Grey Matters ‘Grey’s Anatomy’ vs. real-life residency: You already know how this turns out Amanda Kirzner, DO, MPH, says real-world residency is nothing like its thrill-a-minute depiction on “Grey’s Anatomy.” Sept. 5, 2014Friday Amanda Kirzner, DO, MPH Contact Dr. Kirzner Facebook Twitter LinkedIn Email “Grey’s Anatomy” has been one of my favorite TV shows since its inception in 2005. Back then I was a premed, so I watched the drama about the lives of surgical residents and physicians with great interest, even though I knew many aspects of the residents’ lives were exaggerated or just plain incorrect. When I became a general surgery intern myself last year, these discrepancies became even more obvious to me. I understand that “Grey’s Anatomy’s” producers have to sometimes sacrifice realism to engage their audience and garner ratings. But I dislike the way the show overglamorizes the lives of the residents and often presents false medical information. By portraying the residents’ lives as exciting, dramatic whirlwinds, the show makes real-world residency seem less difficult. I would not be surprised if medical students watching the show are shocked and disillusioned when they finally rotate through surgery and find out what the surgical world is really like. I certainly was surprised. During my intern year, my biggest pet peeve was watching the interns on the show go into the operating room for big, complicated cases such as brain surgery every day. Typically, interns on a surgical service take care of the patients on the floor. They rarely see the inside of the OR, and when they do, it’s usually to assist with an emergency or a run-of-the-mill case. Surgical interns do a lot of scut work, such as drawing stat labs, putting in orders for nurses, talking to patients’ families, rounding with social workers to discuss patient placement upon discharge, accompanying patients to tests, and obtaining patients’ signatures on consent-to-surgery forms. Second-year residents (at least in my program, and it does vary) typically see consults. On the show, the interns appear to have bypassed the floor work and consult stages and function like chief residents in the OR, which is highly unrealistic. Related Mistakes on ‘Grey’s Anatomy’ And while they are rocking the OR, “Grey’s” interns and residents make embarrassingly egregious mistakes. Errant residents on the show are lightly punished for offenses that would get them kicked out of any actual residency program. For example, Izzie cuts a wire on her love interest Denny’s left ventricular assist device to make him sicker so that he would be moved up the transplant list. She was reprimanded but allowed to continue her residency. A real-life resident would not only be removed from the program and likely sued, but also unable to practice medicine ever again, with the chance of jail time. Furthermore, physicians are never allowed to become romantically involved with their patients. I also see interns and residents on the show committing command-chain faux pas that would be frowned upon, or not permitted, in real hospitals. In most surgery residency programs, junior residents report to the senior residents, who in turn report to the attending physicians. Yet “Grey’s Anatomy” makes no distinction of resident seniority. As an intern, I did not run to an attending before speaking to a senior resident as interns regularly do on the show. An intern who bypasses a chief to bring important patient information to an attending would irritate both the chief and the attending. The schedules of the show’s residents are very unusual compared with the schedules of nonfictional surgical residents. Trainees at real-world hospitals won’t find themselves assigned to brain surgery one day, pediatric surgery the next day and plastic surgery the day after that. Surgical residents usually are assigned to a particular service for a set amount of time, often a month. Scheduling is not a free-for-all as fans of “Grey’s Anatomy” are led to believe. Residents do not arrive in the morning and pick their service based on which attending has the best cases that day (or which attending they are having a secret affair with). Moreover, general surgery residents do not typically rotate through orthopedics or neurosurgery as they do on “Grey’s Anatomy.” Those specialties have their own residencies. Once new physicians match into a general surgery residency, orthopedics and neurosurgery are not options for them unless they want to switch residency programs. Where’s the tape? While some of the misrepresentations on “Grey’s Anatomy” are understandable—after all, the show’s purpose is to entertain—the medical errors on the show are just astounding. A recurring error on the show that really irks me has to do with intubation. During surgeries on “Grey’s Anatomy,” viewers often see a close-up of an intubated patient’s face. And 99% of the time, the endotracheal tube is not held in place with tape. In real life, we always use tape because the tube can easily slip from its correct position. If that were to happen, the patient could go into respiratory distress and die because of the powerful anesthetics in his or her system. These anesthetics paralyze the muscles that help you breathe, so patients taking them are temporarily unable to breathe on their own. Also, I have never seen surgical patients with their eyes taped shut on the show. If patients’ eyes are not taped shut during surgery, they can get corneal abrasions. This is the standard of care. I have actually written to the show to tell the producers that if they are going to zoom in on a patient’s face, they should make the depiction as realistic as possible. A little tape can go a long way in the OR. I never received a response to my letter, but I know that the show’s writers consult with physicians, so I cannot understand why there are so many medical misrepresentations on the show. Despite the unrealistic nature of “Grey’s Anatomy,” it is still one of my favorites. I have watched every single episode for 10 seasons. I enjoy the exhilarating, dramatic lives of the characters on the show, and I sometimes wish I were doing my residency in the fantasyland of Grey Sloan Memorial Hospital. More in Training How to develop more clerkships for osteopathic medical students Miko Rose, DO, shares the insider’s tips and tricks that have historically resulted in the most success in securing clerkships for her students. She also shares a few lessons she’s learned along the way. 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