those few issues, the episode was pretty realistic.