June 7, 2008

• Turn on, Tune In, Diagnose?

  Well here we go. In the first of the Medical Choose Your own Adventure Posts, quite a lot of you (three! wow!) were curious as to my take on the plethora of medical dramas available on television today.

  In today’s technological society, almost all of our information is gleaned from one or another media outlet. Newspapers and Magazines are falling by the wayside in favor of television and the internet. And in this context, it is only understandable that concerned as we are about our health, we turn to things like webMD, or google to answer our basic questions. But disease is a pretty frightening thing for the human mind to deal with, especially because we can rarely see what is occuring to our bodies at any given moment. And so, the vast majority of society turns to the authority called The Doctor to help allay our fears. But the only thing that separates The Doctor from the everyday common man is a little bit more schooling (little bit my gluteus maximus!) and a body of knowledge that one could obtain if they were really determined. Right? Or is there something more, some specific character trait that separates man and physician? Are doctors a special breed of people, or do they go through the same troubles as you and I?

  That is basically the premise behind pretty much every medical show out there on television right now, though they all ainswer it in different ways. But do I, a medical student, get the same things out of watching the show, that you do? Well, lets do a brief review of the big medical shows out there at the moment, and find out.

  Greys Anatomy
  This is not a medical show. Sure it has all the right elements: a hospital, people dressed in scrubs, even a snazzy title that is a pun on a classic medical textbook. Despite all that however, Greys Anatomy somehow manages to achieve a level of medical believability paralled only by General Hospital, a soap opera that at least manages to have exciting storylines and evil twins.

  So what went wrong? Grey’s basically tells the story of Meredith Grey, a surgical intern at seattle  grace hospital. Now no question that this is supposed to be a show demonstrating empowered women in the medical field. And there is nothing wrong with that. The cast of characters includes Izzy, who apparently used to be some sort of underwear model to put herself through medschool, sandra oh as the asian gunner, merediths once famous surgical mother who has alzheimers, and a couple throwaway male characters basically placed in the show for the female characters to moon over, like mcdreamy, or steamy, or whatever the hell his nickname is

  And right there is my problem with this show. Female surgical interns? Well, okay surgery has been a male dominated field, but usually because men are better at being assholes, a prerequisite to surgery. Asian intern who is super smart and sleeping with an attending to advance her career? I can buy into all of that pretty easily too. Someone who put themselves through medical school modeling? Now we are getting a little into the realm of fantasy here-while I certainly have attractive friends and coworkers at the hospital, if someone could make a career out of modeling, they are not going into med school. But lets go ahead and ignore that to notice the one glaring problem of the show

  WHEN THE HELL do these people find time to actually treat patients amidst all this sleeping around with each other??!! I did 2 straight months of surgical clerkship, during which time all my hours not spent in the hospital were used to sleep for sometimes as much as 5 hours a night. And I didnt have to do that much follow up in terms of note writing or outpatient clinic, as being only at student level, i merely assisted the residents. Surgery is a field that consumes your life, and yet the operating room or patient contact is usually only referenced tangentially, when one of the characters has a relationship problem they are discussing. I could go on and on with things I dislike about this show, but i think this clip pretty much sums up the show well

  House, M.D.
  Now House is a show i actually only got into recently, and in all fairness, after season three it starts getting a little weird. But the basic premise is that Dr Gregory House is a miserable, misanthropic, yet brilliant diagnostician in the field of infectious diseases working at a hospital in new jersey modeled after the mayo clinic. He has several accomplished fellows working under him and each week they solve rare and interesting cases.

  Now this show has several advantages going for it. All the cases they describe are real, possible, and many have even been documented in medical journals, though certain aspects are certainly played up for the television arena. The team is often confused at first, and may have to struggle through several diagnoses before coming up with an answer, as well as coordinate with other medical departments. These are all things that ACTUALLY HAPPEN in medicine.

  However, House’s crack team of medical fellows for infectious disease seem to be superhuman in that they not only accomplish the duties associated with their actual doctor jobs, but double as surgeons, radiologists, mri technicians, lab techs, and criminals when house sends someone on a whim to break into patient houses about once every other episode. This does not happen. Our jobs are difficult enough without taking on other medical professionals. Not the mention that no matter how genius House is, his incredibly poor bedside manner, and more importantly, his almost complete lack of ethics would result in him being suspended and impossible to hire at almost any medical institution. Hospitals get grants and reputations usually on the basis of their research and academic, not clinical credentials. Additionally House’s practice of instituting treatment plans before confirmation of a diagnosis goes totally againts evidence based medicine which is what we are supposed to practice now

  Despite all that, I like house because they clearly do have a competent medical consultant, and while I know intellectually that all these rare cases are not going to present in a single clinic, I have fun trying to figure out the puzzle along with the team, and come up with a diagnoses. Some of the greatest satisfaction I derive from the show is coming up with a differential before the team does, even if it is later proved to be wrong. And no matter how much of a jerk House may be too patients, I still love him because I have had a number of patients who I really wish I could tell off like he does, however much professionalism demands otherwise. It is truly a great escapist fantasy for a doctor, or more accurately Almost Doctor. Here is a spoof that covers those same complaints again

  Scrubs
  Saving the best for last, Scrubs is far and away the medical show that most accurately portrays the life of a resident and medical student on the wards. J.D. begins the show on the first day of his residency as a medical intern in the intensive care unit, and over the course of seven seasons we watch his slow rise from intern to senior to chief resident and possible attending, though I declined to watch some of the later seasons. He is joined by his friends Turk, a surgical intern, and elliot, another medical intern on the neurotic side.

  I could probably do a entire post about this show alone, but let me sum up some of the factors in it i really like.
  1. All the main characters are believable in their actions: JD is doubtful, nervous insecure both in his professional and personal life initially, though he gains confidence is his abilities in later seasons. He tries too hard sometimes to be accepted and liked by his patients, and struggles to date even as the hospital drags him back in and bleeds his work life and social life together. Turk and Carla showcase the oft publicized nurse doctor relationship, and not only do they do a great job as strong characters in their own right, but manage a convincing job of showing married life and a stable relationship through all the ups and downs of working in healthcare, a nice counterpoint to J.D.s single woes. Elliot has the greatest development from neurotic insecure intern to private practice doctor, and while Dr Cox and Kelso are perhaps a little extreme in their character representations, they are still coming from credible places

  2. The cast has fun with each other, but also actually WORKS. Greys has nothing but sordid affairs, while House tells us little to nothing about how the residents interact outside the hospital. Scrubs balances nicely with its primary focus on the medical, but giving us insight into the home lives of these same characters showing the everyday activities we all struggle through

  3. It does a good job of showing the struggle with balancing patient care and economic/managment concerns. The rivalrly between cox and kelso starts off as pretty black and white, but you come to see that both doctors have good points they make in their stances. Hospitals are a business, and if that is not taken into account every once in a while, the hospital soon ceases to function and cant help anybody

  4. the visual gags…no, i have never had a ton of bricks dropped on me, or bought a porch, or played hide and seek in the hospital. But i certainly have daydreamed while listening to the occasinal patient or attending, and felt like i was crushed when seeing a family have bad news broken to them, or skipped work to take a me day with friends.

  So despite its off the wall antics, the real feel of medicine shines through at least to me when watching this show.

  And yes, i totally get off on the fact that i understand the medical terms in all of these shows when they use them, as medicalese is another language i picked up in my education.

  For the record i purposefully ignored ER, as this post was already waxing long, but I feel it also began well with a strong cast and medical background that has since degenrated into something not quite as entertaining or accurate. But hey, so goes the fate of all good tv, right?

  In the end,  these shows all try to get across the message that the life of a physician may have a different set of job hazards, but ultimately we have to deal with the same ridiculous issues as everyone else. And no matter how pretentious a medical show may try to be, if it cant get across that message in a way that the everyday person can relate to, understand, and be entertained by, well then, people will treat it just like they do their doctors, and simply go somewhere else to make them feel better.

  SO in conclusion, stay the hell away from greys anatomy and go watch a real medical show. Or read a book. Or go outside, you lazy bums. ;-P

  -Almost Dr J

  • 5:54 pm
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