Dealing With The Truth

and so yours truly is on leave, and was casually reading the papers during breakfast this morning, when she came across this article –

Medical dramas give patients false hope

Washington: People love watching television doctors working miracles on patients with mystery ailments or devastating injuries but these medi-dramas are feeding patients unrealistic expectations, experts warn.
Viewers glued to weekly installments of fictional doctors ordering batteries of diagnostic tests and unorthodox medical treatments can be forgiven for believing that rafts of examinations and aggressive interventions are the norm.
But US experts said hospitals are unable to provide the cure-all solutions found on programs like the rabidly popular House, starring British actor Hugh Laurie as the maverick medical genius Doctor Gregory House.
Research also suggests aggressively treating some ailments can do more harm than good, they said. “The shows do tend to be very activist, very interventionist, very aggressive with their care…because action is more interesting,” said Andrew Holtz, a medical journalist and author of a book on House. “You get the pressure to have aggressive medical intervention that almost always works and that’s just unrealistic.”
Not only does such treatment often fail to work, Holtz noted, but sometimes it can have side effects that outweigh the benefits.
“People don’t see that on television,” he said, adding that medical dramas contribute to a false conviction that any ailment can be cured.
Medical professionals often provide the background material that television writers use to script the unusual illnesses that afflict their unfortunate characters. Allan Hamilton, a script consultant for the popular medical drama ‘Grey’s Anatomy’, is also the chairman of the surgery department at the University of Arizona Health Services Center. “They’ll say ‘we need a disease that looks like a person’s going to die, but then there’s this one thing that tips them off that they need to do further diagnostic tests.’ Or ‘we want a patient who is doing really well and everyone’s really happy and then something goes dreadfully wrong,’” he said.
“I always joke with the writers, you know, ‘this wouldn’t really happen or that wouldn’t really happen’ and then they turn around to me and say ‘yeah, but this is Hollywood, anything can happen.’”
As a medical professional, Hamilton is wary of the effects that depicting experimental treatments can have on viewers. “Are we going to suddenly raise people’s expectations? You do worry about that. People see this and there’s a question in their mind, ‘well are there people like that that we could find…is there a House that could fix me?’” AFP

as a doctor who was previously hooked on medical dramas, it does not come as a surprise that half the things mentioned on the telly almost never happen in real life. i remember someone commented about the show House, where the lead character and his team take on cases where the diagnoses have eluded others, saying that House would never have passed the MBBS, because his top differential was way too rare. such things make for exciting television, and even as medical professionals many of us continue to be glued to the screen week after week. deep down inside however, we know otherwise.

hopes are easily raised. i mean, even the BMJ has an article about false hopes raised by tv dramas! i know most doctors are always cautious in outlining treatment and explaining outcomes, but just as dr hamilton says in the article, it is hard sometimes to explain to patients and their relatives the reality of the situation.

but even without hollywood's interference, there will always be people with unrealistic expectations. case in point, yours truly has a patient in her ward with hypoxic encephalopathy, and hence is, well, a vegetable. infection after infection has set in with several close calls, but the family still insists on full resuscitation despite months of hospitalisation. then there was this time when there was a stand off between an a&e registrar and a family hell-bent on micu admission for a relative that had poor pre-morbids and wasn't doing very well. these cases aren't as simple as they sound of course, but you get my point. so no matter how hard you explain and paint the bleakest of pictures if we proceeded according to the family's wishes, some patients are just tossed back and forth.

we of course already have something in place - the DNR order, which some seniors are more enthusiastic to sign about, just so that we can avoid ugly scenes when a patient deteriorates. someone just asked me recently, how do you communicate a decision for DNR to relatives? most times, the truth hurts, but the best thing, in my opinion, is to let a person go peacefully when the time comes. which is what i say, and which is what most relatives accept.

but it is always at this point when dr house steps in, grabs a defib pad, and saves the patient.