Friday, 7 August 2015

Top 10 Medical Tropes that Wind Me Up

Health and disease play a major role in most fiction, whether it's violent trauma or a terminal diagnosis. Even if the show/ book/ film isn't primarily medically focused, sooner or later someone's going to break an arm, get shot or find out they've got a brain tumour.

However, since most writers are not medically trained, many tend to skip over research, and as such we have some well-embedded, if extremely false, tropes prevalent throughout our entertainment media. Most go unnoticed, but for doctors like me it can lead to a lot of eye rolling!

So here are the top 10 Medical Tropes that Wind Me Up (in no particular order):

10. The absent anaesthetist/ medical team

Whenever anyone needs some form of surgical intervention, the surgeon seems to also be the assistant, the anaesthetist, the scrub nurse and the operating department practitioner. The surgeon puts the patient under, does the job single handedly, and the result is always a miracle cure and speedy recovery, rather than the disastrous infection and bleeding rate and more than likely dead patient if this happened in the real world. No wonder surgeons used to think they were God...

9. Consultant Physician Surgeon Obstetric General Practitioner (

Similar to the absent anaesthetist, this is the 'doctor/ healer' character who caters for the entirety of medicine and surgery. Broken bone? No problem. Childbirth? An expert. Ear ache? I can fix that. Need a hysterectomy? Sure! This one doctor has the specialist skills of twenty, she's your one-woman hospital, because come on, it's not like we have specialists for a reason. Your (fantasy) GP can sort it out.

8. Clean, Pretty, Reliable (CPR)

Cardiopulmonary Resuscitation is a key part of emergency first aid for a patient who's stopped breathing and has no pulse. Whether it's just the Basic Life Support (what non-medical people can be trained to do) or the Advanced Life Support (complete with ECG reading, IV drugs to give and the famous 4 H's and 4 T's), it's not surprising that it's featured a lot on media. It's pretty dramatic, and suspense sells, right?

Except on TV etc it's made as pleasant as possible. Whether it's the hero getting a chance to 'kiss' their lover who they haven't revealed their feelings to yet, or the extremely exaggerated success rate (up to 75% on TV, where in reality it's a lot lower, between 37-52% [source]).

CPR is also meant to be the definitive 'life saving' technique. And of course the patient can just get right back to whatever they were doing (we already established anaesthetists don't exist, so who needs ITU and post arrest support, eh?). Not to mention that survival to discharge rate in real life is as low as 11%...

7. One Dose Fits All/ Instant Sedation

Whether it's an assassin planting poison or a princess trying to knock out her guards so she can escape to freedom, whatever dose of sedative or chemical they choose, it's equally effection on all parties and within the same time frame. Never mind size, weight, gender, liver capacity and genetic metabolic processes. If only real medicine was as easy as 'take two and call me in the morning'...

6. Radiograph of Doom

So, we're in hospital, our character (with the Cough That Never Goes Away) has just had their first CT/ CAT scan...and the entire crowd of nurses, doctors, students and even the janitor can see it's clearly a T4N3M1 lung cancer.

Which in reality is a complete farce. While junior doctors and nurse practitioners are trained to read simple X-rays (as I've detailed in my post on medical imaging), and some subspecialties can interpret images directly (such as rheumatologists doing joint ultrasounds), more complex scans like ultrasound, CT and MRI need a radiologist's trained eye to find the subtle changes and give a formal report. Particularly staging scans, which look for spread of a tumour throughout the whole body (or in some cases where the primary tumour is, as a metastasis could have been picked up incidentally).

5. Blood From the Mouth (

Bleeding from the upper oesophagus/ stomach/ small intestine is a very common medical problem...and one the media love to use for ANY penetrating wound to the chest/ abdomen. Got shot or stabbed? Gotta have that FRESH blood pouring from the lips, so the audience knows it's a bad wound. Even if the shot is in the abdomen or no way near the chest.  Perhaps it's a spontaneous gum bleed triggered by the trauma.

4. Televisually Transmitted Disease

Let's be honest here; common things are common. As ridiculously obvious as this sounds, this also turns out to be pretty boring. I mean, who wants to watch about a COPD patient coming in with their eighth exacerbation this year, or the patient with lower back pain who just needs some extra pain killers? No no, that will not do!

So we end up seeing extremely rare conditions being diagnosed far more often than in real life. While this is (sort of, not really) acceptable in series like House which is all about rare diseases (or more often rare PRESENTATIONS of COMMON diseases), it gets really annoying seeing it all the time. That cough that's more than likely undiagnosed asthma just HAS to be cancer.

3. Worst Aid

Don't try this at really, we mean it. These are the wild and wacky 'treatments' that seem to have no consequence when used in media. Just had a terrible car accident? Well let's just pull the victim out, and probably sever their spinal cord in the process. Got a sword through your arm? Just pull it out, you'll be fine, or more likely lose your entire blood supply in under a minute. Spent a few hours in a freezing river? A lovely hot bath will do...if you want to mess up your core temperature even more by causing redistribution of internal fluids.

There's no excuse, writers; do a little bit of research!

Check the link for plenty more examples!

2. Magical Defibrillation

Oh no, that annoying 'beeeeeeeeeeeeeeeeeeeeeeeeeeeeeep' is sounding on the monitor, there's no electrical response from the patient's heart, therefore we must...NOT shock!

Despite what TV will tell you, asystole (whether the heart stops beating altogether) is a NON-SHOCKABLE RHYTHM! This needs treatment with IV medication ASAP, as does PEA (pulseness electrical activity, where you see the 'normal' ECG trace but the patient lacks a pulse, which is the COMMONEST of in-hospital cardiac arrest rhythms).

On the other hand, pulseless ventricular tachycardia (where the bottom chambers of the heart beat themselves into oblivion and can't push any blood out, hence no pulse) or ventricular fibrillation (where the heart just flutters) ARE shockable rhythms, and patients can respond very well to this.

Thankfully the AEDs available to the public do not give bystanders the option to interpret the heart rhythm, and give direct instructions on when to shock and when not to shock. Imagine the chaos if that wasn't the case!

1. Magic Antidote/ Instacure

Human physiology is complex, and even more complex is the pharmacology that goes with it (how medicines interact with our bodies). Why else does Big Pharma spend so much money on research and trials? It's not easy to find that 'silver bullet' that will help attack the disease but leave the rest of the body unharmed.

But nope, not on TV or in film. We don't need to be hindered by things like antibiotic resistance, side effects or allergic reactions; a dose of whatever it is always works, and it doesn't matter how long the poison/ whatever was in your system, you'll be cured of all complications as well. You don't even need a course, just a one off dose will do.

So those are my hang-ups with medicine in the media! Does anything wind you up? Let me know!