Mar 13, 2009

What can we learn from TV?

Last month, our poll asked you to pick the show you thought most accurately portrayed working in health care - E.R. won, followed by M.A.S.H. and Scrubs. House and Grey’s Anatomy get honorable mentions. I don’t usually watch much T.V., but when I do, Iend up watching one of the many shows related to health care. It gets worse – I find myself relating most of what I see to the work that we do. You can't help but notice the many examples of quality and patient safety issues that come up. Here are a few...

I couldn’t sleep the other night, stumbled into my living room during the wee hours, and flipped on the TV. I landed on TV Land and watched an episode of M.A.S.H. By the way, M.A.S.H. = Mobile Army Surgical Hospital.

Teamwork and communication. Alan Alda’s character (Hawkeye) works with a visiting surgeon. You know they’re off to a great start when the surgeon picks on the way Hawkeye washes his hands. They butt heads and can’t agree on what should be done to the patient. The medic assistant finally tells them to stop bickering and save the patient. Then, the camp is hit. Both surgeons fall; one breaks his right arm, the other his left wrist. Can you guess what happens next? They suture the patient together - one working with his left hand, the other with his right. In a very utopian fashion, they defer to one another regarding what’s best for the patient and agree on everything; smiles and all! Perhaps this it wasn't entirely realistic, but it reminds us how important teamwork and communication are, especially during stressful situations.

Surgical Safety. If you caught last night’s E.R. episode, the surgeon enters the O.R. in a rush, ready to jump in, but Eriq La Salle's character (Benton) stops the team from proceeding. They perform a time-out and use a surgical checklist. The surgeon again tries to hurry the team, but Benton tells everyone to "slow down, this will only take a minute." Aside from the checklist, you'll notice Benton also reminds the surgeon the use of antibiotics 6o minutes prior to incision cuts the risks of infection by half. I might have to start watching E.R... (Fran Griffin, thank you for sharing this clip today.)

Blame. I caught part of Grey's Anatomy last night. It looks as though Patrick Dempsey’s character (Derek aka McDreamy) is blamed for "messing up" a surgery on the last episode, resulting in the patient's death. The patient's husband sues McDreamy. After giving his deposition, we find Derek sitting in front of a stack of files. The files represent patients who died while under his care; he realizes he has lost more patients than he has saved. Derek goes into a deep depression and refuses to perform any surgeries, despite being one of few neurosurgeons in the hospital. Blame doesn't do anyone any good.

Hand Hygiene & Infection Control. There’s an old episode of Scrubs that shows the importance of hand hygiene and infection control. In the opening sequence, a bird flies around the waiting room. When asked why the bird hasn’t been removed, the janitor tells him the patients like it! Then, a bit of foreshadowing occurs. Dr. Kelso says,

“Do you know the number one cause of death in a hospital? Infection! And do you know how quickly infection can spread in a hospital...infection can start with a simple sneeze, and then a handshake, perhaps an accidental collision, and a simple touch on the shoulder...and just like that, you have a patient in trouble.”

Later, a character named Cabbage picks up a piece of trash before entering a patient’s room. When he touches the trash, his hands glow. Then, he shakes the patient’s hand, she turns green, (spoiler alert) and dies in the next episode due to an infection. The glow is a great visual of how quickly and easily infection can spread. [While I’m unable to pinpoint infections as the leading cause of death in U.S. hospitals, I can confirm hospital-acquired bloodstream infections are a leading cause of death in the U.S. and medical errors are the 8th leading cause of death in the U.S.] (Thank you, Dr. Rainu Kaushal, for sharing this with me last year.)

Where can I watch these episodes?
1. M.A.S.H.: “Lend a Hand
2. E.R.:

3. Grey's Anatomy: “I Will Follow You Into the Dark”

4. Scrubs: Intro: "My Cabbage

and End: "My Cabbage"

1. What examples of quality and safety have you seen when watching these types of TV shows?
2. What examples do students see in TV shows in other countries?
3. What do you think the effect these have on the audience when they see, for example, poor teamwork or errors?


Eva said...

If you continue watching the ER epidsode "Old Times," around 35 minutes and 40ish seconds a complication occurs and having reperfusion solution on hand (not available until checklist reminded surgical team that it was needed) helped save the day! Dr. Benton then uses the opportunity to highlight the importance of the checklist and the surgical intern closes the scene by saying, "where can I get a copy of that checklist?"


Eva said...

For all of you Scrubs fans out there, read this interview with Scrubs medical advisor, Dr. Jonathan Doris!