Wayfaring MD: Missionary Physician
I like to highlight the hilarious in medicine as I write about patients, medical school, residency, medical missions, and whatever else strikes my fancy. Oh yeah, and I like to use GIFs!
Disclaimer:
HIPAA is for reals, folks. All of my "patient stories" have been changed to protect patient privacy. I will change any or all identifiers, including age, location, race/ethnicity, sex, medical history, and quotes.
Silly surgeon, don’t you know you can’t palpate an abdomen through a blanket?
sayyesandno Asks:
wayfaringmd Said:
Unfortunately, I can’t speak for Gray’s Anatomy, because I’ve never watched it (I know, I know). But if it’s anything like every other medical show out there, it’s only loosely based on reality.
Yes, medical cases like the ones on House do happen in real life, but they are not nearly as dramatic. People don’t get diagnosed and treated for major illness in the span of an hour (usually), and no doctor does everything like House and his team do. I mean, on House, the team is in the lab examining slides and doing their own blood work and such, whereas in real life you would be sitting at a computer hitting “refresh” until the lab results popped up, much like you do when Tumblr is down.
And of course, the illegal shenanigans that take place on House and Scrubs —breaking & entering, switching patient charts, HIPAA violations, doctors working while impaired, etc—get you much more than a slap on the wrist in real life.
I wish a lot of that stuff was real. Real life goes at a much slower, often more frustrating pace. But I assure you, real life medicine is just as interesting and fun and rewarding as tv medicine (and probably more so).
For more reasons why tv medicine is different than real medicine, check out these posts.
As for your last question, please know that real life doctors (and people in general) don’t look like they do on TV. But hey, after a 30 hour call when my hair and face have enough oil to run a diesel truck and I smell like C. diff and gangrene, I always feel like
jamoker Asks:
wayfaringmd Said:
Hmmm, I think I’d have to go with Dr. Cox, because he seems to actually care about his patients (ever so slightly), whereas Dr. House is in medicine just to solve puzzles.
If she noticed something on his thyroid, WHY IS SHE CHECKING HIS JUGULAR VEIN?
The medical profession is rarely portrayed accurately on television, but every once in a while, a show gets it right.
Does it bother anyone else here that the patient charts on Scrubs are always virtually empty?
Seriously, there are no papers in them. Even on ICU patients.
No, just me? Ah, well.
Clinical Skills 101: the heart is not located in the abdomen.
EDIT: And why does a young, seemingly healthy pregnant lady have mitral stenosis? Did she have rheumatic fever as a child? Who knows?
Erm, not so much. There’s always an attending around. If they’re not actually in house, they’re accessible by phone for sure. No intern is out there running the hospital. And where are your upper levels, JD?
And how small is this hospital that all admissions are going to one service? And why does Carla take care of everyone’s patients? Are there no other nurses at Sacred Heart?
OH NO YOU CAN NOT!
Scrub yourself out young lady!
There’s no touching your face in surgery!
So far, it seems that most of the things that Scrubs get wrong about medicine happen in the OR.
drop-the-world Asks:
wayfaringmd Said:
It may be possible (though I doubt it), but it would be illegal and unethical. That would be insurance fraud. Yet another difference between real life and tv medicine.
TV vs. Real Medicine
They’re scrubbing ALL WRONG!
No rings or watches on while scrubbing.
Masks should already be on their faces before they enter the OR and before they scrub.
GAH!
One morning on psych I went to see my favorite aphasic patient, Gus.
Usually he was pleasantly confused and was always alert and interacting (as best he could) with other patients. That morning I found him slumped over in his chair, face almost in his plate of eggs.
I called his name and tapped his shoulder, but he wouldn’t respond verbally. Eventually he turned his eyes up and looked at me with a pained expression. He was very lethargic and stiff. His right arm was drawn up and his hand was in a fist. When I tried to sit him up in his chair, he wouldn’t straighten up.
Something was clearly not right, so I went to the orderly.
“Did you notice Gus? He’s not acting like his usual self. How long has he been like this?”
“I don’t know. He does that sometimes. He’ll get all quiet and mad looking for twenty minutes or so and then he’ll go back to normal. He’ll be fine.”
I still didn’t like it, so I went and got my attending. I told him about Gus’s rigidity and the fact that the orderly said this happens occasionally. He examined Gus and then turned to the orderly.
“How often does he do this?”
“Couple times a day. He’s fine though.”
“NO, he’s not. He’s freaking having seizures! And no one here thought it was important to report it?”
“We thought he was just tired and being moody.”
“This is PSYCHIATRY. Change in mood is not something you can just dismiss! Next time if someone is not acting like their usual self, call me!”
A minute or two later, Gus relaxed. He was already on seizure medication, but obviously it was not fully covering him. His meds got adjusted, the orderly got quite the tongue lashing, and Gus got better.
Moral of the story: any change from baseline could be clinically relevant. Examine your patients. Also, most seizures are not tonic-clonic. Don’t be fooled by what you see on TV.
Did you know that all the time Scrubs was airing that the chest x-ray shown in the opening credits was backwards? You can see the heart shadow going to the right side rather than the left side.
Well, in the last official episode, Dr. Kim Briggs finally turned it around. Although in parts of Season two, the chest x-ray is actually the right way. /endofgeeking
TV vs. Real Medicine, III
TV: I hate it when supposedly educated people on tv cannot pronounce drug names. Granted, they can be difficult, and many doctors botch them, but if you’re supposed to be playing one on tv, don’t lose all your credibility by pronouncing words wrong.
I recently watched a show where the main character is going through a bunch of bottles of pills. He goes through them, correctly pronouncing lorazepam, sertraline, lamotrigine, and olanzapine before coming back to lamotrigine again. The second time he totally botches is, pronouncing it lamb-oh-try-guyne. He acted like it was a totally different drug than the one he read the first time.
Real Life: In real life, lots of doctors and patients mispronounce drug names, but at least the doctors know the same one when they see it multiple times. I tend to be a bit of a grammar / spelling / pronunciation nazi, so these errors really bug me.
Here are some common botched pronunciations:
Metoprolol: meta-PRO-lol instead of meh-TO-pruh-lol (maybe this is an acceptable alternate, but I think it sounds stupid)
Coumadin: cunamin
Lasix: Lasik
hydrochlorothiazide (HCTZ): too many to count
TV: The doctor heroes work up a patient for a strange disease for the first 45 minutes of the show, ordering time and money consuming tests and imaging, when suddenly one of them says, 
“we need to order a CBC. That will tell us what’s wrong.”
The patient is then diagnosed and of course the treatment to the disease is curative within minutes of administration.
Real life: A CBC is the first lab a doctor orders. On everyone who comes into the hospital. It rarely tells the whole story about a patient’s illness, with maybe the exception of infection or leukemia. And of course, very few definitive treatments takes effect that quickly.
