Clear Communication Is Essential

Although some shows get it right (both Palmer and others noted the realism of the BBC show Call the Midwife), they appear to be the exception. One problem is lack of communication within the US healthcare system, which “lacks a formal mechanism for communication risks and benefits of CPR,” noted Dr Portanova and colleagues. This statement easily applies to the risks and benefits of other medical treatments and procedures too, as Zackary Dov Berger, MD, PhD, an associate professor of medicine at Johns Hopkins pointed out when he tweeted, “Our system is so mindbendingly opaque, byzantine and often pointless that patients grab onto any information they can get — because they often don’t hear anything from their doctors.”

Physicians, meanwhile, may not even realize that a patient has a misconception until the patient or a family member has become upset because things did not occur the way they expected based on what they had seen on television.

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Sometimes the misconceptions are minor, such as simply not realizing that a fracture and broken bone are the same. When Elizabeth Murray, MD, a pediatrician in emergency medicine at Golisano Children’s Hospital in Rochester, New York, shows parents a child’s broken wrist or ankle in the X-ray, they often worriedly ask if it’s fractured. “I explain that a fracture is the medical name for a break and then ask why that word is particularly concerning to them,” she told Medical Bag. “Usually the response is something along the lines of that’s the term they hear on TV, or of people needing an operation after a fracture.”

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Both Dr Murray and Scott Krugman, MD, vice chair of pediatrics at the Herman & Walter Samuelson Children’s Hospital at Sinai in Baltimore, Maryland, described the most difficult and concerning misunderstandings as those arising from sexual assault or abuse cases. “We know that in the overwhelming majority of cases of child sex abuse, children will have a normal physical exam, so we have the conversation that ‘It’s not like what we see on the crime shows where they say the doctor took a look and this or that must have happened,’ ” Dr Murray said.

Just as heartbreaking are the parents who fear their daughter has been abused because they don’t understand how hymens work. “Once we talk about anatomy and that no girl would ever get their period if there wasn’t always a hole, parents are reassured, but it’s sad that they went through an emotional rollercoaster because of myths and so many people’s concerns about speaking honestly about our bodies,” she told Medical Bag.

Dr Krugman, too, finds himself frequently telling parents, “It’s not like CSI.” Television portrays sexual assault cases as fast-paced investigations that are solved quickly with apparently easily accessible DNA. “The reality, especially for child sexual abuse in prepubertal girls, is that there is rarely evidence on the child’s body unless they are evaluated within 24 hours of the abuse,” Dr Krugman told Medical Bag. “Most evidence comes from clothes and sheets, and it takes months to years to get a result. Because of the infrequent evidence hits, plus 95% chance of a normal exam, in the vast majority of cases we rely on the child’s disclosure.” (And unfortunately, in real life, many children aren’t believed by the person to whom they initially disclose the abuse, sometimes even including clinicians.)

This article originally appeared on Medical Bag