Medical fiction could be misleading

Editor—Medical fiction series undoubtedly have a deep impact on people. As mentioned by Collee, millions of viewers are so dependent on television that it has become their main source of information.¹ Though some concern may result from the possibility of encouraging harmful behaviour, as discussed by Hawton et al,² there are other medical issues.

As a professor of emergency medicine, I know very well the everyday reality of emergency physicians. I agree with Collee: “If things are too obvious, there is no drama in them. If there is no drama, the story doesn't engage us emotionally.” Series such as ER are tailored to reality in the United States—patients being admitted with harmful severe arrhythmias who are rescued by defibrillation and discharged only a few hours later, patients undergoing sophisticated diagnostic examinations within a few minutes of having been admitted, and so on. Though I accept that this is fiction, I believe that such presentations of reality are non-educational. My students, full of enthusiasm and convinced of the almost mythical status of staff and patients,³ are suddenly faced with a quite different everyday reality: hundreds of visits, much monotonous medical activity which, for the most part could be dealt with by general practitioners, and less than 10% of cases being urgent.

Moreover, lay people often do not understand the differences between healthcare systems and expect to receive free, immediate, and sophisticated treatment to resolve their health problems: “I suffer from headache, and I am here to have my brain scan.” Unfortunately, they are not received by the staff of ER. Instead, they find overcrowded spaces, long waiting lines for visits or examinations, and a long term lack of hospital beds for elderly people with more than one disease. Severe pressure on services is well known in Italy (where until a few years ago all medical care was free of charge) but is now also present in North America.⁴ In these times of economic restrictions emergency departments are the last haven of free assistance.

The subtitle to Collee's editorial says that medical fiction should be accurate, but need not be didactic. Medical fiction viewed in the confines of a lecture hall with students could be didactic, but to lay Italians such didacticism could be a source of misleading expectations and delusions when seeking a doctor's help.