‘ER’: L.A. County Should Have It So Good

Enough already. The new television series “ER” is a nighttime drama that is exciting, fast-paced and emotionally charged. It is not (repeat not) a medical training documentary. It airs on NBC, not on educational TV.

Unlike a documentary, a television drama does not necessarily mirror real life. “ER” is a weekly series and, as such, has the luxury of being entertaining rather than providing a precise exposition of emergency room medical procedures.

Most emergency room doctors who have critiqued the television show “ER” have approached it with the fervor of someone protecting his religious doctrine. They condemn the TV series as blasphemous.

I trained in a Los Angeles County hospital with one of America’s busiest emergency rooms. I find that “ER” captures the reality of the rapid-pace, critical decision-making process and interpersonal relationships between colleagues, subordinates and patients in a county hospital.

Sure, medically speaking, “ER” has some technical problems, but only those who work in the hospital environment would recognize them. In some hospitals, betting pools are set up every week to guess the number of small medical mistakes that will occur on “ER.” To the public, any medical misrepresentations are indistinguishable. In fact, “ER” is a vast improvement over “Marcus Welby, M.D.,” who commonly read X-rays upside down.

Dr. Gerald P. Whelan’s scathing review of “ER” (“Put ‘ER’ Out of Its Misery--Quickly,” Counterpunch, Oct. 3) alleges that it is a lie being perpetrated upon the American people that emergency rooms are staffed by unsupervised resident physicians. He further stated that “all care is supervised 24 hours a day.” However, the fact of the matter is that just a few months ago, one of L.A. County’s ERs was threatened with closure due to lack of supervision. Many other training programs have been reprimanded and cited by the accrediting authorities for the same types of problems.

Contrary to Dr. Whelan’s view, “ER” shows a working environment and conditions--though comparable to most hospitals--that far exceed those of the Los Angeles County public hospitals.

Far from degrading the actual conditions of a public hospital, there are conveniences shown in “ER” that we wish we could have in real life. For example, the television “ER” doctors get units of blood and lab results almost instantaneously. On the other hand, one L.A. County hospital has its blood bank, which is frequently unstaffed and lacking sufficient supplies, a quarter-mile from its emergency room. Many laboratories discontinue operations at 4 p.m. and tests cannot be run until the next working day. Or, even worse, some lab work is only conducted once a week. Compared to “ER,” L.A. County is a MASH unit.

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One luxury afforded the “ER” doctors is a lounge with bright lights, couches or pool tables. Unlike these doctors, the L.A. County residents in training have neither sufficient dormitories nor on-call rooms in which to rest between crises.

One subtle point made by the TV series is that the working conditions are unsafe. Prior to the time that three doctors got shot at USC Medical Center last year, access to even the most critical areas of county hospitals was wide open. In Los Angeles County waiting rooms and/or while patients are being examined in the critical care rooms, guns, knives and other weapons are frequently removed from visitors and patients.

It is true that residency training programs for emergency medicine require, by regulation, no more than 12-hour shifts with two days off per week. However, arrival at the emergency room is only the beginning of a patient’s journey through their hospital course. Unless the patient is dead on arrival, the “buck” does not stop at the ER.

Emergency medicine interns and residents are not the only physicians who work in the emergency room. Pediatricians, orthopedists, general surgeons and other specialists often do not have the luxury of going home after a regular 12-hour shift. They are the doctors responsible for the care of a multitude of patients throughout their entire hospital stay and must provide definitive continuity of care until the patient is discharged.

The TV viewers may notice that some doctors on “ER” never seem to go home. A parallel in real life is L.A. County’s practice of forcing young physicians in training who are sleep deprived, overworked and frequently un- or under-supervised to make life and death decisions and perform highly technical medical and surgical procedures.

Schedules for some specialties outside of emergency medicine include working unlimited hours per week with no overtime compensation.

Critics of the current training system for physicians say that at its best, it is a cruel rite of passage, and at its worst, it perpetuates indentured servitude.

So despite any small technical flaws, “ER” portrays a lot more fact than fiction. And it illuminates a number of disturbing practices in county hospitals that must be rectified.