TV Under the Knife

[Lone Star]

TV Under the Knife

Healthcare professionals weigh in on the latest crop of medical shows

By Robert Isenberg

Special to MSN TV

Let's face it: We love doctor shows. And we like our doctors too, be they smart, sexy or full of sass. We can't wait to see another patient pulled open so a pair of gloved hands can massage a heart back to life. There's nothing as intense as a fresh gurney rolling through the halls -- frantic physicians fight against time.

Physicians themselves are getting passé, which is why nurses and first-responders are getting more airtime than ever. And this fall, we have three new medical series debuting in primetime, not to mention a pair of cable shows with A-list stars which debuted over the summer.

But as much as we love hospital dramas, actual healthcare professionals tend to roll their eyes at them. After all, TV producers want to explore emotion and character, but real hospital work can be very different from the Hollywood version seen on the small screen. Since "ER" has been beaten to death by doctors, we wondered how the latest series measured up. So we asked a few healthcare workers about how well these shows mimicked the real inpatient experience. Here's what they had to say:

Series: "Trauma"

The gist: Paramedics in San Francisco race to rescue victims on the street.

Health care professional: Jim Holman, Administration Chief, Pittsburgh EMS Bureau Paramedics

What they got right: Many of the technical aspects are accurate: Use of endotracheal intubation, use of a special drill -- an intraosseous infusion line into the tibia. Paramedics use a "log-rolling" technique on a patient to keep the spine intact. And much of the mass casualty incident (MCI) scenes were realistic.

What they got wrong: Keeping an accident scene safe is an emergency responder's highest priority: The fire in the MCI was a little hokey, because responders would assess the scene for hazards, such as leaking fuel. The depiction of a chest compression was terrible: At one point, the hand placement on a patient's chest looked like the Heimlich maneuver. A helicopter wouldn't be used for a woman whose only injury was a fractured arm, nor would a helicopter be used in high-density urban environments, nor would the ground crew be along for the helicopter ride. Helicopters don't just land on the roof of a building that is not a designated and licensed helipad. Meanwhile, ambulances do not drive up to trauma hospitals fast and slam on the brakes -- it's way too dangerous and there's no need. Finally, an intern who talked to a veteran paramedic in manner depicted in the premiere would be reprimanded. An intern is there to learn.

Series: "Nurse Jackie"

The gist: A pill-popping nurse toils away in a surreal New York hospital, which attracts victims of freak accidents and grisly pastimes.

Health care professional: Jill McKonley, Registered Nurse, Lancaster General Hospital

What they got right: There are a few moments of merit: Jackie breaks the news of a death to the patient's family in a no-nonsense and practical style, wearing little-or-no makeup and with short hair (long hair hinders the hard physical labor associated with the job).

Real nurses do break sweats and occasionally cry while doing their job, which leaves no time to worry about looking glamorous. It was very refreshing to finally see a smart, experienced nurse who isn't afraid to speak up for herself, even if it is not what the doctor recommends. There have been too many shows that portray nurses as dumb, voiceless workhorses. There is some truth to the sarcasm nurses have to employ during difficult times.

What they got wrong: The show runs the gamut of blatant boundary breaches and professional offenses: substance abuse, sexual relations on the job, HIPAA violations, infection control violations, signature forging, and unauthorized disposal of a patient's body part. Not to mention a nurse disclosing personal information to a patient. The show is a little far-fetched to be effective as a drama.

Series: "Three Rivers"

The gist: Transplant surgeons in a Pittsburgh hospital fight over organs to keep their patients alive.

Health care professional: Nancy Crouthamel, Registered Nurse

What they got right: In general, the camaraderie and kidding among the Pittsburgh docs was pretty accurate. The value of joking around as a stress reliever cannot be over estimated. In the premiere, I appreciated the woman who asked the family about donation: She showed pretty well the difficulty with approaching a family in tragic circumstances. She laid the groundwork quickly and professionally. The family was pretty typical, too -- grieving in different ways and always in different stages.

What they got wrong: I am pretty confident that the fighting between the transplant docs before the organs were removed was way overdone. Transplants are serious business, and in general, the deference between docs in those situations is pretty serious. Also, the transplant business is pretty well regulated, so when one of the transplant teams walks away due to the storm, outside regulators would have had to decide who/what patient was going to get the organs they were there to retrieve.

Series: "Hawthorne"

The gist: Christina Hawthorne is a tough, spirited nurse working in a busy hospital.

Health care professional: Bill Holman, Cardiac Monitor Technician, Allegheny General Hospital

What they got right: "Hawthorne" does a good job fleshing out the hospital environment, the atmosphere and the interactions between staff. A wonderful moment was a new nurse asking "Am I going to cry every day?" and then bravely barging back into the fray. The heavily accented physician speaking faster (as he becomes impatient) is only too true. The humor of the staff was appropriate, as is necessary to get through each day in a hospital environment, and the representation of the hospital caste structure was, while at times overplayed, fairly accurate.

What they got wrong: The major technical flaw is the lack of discernment between different units of the hospital, and the accompanying staff. This is most evident when a lower-care nurse remains with a patient that "coded" as he moved to the ICU. In a large hospital, grades and types of care are sectioned, and each unit's staff is trained accordingly -- but all the nurses at this facility seem to do everything everywhere. The protagonist, Hawthorne, is astoundingly hands-on for a Chief Nursing Officer.

Series: "Mercy"

The gist: Tough nurses grow up fast in Mercy Hospital, New Jersey.

Health care professional: Mary Koopman, Veteran Nurse, various health services

What they got right: Enough that I was curious to watch another episode.

What they got wrong: I'm not one to nitpick, but I take issue when writers of these shows insist on inserting physicians into the nursing chain of command. Doctors have their hierarchy, and nurses have theirs. In "Mercy," we see Veronica being reprimanded by a physician -- not just about a current transgression, but about a past one as well. A medical chief of staff should really only have authority over the medical staff, not the nurses. Where's nursing management? And who dreamed Chloe up? She's more of a caricature than a character: her dreamy face, her cutesy scrub tops (does anyone call them "smocks" in real life?). She acts more like a candy-striper in a sitcom than a new graduate nurse. I hope they develop her character in a more believable way in future episodes.

[Dustdevil]

What they got right: Many of the technical aspects are accurate: Use of endotracheal intubation...

FAIL, Jim Holman! I have seen no ETI in those episodes. In fact, that's the one inaccuracy we all seem to agree on.

[Chief1C]

His response was more of an ass kissing response. As if anyone would want to do an EMS Show about the rust belt (PGH). On a side note, I think that show "Nurse Jackie" was kinda cool.

[JPINFV]

Hawthorn: Really? The best person that they could get to review it was a cardiac monitor technician? Sweet, can I start reviewing surgical shows for accuracy?

Trauma: "Finally, an intern who talked to a veteran paramedic in manner depicted in the premiere would be reprimanded. An intern is there to learn."

I'll admit, I haven't seen the pilot episode yet, but major fail in his understanding of medical education. While an intern (post graduate year 1. Also known as a first year resident) is there to learn, he is still a fully educated (note: education vs training here) physician working under a restricted medical license. A medical intern isn't in the same category as, say, a paramedic student going through an internship. A medical intern already has 2 years of medical (albeit with different levels of contribution and responsibilities) experience in various medical specialties through clerkships (rotations) and subinternships (essentially advanced rotations in a specific field). Since he is an emergency medical resident, he probably has had several EM clerkships at various hospitals (known as an "audition rotation"). Would Mr. Holeman be upset if a 3rd year resident corrects a paramedic? After all, the third year resident is "there to learn" as well? Oh, yea, that person who's overseeing the lower level residents and medical students that your paramedics might have just given report to? Yea, that's the R3 and he's a fully licensed physician to boot.

Now if the interaction was a problem due to professionalism, or the lack there of, then that's a different story all together which transcends any complaint about the level of the physician involved.

[tniuqs]

TV Under the Knife .... well that says it all.

Ahem Trauma comment again.

What they got right: Many of the technical aspects are accurate: Use of endotracheal intubation, use of a special drill -- an intraosseous infusion line into the tibia. Paramedics use a "log-rolling" technique on a patient to keep the spine intact. And much of the mass casualty incident (MCI) scenes were realistic.

I guess I missed the EZ IO part, umm the ETI was a cric ... WOW and a roll to a spine board, thats bloody brilliance just what will they think of next ? a scoop stretcher, or a KED or SKED or maybe long line sling out of a school yard ?

Oh and then the very realistic MCI when Tactical EMS and unarmed enter an non secured area .... oh yea thats super realistic ... on the keystone cops or the three stooges meh.

I did like the colored plastic Tarps for triage that WAS an idea I have not seen but just how would that work say when the weather sucks or the wind is blowing or its - 40 C ?

and with on liter of Ice Water Saline to prevent spinal shock and pericardocentesis for a penetrating injury to the heart from a GSW .. and and and .... not to forget da WASCALLY WABBIT, who in the next show is predicted to wear his underware on the outside of his flight suit.

Did we forget the transmission of MRSA/ VRE in the the back of the gut wagon ... shucks my bad.

So + 25 years in the field as a grunt (non administrator) and I say WTF ... Over ?

Health care professional: Jim Holman, Administration Chief, Pittsburgh EMS Bureau Paramedics

Jimmy H. I believe your nose is so far up NBCs ass YOU need to be intubated ... just to breath !

cheers