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Vet Talk

Medical Mistakes as Seen on TV
August 20, 2018 (published)

I love watching detective shows, especially binging BBC reruns on Netflix. Watching the forensics and emergency medicine parts often make me cringe. Not because it's gory; I've been known to happily eat fried rice while watching maggots crawl out of wounds, but because too often the science is just so wrong. Finding a science advisor isn't that hard, people!

My top ten sneer-inducers:

  • DNA tests done in 15 minutes or less. One or two days is the best case; add in the realities of bureaucratic red tape, understaffed or busy labs, and shipping times, it may take weeks to get DNA results. And the DNA test is not going to tell you to look for a left-handed tall man with a pot belly and a limp. It's good at telling you if the blood found at the crime scene does or does not match the suspect you've found through other means.

  • Toxicology tests that identify super rare poisons. A person that collapses and is rushed to the ER will likely have toxicology testing done, but it will be a standard panel looking for standard things like heroin or antifreeze. I don't know if there's a test for Guatemalan tree frog venom; I do know that test would only be run if there's high index of suspicion, like someone seeing a Guatemalan tree frog hopping away from the collapsed person. And toxicology tests also take longer than 15 minutes, by the way.

  • Broken legs splinted with chop sticks and a bystander's belt. That just plain doesn't work. You need to support the leg with a stiff material (e.g., a broom stick on each side) and then wrap the whole thing up like a mummy. If you don't have that mummy wrap include the joint above and below the fracture, you've done nothing to prevent that fracture from bending like a door hinge. And no matter how well you've splinted it, don't think they're walking ten miles through the woods on that leg: it's never THAT stable.

  • Any scene with CPR. We've all seen those shows where the elderly heart transplant patient lies in the hospital bed and suddenly flat lines. A flurry of white coats, some calls for '50 of adrenaline', and a few jolts from the defibrillator later and the patient sits up asking for lunch. After the commercial break, they're walking out of the hospital ready to live happily ever after. In reality, in humans CPR is effective only 15 to 20 percent of the time (for 24 hours afterwards, not necessarily to discharge) and that's under the best of circumstances, say a healthy adult that hemorrhages in surgery. In pets, it's between four and nine percernt, depending on the study and the species. A chronically ill patient might be resuscitated for a few minutes, but will probably crash again 20 minutes later and never regain consciousness before dying for good.

  • Screaming STAT down the hall, prompting a stampede of doctors. Group text messages to staff cell phones and calm overhead announcements of, 'Paging Dr. Blue to 214,' are how codes are broadcast. The available personnel then walk briskly to the patient - running not only looks unprofessional, it's more likely to result in falls and collisions than faster arrivals. Also, the only time you actually use the term 'stat' is on the paperwork when sending blood to the lab. Everyone in the room while a code is in progress knows things are urgent; you don't have to tell them every other sentence.

  • Developing a vaccine for a new disease in a of couple days. Influenza is a common virus affecting millions of people and animals of dozens of species every year. That virus has been studied for over 100 years and it still takes months of planning and development before the annual vaccine is available in your local pharmacy. Even vaccines for viruses that don’t shift/mutate each year require weeks or months of production time. Vaccines for never-before-seen diseases? That takes years to identify the virus or bacteria responsible, figure out how to isolate the antigen that will induce immunity without inducing the full-blown disease, test the vaccine, design a production process, and then actually produce and ship the vials of vaccine. There's no way you can identify disease X on Sunday and have all of New York City vaccinated by Saturday.

  • Maintaining a clean business suit or high heels and pantyhose in a barn. Veterinarians wear coveralls or scrubs when they're working on livestock. You want clothes you can move in and you don't mind getting dirty. Anything white and starched is a magnet for manure, blood, snot, dirt, and everything else on the OxyClean commercials.

  • Neon fluids in a beaker. Why is no TV laboratory complete without at least one container of some neon green liquid bubbling away in the corner? The only fluid that color I know of is antifreeze. I'm not sure I'd ever want to boil it. /shrug

  • Skin sutures to stop massive hemorrhage from gunshot. It's not enough to keep blood in the body; you need to keep it in the vessels so it goes to the organs. A few randomly placed skin sutures with nasty old fishing line just isn't sufficient, even if they're placed without anesthesia so we can see the actor grimace attractively.
    9b -- A corollary to this is the absolute need to remove the bullet as soon as possible. Removing the bullet is not a cure-all. In fact, removing the bullet before the patient reaches the ER or OR can prove fatal. The bullet often works as a plug; removing the plug before you're ready to do a full repair is a bad idea. I love the way that the bullet goes plink into the tray, and everybody breathes a deep sigh of relief, and the patient sits up and asks for tea exactly like he's just recovered from CPR.

  • Talking someone through surgery over the phone. You need to have a common vocabulary and basic surgical knowledge first, so an OB surgeon could probably talk a new intern through an emergency c-section but even the best surgeon couldn't talk a kindergarten teacher through treating an abdominal gunshot wound. I imagine this dialogue:

Bystander: So I found this guy on the corner. He's been shot but I've done CPR and he's sitting up talking, but the bullet's still inside.
Surgeon: Okay, I'm sure I can walk you through an exploratory laparotomy. First, make a midline incision and see which organs are damaged.
B: Okay, I've got the scissors.
S: No, use the scalpel… The x-acto knife thing. Start cutting from the xyphoid process to the umbilicus. Er, from the solar plexus to the belly button.
B: Okay, I can see inside. There's blood spurting out of the big round thing.
S: Stick your finger in the hole and tell me which organ. Liver, spleen, intestine…?
B: It's red and kind of squishy.
S: Okay, is it a reddish brown or red-red? How big is it?
B: It's kind of purple. Let me shove this other thing out of the way…
S: What other thing?
B: Oh, cool, the blood stopped spurting! Is this where I staple it up now?
S: No, we have to figure out which organ before we know how to seal.
B: Okay, I've wiped all the blood out and all the gauze is in.
S: All the gauze? Where?
B: Next to the long grayish red thing. It used to be more red. Is that a problem?
S: Never mind. I think he bled out.

I've only covered a few of the common medical/scientific screwups in TV and movies. There are tons more… but I'll keep watching my detective shows, even if I do yell at the screen a fair amount.

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