I ahve a question about how "real" ER is or isn't

[Disney1fan2002]

I watched a taped episode of ER last night. It was a couple of weeks ago, a repeat from the fall. It was the one about the surrogate mother refusing a c-section.

Could/would that be allowed to happen in real life? Her body, sure, but at full term, the baby is now a baby, and not a fetus, so, would her cncerns for what MIGHT happen during a c-section be enough for the Dr to just sit back and let the baby die..or be brain damaged, as this one was?

Also, wouldn't they have had a social worker assigned to the patient, to try to convince her to have the c-section?

I KNOW it is a tv show, and we need the drama, but I would hate to think women can refuse a c-section like that in real life.

 

[cardaway]

I don't know anything about the c-section specifics but I have met the consultant for the show. He comes to our company on a regular basis. They use our stuff exclusively for props and they have to be modified to be safe and show readouts when they are actually never hooked up ot a patient (we make medical equipment)

Yes, they try and make it as real as possible.

 

[BuzznBelle'smom]

One of the favorite "sports" in our house has been to watch the show and count the technical errors--we're both EMTs, so we have some medical knowledge. It gets irritating sometimes--you know a patient has lines when they're dying but not wearing a full O2 mask, just the nasal tube. That said, I generally love the show and never miss it.

As far as the woman refusing the c-section, I found the whole story line completely unbelieveable. She already had a child, knew how precious they are, doesn't want a c-section because she wants to go "natural" next time--any pregnant woman who has spent 5 minutes checking into c-sections know that this is a likely possibility, unless the c-section is an emergency one. And why would she let the baby be damaged or possibly die? And then you have Ray, there, saying over and over about the dangers and complications--you know darn well there are going to BE complications because the character just wouldn't shut up! I know there are all sorts of people inthe world, and some have some crazy notions about a lot of medical procedures, but to me, the whole plot line was just ridiculous.

 

[bicker]

As to the question whether a patient has the right to refuse any medical treatment they wish, including a C-section, I believe the answer depends on the state. ER is usually very good about being accurate to Illinois law, and so I would expect the answer to be use, the patient does have that right.

 

[Pea-n-Me]

As a hospital RN with ER experience, I personally cannot watch that show or ones like it. I get too frustrated with how nurses are portrayed and how what I'm seeing is not what it is like in real life. That is my personal experience. (FWIW, The closest thing I've seen to reality is the movie The Doctor starring William Hurt.)

From an entertainment standpoint I'm sure it is a huge challenge to present these situations that attempt to be both realistic and entertaining at the same time. They do have consultants as guides.

With that said, I will say that *in reality* we often have situations that arise which are extremely complicated and more than likely do not have easy answers. When these occur we have services and processes in place that will help guide those involved in the situations such as Ethics, Social Service, Patient/Family Advocates and Legal Departments (among others), and meetings with patients and families which help everyone delineate the issues at hand and hopefully come to resolution. Since these issues are so complicated coming to resolution may not occur right away (or ever for that matter), it can take time (unlike the hour it takes on TV, LOL).

I cannot comment on this particular situation/ER episode, but there is such a thing as the Patient Bill of Rights (example) . I imagine the issue of the mother's rights vs baby's rights in this instance would have to be evaluated before they could force her into having a CSection.

to try to convince her to have the c-section?

Again, I am not a social worker. However, in the hospital, our role is not to try to "convince" anyone of anything. Does that get blurred a bit when we see that someone isn't make the choice we'd like them to make? Sure. But our role really is to present the facts and let people make their own choices. That's what the Patient Bill of Rights is about.

For example, we see patients for which surgery is indicated. Some patients are too afraid to have surgery. Without it they might die, but we cannot force them to have the surgery. We can tell them what is likely to happen without surgery. But ultimately it is their choice. That is actually not too uncommon. Not too long ago I had this happen - a patient's children were begging their mother to have surgery even though she herself didn't want it. Going in she was very high risk and complications were likely. She talked at length to me about her dilemma. Ultimately, she consented to the surgery, but I worried to myself a bit how the children would feel if she didn't make it through surgery; whether she herself would regret having surgery if she had the complications she dreaded, and whether we (as families) should put pressure on our loved ones because we don't want to lose them rather than respect their choices to withhold treatment and live out what time they have left without the pain and exhaustion of going through surgery, chemotherapy, etc. Never easy decisions.

It has also been very interesting to me to be on the other side of the bed as a patient, and be faced with some of the very decisions I've spent my life helping others through. That's given me a whole new perspective on things too.

 

[tar heel]

A friend who has been an ER doc for 30 years won't let his daughter, who plans to go into medicine, watch it b/c it's so unreal. I, on the other hand, think it's a great drama!

 

[twocjsmom]

Wasn't there a real life story about his very thing happening out west a couple a years ago?

 

[twocjsmom]

and my memory was correct -

http://www.foxnews.com/story/0,2933,114016,00.html

 

[Disney Doll]

I tend to have a difficult time watching those shows as well, because of how they portray life in a hospital. They are entertainment, and as such, will "skew" things to enhance the entertainment value of them. An unfortunate side effect of these shows is that they make the general public think that's what it's really like, so that the general public then comes into the hospital with very unrealistic expectations.

I did not see the ER in question, but my assumption, from what I have read here, is that it was about a woman who was refusing a medically necessary c-section?

As Pea-n-me said, there are numerous people, departments, & services in place when we get into those ethically sticky areas, such as social work, ethics committees, the legal/risk management departments etc. Most of the time, with the input of all of the above and the patient, we can usually come to an acceptable conclusion for all. In the case of a medically necessary c-section which a mother is refusing, the conclusion may be "if the baby dies because of your decision, you'll be tried for murder". Perhaps not the best conclusion, but it may be the conclusion. Healthcare is not always a happy ending.

 

[Hannathy]

Way back when in ER's first season or two they were probably the most realistic medical show. Then the stars became stars and it became more important to get their best side in a shot and it turned into a soap opera and I quite watching.

 

[pixiemomma]

Hannathy, I agree. The show was much more realistic in the first few seasons. Lets face it though, after 10 years in such a vacuum, you start to run out of ideas and have to start focusing on the human side. I still watch.

 

[Deb in IA]

I NEVER watch any medical shows. That includes ER, Scrubs, House, Grey's Anatomy, etc.

Since I do this for a living, when I do watch TV, I want to get away from anything medical.

So, I did not see the episode you describe. But, in real life, the mother would have had at least 7 months to build up a rapport with her obstetrician (and possibly longer, if she were a surrogate), and specifics regarding delivery options would have been discussed and agreed upon WAY before the actual birth. And in most cases, some compromise can be reached.



Galahad's wife is an OB. Maybe he'll have some additional insights.

 

[Disney1fan2002]

I NEVER watch any medical shows. That includes ER, Scrubs, House, Grey's Anatomy, etc.

Since I do this for a living, when I do watch TV, I want to get away from anything medical.

So, I did not see the episode you describe. But, in real life, the mother would have had at least 7 months to build up a rapport with her obstetrician (and possibly longer, if she were a surrogate), and specifics regarding delivery options would have been discussed and agreed upon WAY before the actual birth. And in most cases, some compromise can be reached.



Galahad's wife is an OB. Maybe he'll have some additional insights.

That is the thing that cracks me up the most about the show, is how many babies are delivered in the ER. NEVER by the patients on OB.

 

[yeartolate]

I don't know anything about the c-section specifics but I have met the consultant for the show. He comes to our company on a regular basis. They use our stuff exclusively for props and they have to be modified to be safe and show readouts when they are actually never hooked up ot a patient (we make medical equipment)

Yes, they try and make it as real as possible.

Cardaway, when the consultants come up, for the sake of my sanity, can you tell them that when their patients have a nasal canula on they don't need a ventilator billowing in the background?

 

[Davids-Coco]

I NEVER watch any medical shows. That includes ER, Scrubs, House, Grey's Anatomy, etc.

Since I do this for a living, when I do watch TV, I want to get away from anything medical.

I can understand that... I work in Government, and the last thing I want to see when I get home is those talk news guys (but DH ALWAYS has them on).

However, I have to say that you may be missing something with Scrubs. It is so unrealistic that it is funny. So totally off the wall... if the medical profession was really like it is in this show, I would highly consider NEVER seeing a dr again.

 

[Geoff_M]

Go to http://www.digiserve.com/er/ and look at the episode guides for the first several seasons. They have medical commentary from ER docs as to what they got right and wrong in each episode. It's a pretty fascinating read. Back when my wife and I used to watch the show on a regular basis, I used to read this site a lot. However, the fan site pretty much went dormant after it's creators gave up on the show as it went down hill.