TV Docs

[OSUdoc08]

What is your problem? Obviously, I either didn't watch it or I did and just didn't know. But no, I didn't watch it.

Read my signature...

and give respect to the Cosby.

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[mysophobe]

Your posts on the other thread make it a little hard to decipher what really is sarcasm, but aforementioned sarcasm noted and stored. I pay respect to the Cosby everytime I tell someone I have to take a dump.

 

[Sammich81]

I'm watching House right now and the white young doctor and the woman are performing a colonoscopy on a non-sedated female patient.

The best part is when the young male says to the patient "I need you to relax your anus".

YESSSS!!! I am on medicine right now and I am definitely using that the next time I have to do a rectal which will be...four times tomorrow most likely.

I am going to be the outlier and say that I love Grey's Anatomy. I don't expect it to be real! I just want to watch the pretty people and laugh about how badly they screw up their personal lives. Although hearing Sandra Oh mispronounce hemachromatosis DID screw up the way I said it for about a month.

And on the topic of accuracy...man...hospitals are so incestuous. There is PLENTY of hooking up between med students/residents/fellows/attendings, in varying combinations. They're just not as attractive as the people on the show.

 

[mysophobe]

Grey's Anatomy mega sucks.

House sucks.

ER sucks now.

Scrubs is hilarious.

 

[OSUdoc08]

Grey's Anatomy mega sucks.

House sucks.

ER sucks now.

Scrubs is hilarious.

BEST post ever.

 

[mysophobe]

Second only to that one.

 

[Idiopathic]

That British girl was on more than a 1 month rotation in the ER, and there's no way in hell they would have ever given her a residency.

There is no way the medical students would be given the independence they have, either.

Oh, I see. I was talking about the actual medicine stuff. Plenty of things go in for dramatic purposes, but the medicine is often right on.

 

[Idiopathic]

BEST post ever.

Get a room.

 

[mysophobe]

There's a key waiting for you under the mat.

 

[Sylphs]

I was just watching Scrubs and the main character bitches about being paged to start somebody on LMW vs unfractionated heparin, which are apparently the "exact same thing."

I'm not even close to med school, nor will I ever be, but I know this is wrong.

 

[APACHE3]

I was just watching Scrubs and the main character bitches about being paged to start somebody on LMW vs unfractionated heparin, which are apparently the "exact same thing."

Actually they are NOT the same thing (i didn't see the show), LMW has better (different) bioavailibility, less dosage regiment and less scrutinty of coags..personally I should read up more on when to choose LMW over unfract. heparin, but there are scenarios that call for just that.

 

[Skrubz]

I was just watching Scrubs and the main character bitches about being paged to start somebody on LMW vs unfractionated heparin, which are apparently the "exact same thing."

Actually they are NOT the same thing (i didn't see the show), LMW has better (different) bioavailibility, less dosage regiment and less scrutinty of coags..personally I should read up more on when to choose LMW over unfract. heparin, but there are scenarios that call for just that.

LMW (specifially enoxaparin) can be used on an outpatient basis for anticoagulation. it's more reliable than coumadin, though it involves sub-q injections. the longer half-life compared to regular heparin is a double-edged sword - you don't have to administer it as an infusion that may need adjusting every few hours but if you give it and the guy starts to bleed out, you're SOL. also, there's no reversal agent (like protamine) and there's also no good way to monitor efficacy (such as PTT or even INR). You can measure anti-factor X levels, IIRC, but they aren't very helpful clinically. and the dosing regimen for the obese (>100 kg, i think) is sketchy.

but still, i loved it as an intern. no more needing to write out the heparin sliding scale...

sorry to hijack the thread.

 

[Mumpu]

A heparin is a heparin is a heparin. The mechanism of action is the same. UFH is ground up pork gut which contains everything and hence somewhat unpredictable action. As you get more purified (LMW to fondaparinux), you get a more predictable effect.

Amuzing hijack on reversability. People won't think twice about putting someone on aspirin but start screaming about ICH with warfarin. The rate of ICH is the same and guess which one cannot be reversed?

 

[remedios]

A heparin is a heparin is a heparin. The mechanism of action is the same. UFH is ground up pork gut which contains everything and hence somewhat unpredictable action. As you get more purified (LMW to fondaparinux), you get a more predictable effect.

Amuzing hijack on reversability. People won't think twice about putting someone on aspirin but start screaming about ICH with warfarin. The rate of ICH is the same and guess which one cannot be reversed?

To be fair, it's much easier to overshoot the INR than to overshoot ASA 325mg qd...

 

[remedios]

Two glaring mistakes on scrubs tonight!

First, waiting for a donor for a heart VALVE transplant??

Second, Turk pronounced "maxine notrope" for "max ionotrope"

But otherwise good episode...

 

[lateness]

Grey's Anatomy mega sucks.

House sucks.

ER sucks now.

Scrubs is hilarious.

i agree with the above , except i hav a feeling that scrubs is going to get less funny and suffer the fate as the ER did.. this after i saw a commercial where it looks like everyone is all serious.

 

[lama]

Grey's Anatomy sucks.

House sucks.

ER sucks .

Scrubs sucks.

I dont waste my time with any of them.

Everybody knows Nip Tuck is the ONLY "medical" show worth watching. It's as real as it gets...cocaine, Lamborghinis and fine ass women. Ah yeah!

 

[Skrubz]

Two glaring mistakes on scrubs tonight!

First, waiting for a donor for a heart VALVE transplant??

Second, Turk pronounced "maxine notrope" for "max ionotrope"

But otherwise good episode...

Heart Valve Transplantation

i think he was trying to say "max inotropes", which is the correct spelling.

another thing that was wrong/off... if you donate a kidney, i don't think the incisions are inguinal (i think they just made the "scars" too low).

 

[Mumpu]

The incisions for kidney removal are actually at the CVA angle in the back. This was purely for comic effect. Very good episode, by the way. I feel like Scrubs is the only medical show that actually "gets" the ups and the downs of doctoring (Season One was particularly good in that respect).

Remedios, no one actually knows how much ASA you need or how to measure its activity (a bleedin' time I suppose, but it's not standardized to any desirable level of platelet inhibition). Aggrenox uses 25 mg BID (if I recall correctly), baby is 81, adult is 325, what they use in Europe is totally different. Some studies claim 20 mg a day chronically is sufficient to maintain antiplatelet activity. INR makes people freak out but it's an exponential scale of sorts, so 3 vs 4 vs 5 is not all that big a deal and IIRC bleeding risk doesn't really go up until you get over 10.

 

[Skrubz]

The incisions for kidney removal are actually at the CVA angle in the back. This was purely for comic effect. Very good episode, by the way. I feel like Scrubs is the only medical show that actually "gets" the ups and the downs of doctoring (Season One was particularly good in that respect).

i thought as much, but one of the references i was reading made mention of a frontal/peritoneal approach. the retroperitoneal approach makes more sense logistically, though.

i agree that Scrubs, especially the early seasons, portrays what it feels like to be a physician, specifically a resident. i've lost count of the times that i've sat back after finishing an episode and realized that i've had the same emotional experience.

 

[mysophobe]

Second, Turk pronounced "maxine notrope" for "max ionotrope"

I heard him say it right, but maybe my brain just corrected it automatically. But anyway, it's scrubs. Half the time they don't even do anything related to medicine in that show except do the scenes in a hospital. Who cares if they get a little of it wrong? It's a funny show.

 

[remedios]

I heard him say it right, but maybe my brain just corrected it automatically. But anyway, it's scrubs. Half the time they don't even do anything related to medicine in that show except do the scenes in a hospital. Who cares if they get a little of it wrong? It's a funny show.

Don't get me wrong, I love the show, it's just that they are usually pretty good about the medical details, so it was unusual when they mess up. (if they messed up?)

@ Skrubz:

I didnt realize that about heart valves, but I would say if someone has an emergent valve issue they wouldn't have had to wait for a donor, as there are well-tested mechanical ones and bioprosthetics.

@ Mumpu:

I know that the antiplatelet effect occurs at lower dosage than we usually prescribe, and that you don't usually the bleeding time. I guess you are right thought in terms of risks of ICH, I just did a quick search and ASA is about 0.2-0.4 per 1000 pt year and Warfarin about 0.3-0.6 per 1000 pt year. Pretty interesting...

 

[mysophobe]

Don't get me wrong, I love the show, it's just that they are usually pretty good about the medical details, so it was unusual when they mess up. (if they messed up?)

Yeah, but I still heard him say it right. Scrubs' integrity is preserved.

 

[Loopo Henle]

Everyone is upset they said max inotropes wrong, but nobody is concerned that the crazy chick died suddenly of RABIES without any symptoms then everyone else dies of RABIES. Holy crap, that was a little far fetched dontcha think? Still I think Scrubs more accurately portrays medical life than most of the other junk on the tube except for that reality show (Nip/Tuck).

 

[mysophobe]

That's like when people nitpick about the speed of the helicopters in godzilla, while a giant 300 ton lizard is destroying new york.

 

[remedios]

Everyone is upset they said max inotropes wrong, but nobody is concerned that the crazy chick died suddenly of RABIES without any symptoms then everyone else dies of RABIES. Holy crap, that was a little far fetched dontcha think? Still I think Scrubs more accurately portrays medical life than most of the other junk on the tube except for that reality show (Nip/Tuck).

It IS possible that I heard it wrong.... but just because it's otherwise an excellent show doesn't mean we shouldn't hold it to high standards in terms of medical details too...

 

[DD214_DOC]

I'm lucky I don't start until August. In my ignorance of medical knowledge I can continue to enjoy these shows, or at least House and Scrubs. House is only good because the guy is such a dick, it's funny.

 

[remedios]

I'm lucky I don't start until August. In my ignorance of medical knowledge I can continue to enjoy these shows, or at least House and Scrubs. House is only good because the guy is such a dick, it's funny.

It's just more ways to enjoy it although my second or third year i was definitely anti-house and anti-grey's, but now i'm loving both of them for what they do well..

 

[Docxter]

Except it is something that is done, albeit rarely. Otherwise untreatable basilar aneurysms are treated by Spetzler at BNI this way. Read the book "The Healing Blade," and there is a new series on discovery health channel on just this operation.

Patients sometimes go on a pump for some aneurysms or intracranial bypasses so the circulation can be controlled and intermittently stpped, plus they can induce hypothermia. Correct me if I'm wrong, but I don't think they induce cardiac arrest anymore these days while the heart is still in the circuit. It's done at many places all over the country, not only at BNI.

 

[Docxter]

Remedios, no one actually knows how much ASA you need or how to measure its activity (a bleedin' time I suppose, but it's not standardized to any desirable level of platelet inhibition).

The Ultegra Aspirin test is now available to measure aspirin efficacy in platelet inhibition. Used routinely by cardiologists and stroke neurologists at my hospital.

The rapid assays to measure Plavix and IIb/IIa inhibitor efficacy are out as well.

 

[Mumpu]

Really? Is there literature other than studies paid for by the manufacturer to say it's actually clinically relevant or is it the next d-dimer?

Remedios, the "ASA good warfarin bad" is one of those stupid-ass medical myths that get perpetuated because some hairy-eared attending says so and refuses to believe the literature.

 

[W06]

Patients sometimes go on a pump for some aneurysms or intracranial bypasses so the circulation can be controlled and intermittently stpped, plus they can induce hypothermia. Correct me if I'm wrong, but I don't think they induce cardiac arrest anymore these days while the heart is still in the circuit. It's done at many places all over the country, not only at BNI.

In the hypothermic cardiac standstill operation the heart is put on bypass, arrested, and then for a period up to an hour the circulation is entirely stopped so that the dome of the aneurysm can be deflated and manipulated, clipped without danger of rupture, and so that small perforating vessels can be seen that would otherwise be obscured by the aneurysm.

At BNI where this technique was developed, they currently perform a handful (10-15?) of these procedures per year. They are used for only select patients because of obvious morbidity and mortality, but there is little alternative for giant basilar aneurysms not treatable by coiling.

J Neurosurg. 1988 Jun;68(6):868-79.
Neurosurgery. 1998 Jul;43(1):10-20; discussion 20-1

 

[caroladybelle]

LMW (specifially enoxaparin) can be used on an outpatient basis for anticoagulation. it's more reliable than coumadin, though it involves sub-q injections. the longer half-life compared to regular heparin is a double-edged sword - you don't have to administer it as an infusion that may need adjusting every few hours but if you give it and the guy starts to bleed out, you're SOL.

On an Outpatient basis... you better hope that your patient is either wealthy or has awesome insurance.

Many insurances at last check, (unless changed in the last 24 monthes- I haven't kept up with that part of it)do not cover enoxaparin outpatient. And given that the daily cost amounts to at least several hundred dollars up to $700 to $800, many of the patients that are in need of enoxaparin and could use, cannot afford it.

While that may have changed with latest version of medicare w/meds, they were notorious for denying coverage for OP enoxaparin. Sad but true.

As a note, this was discussed on a episode of ER, a few years ago.

-------------------------------------------------------------------------
As far as back to the topic:

Love "Scrubs" and have a crush on Zach.

Despise "Chicago Hope".

Am disappointed in the last 4-5 seasons of ER.

And laugh my butt off at the stupidity of "House" and "Grey's Anatomy".

(The "Rabies" episode of "House" stands out as overblown. The "rabies vaccination" of the intern - that involved what appeared to be a 20cc syringe and a 2 inch 14 guage needle - in the abdomen, played into the worst stereotypes. Not to mention the almost instantaneous incubation and onset of symptoms).

 

[fomites]

So I'm whiling away the remainder of 4th year by watching all four medical shows on prime time. The other night I had an epiphany about a simple classification system of the level of medical knowledge and the accurateness of the shows (Hard and easy refers to level of knowledge, right and wrong refers to accurateness):

1. ER-- Hard and right
2. House-- Hard and wrong
3. Scrubs-- Easy and right
4. Grey's Anatomy-- Easy and wrong (or, as my fellow TV watcher MSIV puts it, it's just wrong and wrong)


Discuss.

all those shows are gay, as in lame.

um, unkay, my favorite thing is how on these shows no one is sterile when they put in central lines and do invasive procedures. no gown, no mask, no sterile tray! Pretty damn awesome!

PS: oh yeah, I also like how House can do everything! He is a cardiologist, neurosurgeon, general surgeon, transplant surgeon, oncologist, ID specialist, pediatrician, etc, all wrapped in one.

 

[mysophobe]

Haha, I know. His residents too--who, by the way, are apparently only his and nobody else's. I saw ONE episode of Grey's Anatomy, and somehow some guy got a bomb stuck inside his chest. He was still alive, as was obvious by the miraculous NSR on the monitor. He wasn't intubated, there wasn't even an anesthesiologist or CRNA in the room, no nurse or scrub tech, and they all had bulletproof vests on TOP of their sterile garb. Oh, and when she reached up to pull her mask down so we could see her face and that tear go down her cheek, she was somehow still sterile.

None of those shows even come close to matching the level of awesomely badness that is Chicago Hope. I still laugh at that show.

EDIT: And how come on ER, the surgeons always start scrubbing for cases with their masks down?

 

[OSUdoc08]

Haha, I know. His residents too--who, by the way, are apparently only his and nobody else's. I saw ONE episode of Grey's Anatomy, and somehow some guy got a bomb stuck inside his chest. He was still alive, as was obvious by the miraculous NSR on the monitor. He wasn't intubated, there wasn't even an anesthesiologist or CRNA in the room, no nurse or scrub tech, and they all had bulletproof vests on TOP of their sterile garb. Oh, and when she reached up to pull her mask down so we could see her face and that tear go down her cheek, she was somehow still sterile.

None of those shows even come close to matching the level of awesomely badness that is Chicago Hope. I still laugh at that show.

EDIT: And how come on ER, the surgeons always start scrubbing for cases with their masks down?

You obviously didn't watch the whole episode. The anesthesiologist was the second to last person in the room, until he handed the paramedic girl the BVM and ran out of the room. Also notice that the paramedic girl who had her hand stuck inside the chest holding the bomb was never sterile at any point anyway.

 

[mysophobe]

No, I didn't. It was part of that "Under Pressure" thing, and I got the whole story from someone else. Obviously, they were mistaken. From what I understand, that paramedic girl was that surgeon girl, not a paramedic. But, I don't watch the show, so I could be wrong. Either way, it sucks.

 

[mysophobe]

And why was a paramedic wearing a gown, gloves, mask, cap, and acting like she was sterile if she wasn't?

 

[OSUdoc08]

And why was a paramedic wearing a gown, gloves, mask, cap, and acting like she was sterile if she wasn't?

The paramedic was wearing a paramedic uniform. It was her and the anesthesiologist and then he ran out of the room and left her alone.

Later, Grey, the main character, took over for the paramedic girl. Sterile field was no longer a concern at this point. Grey just didn't change out of the surgical attire when she returned to the room. She had already left and didn't remove the attire.

 

[Sugar72]

On an Outpatient basis... you better hope that your patient is either wealthy or has awesome insurance.

Many insurances at last check, (unless changed in the last 24 monthes- I haven't kept up with that part of it)do not cover enoxaparin outpatient. And given that the daily cost amounts to at least several hundred dollars up to $700 to $800, many of the patients that are in need of enoxaparin and could use, cannot afford it.

While that may have changed with latest version of medicare w/meds, they were notorious for denying coverage for OP enoxaparin. Sad but true.

As a note, this was discussed on a episode of ER, a few years ago.

-------------------------------------------------------------------------
As far as back to the topic:

Love "Scrubs" and have a crush on Zach.

Despise "Chicago Hope".

Am disappointed in the last 4-5 seasons of ER.

And laugh my butt off at the stupidity of "House" and "Grey's Anatomy".

(The "Rabies" episode of "House" stands out as overblown. The "rabies vaccination" of the intern - that involved what appeared to be a 20cc syringe and a 2 inch 14 guage needle - in the abdomen, played into the worst stereotypes. Not to mention the almost instantaneous incubation and onset of symptoms).

Literature also suggests that lovenox is extremely unreliable in obese patients and thus not recommended for them for prophylaxis or treatment of DVT's.

Additionally, I freakin love Grey's anatomy. I think either you have the gene for appreciating bad tv (medical or not) or you don't....and I have been lucky enough to get this gene. The more ridiculous the better.

I am so glad someone mentioned Chicago Hope - My favorite episode was when one of the surgeons was on his way home from dinner after having a couple of beers and comes across a car accident and decides (based on his drunken physical exam) that the driver has transected great vessels and proceeds to use a chainsaw to cut off his leg to free him from the crash so he can get to surgery faster. Oh and I am pretty sure the chainsaw wasn't sterile.

 

[Mumpu]

The US healthcare system cracks me up. Insurance companies won't pay for outpatient LMWH but will pay for 5 days of hospitalization to get warfarin to the therapeutic level.

House is an ID doc apparently. His peons are actually not residents, they are physicians. I had to read Wikipedia to gather that bit of info.

 

[shtarker]

House is dual certified in nephro and ID, not that anyone really cares...

 

[OSUdoc08]

House is dual certified in nephro and ID, not that anyone really cares...

Which is exactly why I'm confused as to why he ran a code in the ER on one episode. The fact that he used the wrong ACLS meds made it evident that he did not belong there, nor anywhere near any patients.

Due to his bedside manner, he'd make a great pathologist.

 

[mysophobe]

The paramedic was wearing a paramedic uniform. It was her and the anesthesiologist and then he ran out of the room and left her alone.

Later, Grey, the main character, took over for the paramedic girl. Sterile field was no longer a concern at this point. Grey just didn't change out of the surgical attire when she returned to the room. She had already left and didn't remove the attire.

EDIT: Read the second part of your post. I only saw the second part of the clip after Grey went back in, as it was part of that clips episode last week. If you look back at the episode, the monitor still showed NSR, so unless it was connected to Grey, the pt was still alive.

 

[igcgnerd]

As far as ER accurcay goes ive seen quite a few instances where there is a total lack of regurd for c spine immobilization and the residents and attendings seem to be on every service? I just wish I could work with doctors that could look like the actors.

 

[OSUdoc08]

EDIT: Read the second part of your post. I only saw the second part of the clip after Grey went back in, as it was part of that clips episode last week. If you look back at the episode, the monitor still showed NSR, so unless it was connected to Grey, the pt was still alive.

What does the patient being alive have to do with anything?

 

[Hurricane]

House is an ID doc apparently. His peons are actually not residents, they are physicians.

I thought they were fellows. I was watching one of the old eps the other day, and one of them was saying they put up with House's crap because it was a "very prestigious fellowship."

 

[Tenesma]

i realize these shows are TV shows and therefore are going to be riddled w/ inaccuracies and frought w/ love stories...

but what scares me is when I hang out with non-medical friends and relatives, they are convinced that Grey's Anatomy and House are EXACT duplicates of what happens inside a hospital... trying to argue w/ them about it is useless, because it is hard to prove to the lay person that there REALLY isn't that much CHAOS, DISORGANIZATION, HANKY-PANKY, HECTIC TO-AND-FRO in the hospital.

ER is a classic example of that - how often do paramedics bring in patients into the NBC ER with one paramedic straddled over the chest doing CPR, and as soon as they are in the trauma bay - a 1st year ER resident does a bed-side thoracotomy? About once every episode

How often in the real world level I trauma ER? NEVER...

i love watching Grey's anatomy cause the chicks are cute - but usually within 15 minutes i have to turn it off because it is soo darn irritating.


I am sure this rant is very similar to what Detectives think of Law & Order, Medical Examiners think of CSI, Lawyers think of L.A. Law, etc....

 

[Mumpu]

Ah yes, good old "code surfing." Only done that once. The frequency of ED thoracotomies seems to depend on how aggressive the trauma surgeons are. Our Level 1 county gets one every couple of weeks.

 

[mysophobe]

What does the patient being alive have to do with anything?

Er...um...nothing. Yeah, that's the ticket.