Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
In defence of ER
- Kenneth Wong (29 November 2003)
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Further nurses' notes on "ER"
- Sandy Summers (30 November 2003)
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Nursing's dominant ideas
- Phillip J. Colquitt (30 November 2003)
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Misrepresentation in ER
- Alex Psirides (1 December 2003)
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Kenneth Wong, surgical registrar port macquarie base hospital, australia
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Dear Editor, ER has to be one of the best medical dramas of the past decade. Well produced, controversial, realistic and always riveting, I would suggest that the earlier series ought to be compulsory viewing for senior medical students and hospital doctors. As a medical student in the mid 1990s when the show first came to air, I could identify with Dr. John Carter (played by Noah Wyle) as he tried to come to grips with the public hospital system and the inherent hierarchies and politics. As he and I both progressed through the system, the parallels meant that I kept watching the show through good times and bad. The interactions with patients, allied health professionals and nurses are pretty spot on. The struggles of Dr. Benton as a black surgical trainee reflect upon the extra stresses of doctors from an ethnic background. The trials and tribulations of trying to juggle a family life and work pressures are well depicted. All these issues are in addition to the medical dilemmas confronting the ER doctors - who to resuscitate, when to stop resuscitation, teenage pregnancies, informing legal authorities, etc. The tips and pitfalls that young doctors can pick up by carefully watching the show make it educational viewing. If doctors must watch TV, an hour of ER each week can go a long way for serious medical entertainment. I would propose that medical faculties should incorporate selected episodes into their cirriculum. Competing interests: None declared |
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Sandy Summers, Executive Director, The Center for Nursing Advocacy 203 Churchwardens Rd., Baltimore, Maryland, USA 21212
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The Center for Nursing Advocacy appreciates Ms. Lenzer's article about efforts to persuade "ER" to treat nursing more accurately and fairly. We would like to offer a few additional notes. Warner Bros. says its show "goes to great lengths to portray medical situations accurately." Dr. Kenneth Wong suggests it is good enough to be used in medical education. To the extent "ER" is accurate about technical medical elements such as diagnosis and treatment, it leads viewers to believe that other health care elements on the show are equally true-to- life--including the portrayal of nursing, which is not accurate. The nurse characters on "ER" are generally decent and competent, and they do on occasion have serious interactions with physicians about patient care. But the show's overall portrayal of them as marginal, subordinate physician helpers and wannabes does a grave disservice to an autonomous profession in crisis. Frank Sloan asserts that working conditions and pay are at the heart of the shortage, that "we had this problem back when television was black and white," and that today's women, with more options, no longer want nursing jobs that pay less and command less respect, "even if undeservedly so." Awful working conditions are the most obvious current factor in the shortage, but we must consider how they came about. In our view, the economic decisions behind those working conditions reflect, at least in part, a misunderstanding of nursing heavily influenced by the mass media. Sloan virtually admits that the inaccurate popular image of nurses is a factor when he suggests that the lack of adequate respect for nursing, which deters female career seekers, is undeserved. And if the persistent "handmaiden" image deters today's more empowered women, consider how it continues to hamper the recruitment of men. Even today, only about 6% of North American nurses are male. We did not have "this problem" back when TV was black and white. Hospitals in the U.S. began feeling the effects of the current shortage in about 1998, it is already the worst in recent memory, with a significant effect on patient mortality, and it is projected to grow far worse. Yes, media distortions of nursing have always been with us. But we can no longer afford them. Of course, contrary to one interpretation of this article's headline, the Center has never argued that "ER" is the sole cause of the shortage. The Center does believe that popular media products like "ER" contribute to the shortage by influencing how people view health care, as reflected not only in testimonials from experienced professionals like Dr. Wong but also in recent research not mentioned in this article. This research merits close attention. In 2000, JWT Communications did focus group studies on 1800 students in grades 2-10 in 10 U.S. cities, and found that the youngsters got their most striking visualization of nursing from "ER." Under "ER"'s influence, these youngsters considered nursing a technical career "like shop"--not a profession. They did not consider nursing a career suitable for private school students, because "more" is expected of them. In their view, nursing was "a girl's job." http://tinyurl.com/tci8 In a 2002 Kaiser Family Foundation study, more than half of regular "ER" viewers studied reported that they learned about health issues on "ER" and discussed them with their friends and family. A third used "ER" to help them make choices about their or a family member's health care. The study concluded that it was worth the effort to make entertainment television like "ER" as accurate as possible because of its potential influence on the public. On the other hand, the authors stressed, "fictional depictions could lead to viewers' obtaining inaccurate information or taking away critical misperceptions about health topics." http://www.kff.org publication 3230. This research shows that many people--especially youngsters--take very seriously what they learn from popular media products like "ER." Yet the show's portrayal of nursing is woefully inadequate and inaccurate. I grew up with no real interest in nursing, my impressions formed by the views of those around me and the media, until I saw a nurse operating autonomously--shattering all my previous images of it. If "ER" were to do for nursing what it has been doing (as Dr. Wong assures us) for medicine, I believe many more people would, like me, be drawn to the profession. Why doesn't it? One likely reason is that no nurses are involved in the preparation of "ER" scripts--a point not disputed by those responsible for the show. It means very little if real nurses are on the set showing the actors who play physicians how to defibrillate, or if the show's "technical directors" (all physicians) respect nurses in some general sense, as long as the show that employs them misrepresents nursing to over 20 million households each week. Competing interests: Sandy Summers is the executive director of the Center for Nursing Advocacy. |
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Phillip J. Colquitt, RN Place of work: this is an idependent comment
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Dear Sir, I doubt the nursing shortage is caused by a TV program, though it may be convenient to attribute blame to something other. The culture of nursing may be changing, though it’s far from clear what the guiding vision might be. It seems unlikely that there would be a paradigm forthcoming that would embrace the idea of a dominant occupational culture – even a female one. Nursing, it’s very name and it’s behaviors, is based on the expectation that a nurse will be a woman, and this is a dominant idea. A workplace atmosphere wherein equality of access to employment is generally expected. People should feel entitled to receive services from occupations that represent them in terms of sex, race, background, etc. I believe that many female nurses see their training as merely a rubber stamp to that which is already theirs by sex decree. If there is a nursing shortage, and Im not sure there is, and if it is "caused", then it's caused by the basically outdated set if ideas that still dominate the nurse's own thinking. Competing interests: Minority male status. Reactionary management. |
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Alex Psirides, Registrar, Intensive Care Wellington, New Zealand
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In my admittedly limited experience of ER (I came to it somewhere in the middle of the 7th series) I have noticed that drug dealers are nearly always portrayed as monosyllabic halfwits with psychopathic personality traits, bad skin and even worse personal hygiene. In fact, this does not seem to be limited to ER but extends across most mainstream media. Although I do not personally know anyone involved in the drug industry (except those who keep giving me pens with their product names on) I feel this is probably an unfair stereotype to perpetuate. I wonder if any such people regularly peruse the BMJ Rapid Responses and would care to contribute. Or, failing that, complain to the producers of ER. In response to the claimed & perceived accuracy of what is shown, I would take issues with the inordinate speed in which ET tubes & chest drains are inserted which, despite my best efforts otherwise, I have singularly failed to replicate. I think, when all fingers have been pointed & blame appropriately apportioned, it is fair to say that you shouldn't believe anything you see on television. If you do then more fool you. This particularly applies if the programme in question claims to be 'realistic' or 'based on fact'. Competing interests: None declared |
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