M

edical storylines have riveted television viewers since the earliest days of the medium — and for just as long, TV writers and directors have had to navigate the age-old tension between truth and storytelling.

One early solution, beginning in the 1950s, was a group of doctors who advised television producers directly. The group, known as the Physician’s Advisory Committee (PAC) on Television, Radio, and Motion Pictures, reviewed scripts, helped find props, and showed actors how to properly hold a scalpel.

Both medicine and television have changed a lot since then. Production companies now hire their own medical consultants. And the widespread availability of medical information means that TV shows must work harder to get viewers to suspend their disbelief.

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That desire for drama can create some unforgettable television moments — as well as some unlikely bits of fiction. Here, some of the most unrealistic parts of TV medical dramas.

1. Shocking patients for an hour

Last season’s “The Night Shift” featured this familiar scene: Dr. Clemmens leans over an unresponsive patient with a tube in her open mouth. His arms are straight and his hands are crossed on the young woman’s chest. He is desperately and rhythmically pushing into the patient’s chest, stopping every five pushes to allow another doctor, who has been holding the defibrillator pads aloft and ready, to shock the patient one more time.

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“It’s not unheard of, I guess,” said Dr. Peter Chai, who teaches emergency medicine and medical toxicology at the University of Massachusetts. “Maybe in a pediatric situation, if it’s a kid, we may work on them for 45 minutes or so. But most times, you’re doing things in increments of three minutes,” he added. “So you’re shocking them after three minutes of CPR, or after EMS has been doing it on the way there. And by then, you either get them back or you don’t.”

2. Gory scenes

Robert Mills, media and editorial director at the American Medical Association, said that the PAC used to let TV directors know how to make scenes realistic. “They would tell the TV writers, ‘OK. If you do this procedure, this is how much blood you should see.'” It may be only a coincidence, but since the committee disbanded in the 1980s, medical shows have been awash in sticky red liquid.

And TV blood is used to highly dramatic effect. It spatters across surgical masks and gowns and spurts dramatically from incisions. On “Grey’s Anatomy,” a wound over a patient’s carotid artery throbs menacingly and then pops open, throwing a wide, red streak across a doctor’s lab coat and blouse.

“It doesn’t really happen that way,” explained Chai. “Even when you hit an artery [during surgery], its coming out a little faster than when you hit a vein, sure, but you’re not getting blood on the wall on the other side of the room.”

3. Surgery on the fly

TV surgeons seem to be constantly called into action in every place except the hospital. In an episode of “The Night Shift,” Dr. Alister performed a C-section on a plane mid-flight (with, among other things, a pair of spoons). He was at it again in another episode when he drilled into a patient’s skull while awaiting help in a stalled elevator. “I’ve never seen any of that,” said Chai. “After all, we have these things called operating rooms.”

And then there’s the similar scene where doctors are in or near a bank heist, war, or other gun-involved situation outside the hospital, and find themselves urgently needing to remove a bullet from the victim’s body. “MASH” and “ER” featured this one; “Chicago Med” almost did, when an overcrowded hospital forced Dr. Rhodes and Dr. Choi to consider a hallway bullet removal.

“Nope,” Chai said. “If the bullet is in, it stays in until they’re in an operating room,” he said emphatically.

4. Makeshift medicine

To save fictional lives, actors on hospital shows have used myriad non-medical implements — from garden hoses to tree limbs — in cases of emergency. The most common of the DIY procedures is a tracheotomy, in which a doctor makes a hole at the base of the throat to insert a tube when a patient has no other way to breathe due to injury or illness. “ER” offered a particularly memorable instance when Nurse Hathaway, held hostage by a pair of robbers in a convenience store, attempts a tracheotomy on a gunshot victim using a penknife, a juice straw, and duct tape.

“We’re taught to do emergency tracheotomies, and you can even buy a kit to take with you,” Chai said, adding that he couldn’t understand why a lot of TV doctors seem to keep forgetting their kits.

In most cases, Chai added, it isn’t even necessary to improvise. “Maybe if you’re in the middle of a hurricane or the wilderness, or in a rural area, then you can MacGyver something together to save a patient, but in ordinary cases, EMS has time to get there before you have to do that.”

5. Instant out

On “The Night Shift,” a large, angry prison inmate is wheeled in under armed guard. He yells insults and breaks his restraint before being instantly knocked out with an injection.

“I wish we had a drug that could work that fast,” said Chai. “When they come in high or psychotic, those people are agitated, and it might take several people to hold them. That part’s true. But after the shot it takes about five to 10 minutes for them to calm down.”

Wide-awake patients don’t just instantly fall unconscious either, no matter what they’re injected with. Whether a patient has missed doses of antipsychotic medication or is just high on street drugs, no injection can simply put them out in seconds.

6. ‘Stat!’

It’s still the official term of urgency and speed, but the word is uttered more often on television (and in our office) than in real life. On “ER,” “Grey’s Anatomy,” and “Chicago Hope,” among others, medical personnel jog alongside gurneys or run around patients’ rooms asking for a procedure or medicine, “Stat!”

But in a real hospital, the word is usually written rather than “shouted out like it is on TV,” said Dr. Helen Farrell, a professor of psychiatry who’s had her share of emergency-room rotations.

“You’ll see it usually on a written or electronic order, like for a drug, so that the pharmacy knows to get it up right away,” she added. “But you don’t usually hear people saying it.”

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  • I know a drug that’ll knock you out in a few seconds. Propofol! And I knew a doc that would use it on those agitated patients that had IVs. I saw him jump up on a stretcher and give a dose to a violent patient. He stopped doing it obviously cause it’s dangerous and I believe he got reprimanded. I used to get freaked out and run behind him with O2 sitting the patient up and securing the airway. Was with him when it happened twice. Crazy, but fun experience.

  • I understand that the actors playing doctors have to have screen time to justify their salary but they seem to do everything. Drawing blood, giving injections, passing out pills, adjusting machinery. In some shows nurses don’t seem to be left with much of anything to do. Pretty much the opposite of real life.

  • As a former nurse, what amazes me is the time TV doctors and nurses have to discuss their over-heated personal lives. In reality medical staff barely have time to grab a cup of coffee.

  • I watched an episode of “The Tunnel” yesterday where a kindly female doctor sat down with an emergency room patient to discuss the patient’s stress over her husband’s infidelity. They were still sitting and chatting at the time the husband rushed in to the ER to check on his wife, at which point the husband was scolded for being a man by the kindly female doctor. Brought to you by PBS.

  • One thing I learned recently from a friend who’s a cardiac nurse: unlike on TV, you can’t defibrillate a patient with no heartbeat in the hope of reviving them. Defibrillators work to correct an arrhythmia, not to start a nonexistent one, so the scenes where the patient completely flatlines and they break out the chargers to revive him make no sense.

  • Oh, Lordy. To get your average psychotic to chill out you usually use a lot of IM meds like 200mg Thorazine, 100mg Cogentin and 1-2mg Ativan. The way these meds are supplied that 6 to 8 needles, kids. 6 to 8! usually given when a patient is bring restrained by a lot of help. Oh the fun you will have…

  • I’ve never seen an episode of a medical show, but I wonder if another difference is that the patients on the TV shows get treated before their insurance benefits are verified.

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