Put ‘ER’ Out of Its Misery--Quickly

Howard Rosenberg said it best in the final line of his review . . . “Left untreated, ‘ER,’ too, may have less than a year to live” (“ ‘ER’: Call It General (Electrified) Hospital,” Calendar, Sept. 19.) Unfortunately, only the good die young!

As a physician, I am a constant source of annoyance for anyone trying to simply enjoy a medical show. I have a moral obligation to point out why it just isn’t done that way, why the diagnosis is obviously (to me) inconsistent with the patient’s presentation, why the whole show is absurd. But watching the premiere of “ER,” my ire reached new heights. It was not due simply to technical errors. Rather, it had to do with something much more disturbing and even malicious--namely, the dangerous, erroneous and demeaning depiction of emergency medical care that was foisted on an unsuspecting American public.

The “ER,” allegedly Chicago’s Cook County, was staffed by an assortment of unsupervised resident physicians. The “director” dropped in thrice, once to say hi, once in a tuxedo to tell the resident he was responsible for the morale of the unit in the midst of a profound (or profoundly contrived) crisis and, finally, to save the day--at which time he revealed his true identity as a surgeon (in the OR, not the ER).

Medical students were cut loose on unsuspecting patients to perform procedures in which they had neither instruction nor practice. Babies trying to deliver had their little heads pushed back in (not a good thing!) and patients with significant neurological symptoms were advised to come back if they recurred to save the cost of a consultant. And through it all, there was neither hide nor hair of a single attending physician!

In a perverse way, I might actually thank the alleged Dr. Crichton for portraying what emergency medical care in this country probably would be like, had not some very visionary physicians 25 years ago realized that staffing ERs, where the sickest and most severely injured patients arrive, with unsupervised residents and medical students was inviting disaster.

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In 1994, Emergency Medicine is a recognized medical specialty with more than 100 residency training programs at major training hospitals across the country, including Cook County. Residents train for up to four years to manage the whole gamut of medical, surgical and pediatric patients. They work, by regulation, no more than 12-hour shifts with two days off per week; not, as “ER” would have it, “36 on and 12 off, 52 weeks a year.” That was long ago recognized as being dangerous for everyone, especially patients. Medical students come to learn, but are allowed only what is appropriate to their level and experience.

And finally, all care is supervised 24 hours a day by a physically present, qualified attending physician, usually certified by the American Board of Emergency Medicine.

The TV problem, of course, is that this scenario is nowhere near as “dramatic” as the life-and-death crises of the poor, struggling residents in “ER,” clearly in over their heads with no one to turn to and having to just tough it out . . . regardless of the effect on patients or anyone else.

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The bigger problem, though, is that the American public is being presented with a picture of emergency medical care that is 20 years outdated. It is a picture that can and should frighten people and make them avoid a visit to an ER at any cost! This is dangerous and a disservice to the public, and all in the name of not-so-high drama.

It is also an affront to the tens of thousands of dedicated doctors, nurses and other staff in ERs across the country who work night and day to provide emergency care that is competent, caring and real. They are too busy for the soapbox world of “General Hospital” . . . and they are too good for the ludicrous world of “ER.”

One solution, consistent with the premiere episode’s general level of the pseudo-dramatic at any cost, would be to have a guest appearance featuring the renowned Dr. Kevorkian. He could then painlessly put “ER” out of its misery. A year is a long time to make us all suffer needlessly.