I recently became irked with The Art of Baking Blind by Sarah Vaughn. Although I mostly enjoyed the book, it definitely has its issues, including a hospital scene drawn directly from Holby City reruns. It is a little unfair of me to single out one book for this, though. As a registered paediatric nurse, one of my most common frustrations is when authors get healthcare wrong. There are so many nurses in the UK, and we love talking about nursing. Seriously, get any group of nurses together and we will be talking about catheters, the Bristol Stool Chart, and leg ulcers within thirty seconds (we are fun at parties). In light of this, there is no excuse for the stereotyped and factually inaccurate descriptions of hospital scenes that abound in book after book.
I’ve talked about this on the blog before in relation to specific books (ahem, Me Before You springs to mind), but I thought that sharing one nurse’s perspective on three common healthcare tropes in fiction might be an interesting read. Please note that this post contains generic discussion of hospital/healthcare procedures, including (successful and failed) resuscitation. It’s also not intended to be representative of everyone who works in healthcare! It’s just a few thoughts I have on the subject.
Perhaps the most common thing that winds me up in fiction (including TV and film) is when a healthcare professional is depicted as an absolute villain for preserving a patient’s confidentiality. A character will dash into a hospital, demand to see their relative or loved one, and then a nurse (and it is always a nurse, and always a woman) will say, with cold glee, “We are not at liberty to release that information”. It’s always very clear that we are meant to be on the side of the main character. Often, they will then go over her head to a (usually male) doctor, who rolls his eyes at his ridiculous jobsworth subordinate and hands over great swathes of deeply personal information without any further questions.
Confidentiality really matters, though. In 2012, a nurse committed suicide after falling for a supposed prank and inadvertently breaching Kate Middleton’s confidentiality. Although it’s clear that she had pre-existing mental health problems, I can very much understand why that would drive someone to suicide. Every nurse I’ve ever worked with has cared deeply about his or her patients. Mistakes, even small ones, are devastating. I made a drug error once, as a newly-qualified nurse. The patient was absolutely fine, but I still cried myself to sleep every night for a long time afterwards.
An important part of providing professional care is the preservation of confidentiality. In the case I cited, Kate Middleton had her privacy inexcusably invaded but was not otherwise harmed. However, nurses frequently deal with children who have been abused, adults who have run away from violent partners, and other people who are in imminent danger if their confidentiality is breached. As someone with a fair amount of child protection experience, I promise that there are extremely strict and totally reasonable rules governing the way that information is shared. If someone has just come into your care, you have no idea what their background is, and it’s even more crucial to have a handle on that before you start doling out information willy-nilly. It is so lazy, and so inaccurate, to use this as a shorthand for “petty and unlikeable”.
2) Mavericks and the “great man” model of medicine
Here is a home truth: doctors and nurses who frequently disregard rules tend to kill patients and get themselves struck off. It is not heroic behaviour to ignore protocols and guidelines because you fancy yourself as some sort of Dashing Rogue who Knows Better than Everyone (Including those Pencil-Pushers who Wrote the Policy*). Fortunately, it doesn’t happen very often in real life.
That’s not to say that healthcare professionals should never take risks. However, if recklessness becomes the norm, that’s a problem. Hubris, refusal to follow procedure, and failure to listen to colleagues are some of the human factors commonly involved in serious hospital incidents (note, that video is very interesting, but also distressing in places). Romanticising that behaviour is troubling.
A good antidote to this is The Checklist Manifesto by general surgeon Atul Gawande, which talks about the importance of simple procedures and routines in preserving patient safety, and the value of teamwork. It’s also much, much more interesting than it sounds, and written for a non-medical audience. I would recommend it just for general interest, but especially for any author who intends to write about medical professionals. (Also, Scrubs deconstructs this trope better than any other TV programme. You should watch every episode of Scrubs immediately, because it’s amazing). I’d also recommend the Sawbones podcast if you want to hear about catastrophic things that happened in the “great man” era of medicine, before we had policies and guidelines.
Honestly, stories which focus on the teamwork and collaboration between different professionals in a healthcare team, or even on tensions between clinicians who have different interpretations of the situation, have the capacity to be incredibly interesting. One person steamrollering everyone else and turning out to be right–that’s been done to death. Team dynamics and ward politics are such a big part of hospital life and healthcare, and they could be so fun to explore.
CPR does not resuscitate people by itself**. The purpose of basic life support is to maintain blood flow to vital organs, despite the fact that the person does not have an effective cardiac output, until someone arrives with a defibrillator and adrenaline and a whole load of other things. That doesn’t mean that basic life support doesn’t matter. In fact, here are two videos put out by the British Heart Foundation about CPR with and without rescue breaths. Basic life support is absolutely essential and anyone can learn to do it. It has saved countless lives. Also, AEDs (portable, user-friendly defibs) are now available in lots of places, and they have resulted in more people surviving cardiac arrests. However, someone does not wake up mid-compression because the rescue breaths have somehow restarted their heart. I read this inexplicably often in books, and it bugs me.
Stuff like this matters because fictional representations of resuscitation have a direct impact on the way it’s viewed by the public. If people are constantly seeing people recover miraculously after three compressions, they will expect that to work in real life, and could give up when it doesn’t seem to be working. On the flipside, I have heard of relatives getting absolutely livid when resus teams call a halt to resuscitation because it isn’t working—because they expect it to work every time, and think that the team just aren’t trying hard enough. Obviously, there are a lot of emotional and psychological factors that go into that, but there is definitely a misrepresentation issue. A recent study showed that, on TV, resuscitation restores works around 75-100% of the time, whereas in real life, resuscitation is only effective between 2-30% of the time (depending on various factors). That same study suggests that relatives may be less willing to discuss Do Not Resuscitate orders if they have a skewed understanding of how effective resuscitation is, how barbaric it can be, and whether successful resuscitation has other lasting consequences. It’s so irresponsible to feed into that misinformation simply through lack of research.
I haven’t touched on other clinical inaccuracies. Those come in so many exciting varieties, most of which will necessarily be outside my area of expertise. However, these can be fairly easily avoided too. Quite apart from the fact that experts in these areas do exist, many trusts and organisations have their treatment protocols available online for free. They are a great starting place, although I really have to recommend talking to nurses (and doctors, and other professionals). I mean there are loads of us. We’re all over the place, and we’re friendly!
I understand that this is a very niche interest sort of blog post, but the way healthcare is depicted in fiction has been driving me crazy since I was a teenager. I had to get it out of my system somehow! Who knows—maybe some author will stumble across this post while researching, and we will all be spared another scene where someone gets given diamorphine for his or her poorly toe. Thank you for reading this rather ranty blog post.
*Clinicians actually write policies, generally teams of very skilled and highly knowledgeable ones, and normally after extensive review of all the medical and scientific evidence available to them at the time.
**With the very occasional exception for drowning victims, choking victims, and young children, for physiological reasons that I am not going to go into here.