Wayfaring MD

I am a family medicine resident who likes to highlight the hilarious in medicine as I write about patients, medical school, residency, medical missions, and whatever else strikes my fancy.



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. Also, I am an anonymous internet person. Why should you trust an anonymous internet person to give you medical advice? Don't ask me, ask your doctor!
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Posts tagged "tv medicine"

What are codes? - anon

Every hospital has “codes” that they will call over an intercom to alert employees to an emergency situation. For example, at my hospital, code red is fire, pink is a stolen baby, green is hazardous materials exposure, and gray is “code act a fool,” alerting security to come take care of some belligerent family members ;).

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The designations vary from hospital to hospital, but almost universally a "code blue" stands for cardiac / respiratory arrest. The code blue is the most commonly called code, and thus often is shortened to just “a code”. When we say that a patient coded, this is what we mean. 

Real life codes are WAY different than on tv.

When a patient is found in cardiac arrest, the first responder immediately starts chest compressions and calls for help. A team will come into the patient’s room with a crash cart containing various medications, a defibrillator, intubation supplies, and a heart monitor. While chest compressions are being done, someone else will assess the patient’s airway and likely will start giving breaths by a bag.

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You’ve seen this all on tv. What you don’t experience on tv is the simultaneously squishing and grinding sound of ribs cracking and rubbing against each other when CPR is done properly. They tend to gloss over the eternity that is the 2 minutes of chest compressions between every pulse check and epinephrine administration. You don’t experience the unmistakable smell of stomach contents as the patient vomits involuntarily and aspirates on their own gastric juices. They clean up codes on tv. They don’t want you to see a patient’s head flopping around with eyes rolled back or a nurse jam his hand into a patient’s crotch to try to find a central pulse. 

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On tv they show you two shocks (even in asystole, when you’re not supposed to shock) and the patient miraculously recovers with full brain function. They don’t show a chaplain explaining to family members that the patient has died and the team is trying to bring them back. And they certainly don’t show the transfer to ICU, the intubating, the starting of pressors, or the eventual exam to declare someone brain dead. 

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You see, only 11-35% of people who have cardiac arrest IN the hospital survive to discharge, and only 6-17% survive with good neurologic function (reported by he National Registry of Cardiopulmonary Resuscitation). So yeah, we can bring people back. Sometimes. But most of the time their brains are gorked. Codes are violent, messy, and often unsuccessful. They do occasionally save lives, but when it comes to me, hey, don’t code me bro. 

jameslj:

Does anyone know what that little hexagonal thing worn by TV doctors is? This is from House, but I see it on Grey’s Anatomy, too, particularly while they’re in surgery. #doctor #medicine #hospital

The hexagon thingy is a docimeter. It’s a little device that measures how much radiation you’ve been exposed to when you’re working around x-rays, CT scans, radiation therapy, or fluoroscopy. It’s an OSHA requirement that anyone who works around radiation wear one so that your total radiation exposure can be documented. 

Unless they’re using fluoroscopy in surgery, there’s no reason to wear one. I don’t wear one unless I go to the cath lab or something. I guess they wear in on TV to look more doctor-y. 

Asker Anonymous Asks:
Do you watch the following? There's a character who has a pace maker bc he was stabbed in the heart and they always show him like oh shit my pacemaker when Hes stressed but is this realistic? Shouldn't it be regulating his heart normal regardless?
wayfaringmd wayfaringmd Said:

Being stabbed in the heart would be a weird reason to have a pacemaker. And I’m not entirely sure, but I’m pretty sure most folks can’t feel when their pacer kicks in. And why would his pacer kick in when he’s stressed? Usually your heart rate increases when you’re stressed, and pacers only take over when the heart rate slows below a certain rate. Now if the guy had a pacer-defibrillator, he definitely would be able to feel if the defibrillator fired. If a person had a defibrillator that fired regularly, they’d likely be in pretty poor health. 

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Asker Anonymous Asks:
is life in a hospital anything like house or scrubs or grey's ana...?
wayfaringmd wayfaringmd Said:
Asker Anonymous Asks:
Okay another tv/medicine not crossing over why are hospital rooms on tv so freaking big!!
wayfaringmd wayfaringmd Said:

Gotta make room for all those cameras!

Airplanes always look suspiciously spacious on tv and movies too…

FINALLY A SHOW THAT GETS IT RIGHT. 

My only problem with this scene (from Breaking Bad) is that they did CPR for all of 15 seconds before “calling it”. Otherwise though, not a bad job. 

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Ok, I know it’s not busting crappy medicine on TV, but close enough.

This gif makes it look like this baby has lots of room to push through that pelvis. In reality, if you’re pregnant, you really DON’T want your baby to come out face-up. This position, known as the dreaded OP (occiput-posterior) is notorious for producing bad obstetrical tears. 

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See, in case you forgot your anatomy, vaginas are small. Babies’ heads are big. To make big come from small, big has to try to be as small as possible. So babies tuck their heads and, if all goes well, come out crown-first. This position makes the diameter of their head as small as possible. Also, unlike in the gif, babies’ heads are moldable, and the cranial bones squish and overlap a little to squeeze the head through. As the head comes out, the baby rotates a bit to one side or the other so the shoulders can be delivered. image

So next time you’re making skeleton birth gifs, mind your anatomy!

There’s a scene in Elementary where Dr. Watson is talking to her therapist and hesitates to talk about Sherlock, and her therapist says “my confidentiality protects your confidentiality.” Watson’s not technically Sherlock’s doctor, but I was wondering if that’s really true in the case of HIPAA. Could a medical professional divulge potentially identifying information about their patients to their own psychiatrist? Does their confidentiality really “protect” yours? -asortoflight

I’m not so sure about that. The rule is pretty much don’t give identifying patient information to anyone other than the patient or people who they permit you to share with. I suppose Watson could talk about Sherlock and not give away identifiers, though. But no, doctors shouldn’t be telling other doctors about their patients unless it’s a consult situation or a group practice type thing. 

Now in my (and Cranquis’ and all the other TOADS) case, our anonymity does protect our patients’ anonymity. Sure, we change demographic information, but even if we didn’t, it would be very difficult to identify our patients without knowing who we were or where we lived or worked. 

Asker Anonymous Asks:
All the relationships and sex that go on in medical TV shows, is it really like that in real life?
wayfaringmd wayfaringmd Said:

I mean seriously, is anything on tv like real life anymore?

Sure, there were some fairly promiscuous people in my med school class, and there was some medcest going on, but for the most part, we were all studying too much to be gettin busy in the call rooms. While it is true that a few people find their mate in med school, it’s certainly not the majority of people. 

There were always rumors in med school about this resident and that attending, or that student and this resident, or this attending and that nurse, or whatever, and I’m sure some of the rumors were true. When people are around each other ALL the freaking time, there’s probably bound to be some cheating and sexytimes going on. But most of us didn’t have time for that drama. 

wayfaringmd:

I dont usually relate real life MD’s to fictional Tv series doctors. But I was curious to know can/are some doctors as really cynical,cold and aloof as Dr, Cox, Kelso, and House? If their are Dr. like this what got them to that point, and is it permanent/reversible? -illegallyawesome

Of course there are doctors like this. I think the big difference between the real life guys and the tv docs is that the real life guys (hopefully) don’t show their cynicism as blatantly to their patients. 

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How do doctors become cold and cynical? Personally I think they start out with a little of that in them already, and then it just grows through their career. I constantly hear snide remarks about patients in the “behind the scenes” times in the hospital. I know fellow residents, attendings, and students who very clearly hate patient care, yet they’ve chosen a profession that requires them to interact with people all the time. I’m not sure why people do this.

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If money is your goal, be a businessperson. If it’s prestige, do research and win the Nobel. If you love science but hate working with people, work in a lab. Get a PhD. Be a non-clinical physician. Don’t be a doctor if you don’t like dealing with people. 

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wayfaringmd:

  • For every cool medical show or funny story on a medical blog, there are hundreds of boring stories. 
  • Tv shows like House and even the ones on the Discovery channel are made for entertainment
  • They all have a morsel of truth (a very small morsel in the case of House), but it’s portrayed in such a way as to make it sensational so that more people will watch it. 
  • The boring parts like paperwork, charting, waiting for test results, dealing with insurance companies, and the tons of routine patient visits are left out because they don’t draw tv viewers (or blog followers…). 

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SP: Ok, I’m going to go get my attending now so he can check on you too.

Patient: Your what?

SP: My attending. I’m a resident.

Patient: What’s a resident?

SP: Did you ever watch Scrubs? Those are residents.

Patient: OH! So you get stepped on a lot, huh? 

SP: 

Pretty much…

Asker s-seeking Asks:
Okay, I'm seriously wondering, please don't think I'm being a jerk: On a scale of 1-10, how similar is working at a hospital to the show House?
wayfaringmd wayfaringmd Said:

It’s about a 3. 

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The similarities: 

- real life and House happen in a hospital

- there are patients 

- patients often lie

Um, yup. That’s pretty much it. In real life, doctors stick to one specialty. We’re not all beautiful, especially after 24 hours on call. The puzzles are often less complicated, but sometimes just as hard. Our treatments are rarely effective immediately. There’s a lot more boring paperwork and procedural stuff that is never shown on tv. And generally, doctors who are drug addicts are given much more than a slap on the wrist when they get caught. 

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For more similarities and differences between tv and real life, check my Tv Medicine tag. 

I dont usually relate real life MD’s to fictional Tv series doctors. But I was curious to know can/are some doctors as really cynical,cold and aloof as Dr, Cox, Kelso, and House? If their are Dr. like this what got them to that point, and is it permanent/reversible? -illegallyawesome

Of course there are doctors like this. I think the big difference between the real life guys and the tv docs is that the real life guys (hopefully) don’t show their cynicism as blatantly to their patients. 

image

How do doctors become cold and cynical? Personally I think they start out with a little of that in them already, and then it just grows through their career. I constantly hear snide remarks about patients in the “behind the scenes” times in the hospital. I know fellow residents, attendings, and students who very clearly hate patient care, yet they’ve chosen a profession that requires them to interact with people all the time. I’m not sure why people do this.

image

If money is your goal, be a businessperson. If it’s prestige, do research and win the Nobel. If you love science but hate working with people, work in a lab. Get a PhD. Be a non-clinical physician. Don’t be a doctor if you don’t like dealing with people. 

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Read More

I understand how stupid it is to go into medicine solely based on a TV show but on a related note to that post, how often do you actually have puzzles to solve in family medicine? How many intellectually challenging cases would you, or a real-life doctor in a specialty similar to House's, get? Obviously you're not gonna be getting a case of smallpox from someone who was cut while diving in an 18th century shipwreck, but do you often have cases that are interesting and difficult to solve?
wayfaringmd wayfaringmd Said:

Whoa, I forgot this question was in my inbox. My bad. 

Well, every patient you see is a puzzle. The puzzles range from 10 piece kiddie puzzles to 1000 piece 3D jigsaws. Some don’t require much thought, while others can be very challenging. 

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Many patients will have something about their case that makes you go “hmm”. It may be something like “what drug did they overdose with,” “why is their sodium 124,” “what’s causing that weird feeling I get when I talk to the family,” “they’re allergic to every antibiotic I want to give them” or “is this appendicitis or something ovarian”. 

In the hospital, I’d say that maybe 1 in 40 patients is a real head scratcher. In an outpatient setting, it’s less. But almost all patients have some element of mystery. Also, every patient is different, so patient X with electrolyte imbalances may be handled very differently than patient Y with the same thing. That’s where your intellectual challenge comes in to play. 

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Regardless of your specialty, you’ll get challenging cases. You don’t have to be double boarded in nephrology and infectious disease (which is totally random, btw) like House to get good cases.