10 Completely Unrealistic Moments in Television ERs

“ER” made for great TV drama, but the medical science wasn’t always on point. © 2001 Warner Bros. International

Did you ever notice that no male doctor ever sat on a female patient's bed on "Ben Casey"? Or that, for a long time, all TV doctors were men? Today, TV doctors — male and female — are more likely to be flawed characters. (Look at the case of Dr. Carter on "ER," who was stabbed by a mentally ill patient and went on to become addicted to painkillers.) And while shows hire medical experts as technical advisers, writers aren't under any obligation to make any changes based on the suggestions of those pros.

It wasn't always that way. In 1951 when the first TV medical drama, "City Hospital," aired (and in the 1960s when "Ben Casey" was popular), the American Medical Association was invested in portraying medical accuracy, not preserving the story line. And for a few decades it was within the organization's right to demand script changes over concerns ranging from proper decorum to the way TV surgeons and doctors held their instruments. And in return, they'd stamp the show with the AMA seal of approval (shown at the end).

Many of us get a lot of our medical information from fictional TV shows. Let's look at "ER," for instance: "ER" debuted in 1994, and by 2001 one out of five doctors reported their patients were asking not only about diseases highlighted on the show, but also about specific treatments used in episode story lines. By 2002, the "ER" audience knew more about emergency contraception and human papilloma virus (HPV) after watching episodes relating to those health topics than before, and one-third of the viewers admitted they applied their TV-acquired knowledge when making personal health care decisions [source: Belluck].

That's a little scary, though, since it turns out that while the mortality rate in our real-life hospital emergency departments is 5 percent, in TV hospitals such as "Chicago Hope," "ER" and "Grey's Anatomy," it jumps to 17.5 percent [source: MedicalBag]. They're losing a lot of their fictional patients. Maybe because they're also getting a lot of things wrong.

Seizure Treatment
A real doctor would not stick a tongue depressor in a seizing patient’s mouth, but it happens on TV all the time. © joeygil/iStockphoto

In the name of science, researchers at Dalhousie University watched every episode of "Grey's Anatomy," "House," "Private Practice" and the final five seasons of "ER" — and they found that in those 327 episodes, 59 patients experienced a seizure. In those 59 cases, doctors and nurses incorrectly performed first aid treatments to seizing patients 46 percent of the time (including putting an object, such as a tongue depressor, in the seizing patient's mouth). A quarter of the episodes couldn't be accurately evaluated, and the remaining 29 percent did realistically portray seizure care [sources: Devlin, Landau].

It's surprising more patients in TV emergency rooms don't die while being treated for a seizure.

Seizures are caused by surges of electrical activity in the brain, and as many as one out of 10 of us will experience at least one seizure during our lifetime, accounting for as many as one in 100 visits to emergency departments across the U.S. [source: Epilepsy Foundation, Martindale et al.]. In reality, there's one more important directive when caring for a person having a seizure: Prevent injuries. For instance, loosen clothing, and never restrain or put anything in a seizing person's mouth while convulsions are happening. Once any convulsions have stopped, turn the person onto his or her side — a small but important step to help prevent choking. Some seizures, such as those lasting longer than five minutes, need immediate care. Emergency treatment may include benzodiazepines and anticonvulsants, in addition to a consultation with a neurologist.

Every Case is Critical
There are many fairly mundane and non-life-threatening issues being treated in hospitals all the time — it’s not always an emergency or a dire situation. © Spotmatik/iStockphoto

It seems like everyone is having some kind of critical case in hospital emergency departments on TV. There's a steady stream of dramatic issues coming through the doors. While fictional doctors may be treating fictional severe injuries continually during their fictional shifts, one-upping each other on the severity of each new case or spending all day (or night) investigating and diagnosing a single patient, the reality is that more than half of the visits people make to emergency departments aren't actually for life-threatening or urgent problems [source: Cunningham].

Millions of people will visit ERs this year seeking treatment for cuts, despite the fact that most cuts and scrapes are considered minor enough to treat at home [source: Hines]. When's the last time you watched a TV medical drama featuring a minor cut? There's intrigue in critical cases, though, right? And isn't that really what TV is all about? Cases of minor kitchen-knife accidents and banged-up knees from outdoor adventures wouldn't be likely to garner the same ratings as more histrionic fictional patient cases.

Meeting the Ambulance
Sorry, if you’re hoping for a doctor to meet you at the ambulance, you’re likely to be disappointed. © katifcam/iStockphoto

Did you see the episode of "ER" where Dr. Romano accidentally lost an arm while meeting an emergency helicopter transport? Or when he is crushed to death in the hospital ambulance bay by — that's right — another air ambulance? I hate to be the bearer of bad news, but if you arrive by ambulance to the hospital's emergency department, whether by road or air transport, there won't be an ER doctor, nurse or a surgeon waiting to meet your ambulance.

Normally when a new patient heads to the emergency room via medical chariot, emergency medical services personnel advise the hospital emergency team of the incoming situation while they're in route. Then, depending on the severity of the patient's condition upon entrance, he'll either be immediately whisked away for lifesaving care, or he'll be sent to the triage nurse. The triage nurse then evaluates the patient's symptoms and decides the level of need for care, and where on the patient priority list the new patient should go. Most emergency departments stay so busy that doctors don't have the time to wait on an incoming ambulance or helicopter the way their TV counterparts do.

All comas are not the same, despite what you may have seen on TV dramas. © 4774344sean/iStockphoto

Fictional comatose patients in fictional hospital emergency rooms often just appear to be sleeping, maybe with a nasal cannula, an IV and attentive family holding a bedside vigil. And that's a fairly standard representation across the board for TV medical dramas.

In reality, not all comas are the same. They're classified based on a patient's level of eye response, verbal response and motor response. The lower the score, the more severe the coma. The causes of a comatose state can be extremely varied, but traumatic brain injury (such as a concussion or lack of oxygen from drowning) or certain conditions such as diabetes are the most common.

Comatose patients are often hooked up to tubes, pumps and machines to help keep the body functioning. Treating a coma may require ventilation, a feeding tube, a catheter for bladder control, a catheter to monitor blood pressure and a heart monitor, among other lifesaving devices and medications. Most of that equipment isn't especially telegenic, and some of it would block an actor's face, so TV dramas tend to skip it.

The ER and a Home Life Don't Mix
There are definitely long days (and nights) for ER doctors, but most of them also have lives away from the hospital. © 4774344sean/iStockphotos

ERs are 24/7 operations, so physicians and other emergency team members may pull some overnight and holiday shifts, but if you watch TV shows about emergency rooms, you might think the staff practically lives at work. The reality: In general, most ER doctors typically work eight- to 12-hour shifts, and in total work upward of 1,500 to 2,000 hours annually [source: Reiter]. Although that's a serious time commitment for work, contrary to the day-to-day workloads we watch our favorite fictional medical teams handle (and their nights catching a few zzzs on an empty hospital cot), emergency medicine physicians do have lives outside of the hospital. In fact, on average, emergency medicine physicians take about four weeks of vacation every year, and about one-fifth take more. And, despite the long hours they may sometimes work, the marriage rates among ER doctors are higher than the rate among all Americans, and nearly half of those who are married consider themselves happily so [source: Medscape].

No Protective Gear, No Worries
A real surgeon would never go without a mask during a procedure. © dmbaker/iStockphoto

Operating rooms have a dress code, including personal protective gear (gloves, gowns, masks, eyewear and disposable, fluid-resistant shoe covers). Surgical masks are worn in the procedure area — a fresh mask for each surgery — and please leave the jewelry at home (we're looking at you, surgeons of "Grey's Anatomy").

Surgical masks, or at least the notion of covering the nose and mouth for infection control, date back more than a century. The idea of avoiding infection by filtering the air we inhale dates back to the turn of the 20th century and a German physician named Carl Flugge, a bacteriologist who argued we could avoid spreading infection if we avoid breathing in airborne bacteria and viruses, such as those that cause tuberculosis and measles. He was right.

While it's been common for surgeons and physicians wear surgical masks as part of wound control (studies don't necessarily indicate that masks provide any measurable level of disease prevention in this scenario, or at least it's difficult to prove any positive impact) and to avoid blood and other bodily fluid splatters, it's common to see TV physicians and surgeons without proper protective gear. It's also common to see improper hand washing [source: Phend].

Physicians Do It All
ERs are run by whole teams of trained staff. © michaeljung/iStockphoto

ER doctors evaluate, treat, and then either discharge or admit each patient who visits the emergency department, from major trauma cases to non-life-threatening, minor injuries. While it's true that practicing emergency medicine requires physicians to hold knowledge and skills that extend across many fields of medicine, from surgery and internal medicine to pediatrics and psychiatry, that doesn't mean an emergency physician is a one-person show. ER doctors spend only about one-quarter of their shift directly with patients; in comparison, nurses spend about 37 percent of their time directly caring for patients [sources: Füchtbauer, Westbrook].

But fictional ER doctors are often seen doing pretty much all the work you'd normally expect to see managed by other members of the emergency medical team. For example, they might insert an IV (usually handled by a nurse), operate specialized equipment such as MRI scanners (usually handled by a technician), and take care of duties that normally fall to nurses, technicians, pharmacists, surgeons and other specialists. It takes an entire team of trained staff to run an ER, but on TV, the docs often seem to handle it all.

How and When to Use the Defibrillator
“I know it will void the warranty to rub these together, but it looks so cool when they do it on TV!” © sudok1/iStockphoto

You know (from watching TV, most likely) that when a patient is in cardiac arrest the defibrillator is going to come out. And if you believe what you see in your favorite TV emergency room, it's quite a dramatic survival tool for saving flatlining patients. Paddles are rubbed together, someone yells "CLEAR!" and then one big shock is delivered to the patient's chest. He jerks, probably violently, and then you hear the sound that's always music to the entire fictional ER team's ears: the beeping of the heartbeat on the heart monitor.

But defibrillators don't work that way. In reality, a defibrillator sends an electric shock to a heart to reset a rapid or uncoordinated heart rate. (The irregular contraction of heart muscle fibers that causes this condition is called fibrillation, thus the name of the device). It can't restart a heart once it's stopped beating, though. And rubbing those pads together? Only if you want to void the warranty on the equipment. It can permanently damage the device.

CPR Survival Rates
CPR has saved many lives through the years, but unfortunately, it’s not as successful in the real world as it is on TV. © windcatcher/iStockphoto

If you were to believe what you see on your favorite medical drama, most patients requiring cardiopulmonary resuscitation (CPR) survive after being resuscitated. Additionally, those patients are primarily young, otherwise healthy people who have been shot, for instance, or injured in a car accident [sources: Stix, Duke Medicine].

CPR has been an essential emergency medical treatment since its introduction in 1960, so it's no surprise how prominently it's featured on TV medical shows. Fifty years after the debut of CPR, more than 14 million people worldwide undergo training on the lifesaving technique annually [source: AHA]. But if you base your CPR knowledge on what you see on TV — like 70 to 92 percent of U.S. seniors do — you're in for a surprise. In reality, most of the patients who need CPR are elderly or have chronic conditions such as heart disease. The majority either won't survive the resuscitation, will die shortly after resuscitation, or will never recover from the brain damage resulting from oxygen deprivation related to cardiac arrest [source: Duke Medicine]. While more than 75 percent of resuscitated TV patients immediately go home and on with their lives, the actual survival rates fall between 2 and 40 percent if the CPR's performed outside of a hospital, and between 6.5 and 15 percent when the CPR's performed inside a hospital [source: Stix].

Always Time for a Quickie
Ummmm … no. © iofoto/iStockphoto

It's not only measles lingering in the air of emergency room. If you believe what you see on TV, love is also in the air. Or, at least, lust. Just look at how busy the on-call room is on "Grey's Anatomy" alone: Cristina and Burke in the on-call room, Callie and Mark in the on-call room, Addison and Alex in the on-call room, Meredith and Derek in the on-call room.

In reality, physicians and surgeons rank No. 6 among professions most likely to find love at work, but medical professionals are missing from the top 10 most likely to have an office fling [source: PayScale].

But realistically, there's just not time for hanky panky in an ER. The wait times at hospital emergency departments are legendary, and that's partly because of a never-ending line of incoming patients. Finding a moment to wedge in a bit of romance would likely only make the lives of doctors, nurses and other staff harder as they struggle to make up for time lost to trysts.


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Author's Note: 10 Completely Unrealistic Moments in Television ERs

Ever notice that House uses —OK, used — his cane wrong? It should be on his body's strong side, but he uses it on his limp side. Or was that an intentional quirk of character? If he has a reason, I missed it. And while we're on the topic: Have you noticed how many medical professionals across many medical shows aren't correctly wearing their stethoscopes and need to turn them around?

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