Watching “Hopkins” on Independence Day

Soooo, Happy Independence Day.  It is almost 11 p.m. and my neighbors have kept up their artillery barrage of fireworks for more than two hours.  My brain is exhausted.  It works slowly at best during a flare of lupus, and the constant noise has exaggerated this.  My reluctance to approach them and request a cease fire reminds me of my daughter’s difficulty confronting her peers when they are doing something outrageous or hurtful.  We all want to keep the peace, don’t we?


Tonight, after another person asked me if I was watching the ABC series “Hopkins”,  I went to their website and watched the first two episodes.  I knew that folks would ask me because of my residency training at “the John”, and I did have some curiosity about the lives of the young people training there 30 years later.  A few things struck me.  First, it doesn’t seem that the 80 hour per week limits on clinical training time is actually being practiced.  There was no limit when I was training, and our weeks averaged 120 hours “at the bedside”, as Victor McKusick called it, pointing out our good fortune to be immersed in that service (read “servitude”).  The second thing that struck me was the obnoxious music, complete with lyrics that were meant to reflect whatever emotions went with the situation.  It was cheesy and frequently inappropriate-too light a treatment for the gravity of the subject matter.  I don’t know if the regularly scheduled broadcasts were heavily laced with invitations to hear more of the music, as the webcast was.  Third, as many medical shows tend to do, “House” being a notable exception, this series is heavily weighted toward showing surgical specialties.  It is grossly misleading, as the majority of physicians are not surgeons.  It falls into the trap of presenting medicine as a “let’s go in and fix it” kind of profession, something like plumbing with more delicate pipes.  The real meat of medicine is prevention and diagnosis.  Most physicians are involved in trying to keep people healthy, assessing patients’ level of health, and figuring out what’s wrong and what can be done about it when someone has a problem.  The vast majority of medical problems that plague people (diabetes, high blood pressure, liver and kidney and heart disease, asthma, infections, addictions, allergies, arthritis and joint problems) are treated with lifestyle changes and medication, not surgery.  When a patient does arrive in the surgeon’s office, she/he usually already has a diagnosis, with tests to prove it, and the surgeon is the technician who spends ten minutes in the office and some number of hours in the operating room to “fix” it.  The more unusual case is for the surgeon to be the one who has to operate in order to find or diagnose the problem.  I do not say this to suggest that surgeons are any less smart, but to note that the role of the diagnosticians and physicians who use an arsenal of medications and other nonsurgical techniques is vastly underplayed in the television world.  And of course, I say this from the point of view of a Board-certified Internal Medicine specialist who loved the realm of diagnostic medicine and the long-term relationships we kept with our patients as we tried to improve their lives.  No prejudice-some of my best friends are in surgical specialties.  Oh wait, no they’re not. 


I heard three male physicians ask patients for reassurance instead of asking how they felt:  “are you alright?”, “are we still friends?” (to an older woman whom he just met in the emergency room), “are you happy?”.  Ugh.  Thoughtless words meant to forestall a patient’s revelation of how s/he really feels; it’s easy to put words in someone’s mouth, time-consuming to actually listen to them.  I also heard some overly-optimistic words about the effects of some surgery.  Um, no doc, when you cover up that piece of brain by replacing the lost section of skull, you aren’t going to heal the brain.  It’s still damaged, and will have to heal itself-or not.  On the up-side, a capable young woman who is the first female urologist at Johns Hopkins.  Her thoroughness and attitude with her patients was refreshing. 


There was also a lot of talk from the surgeons about how they held patients’ lives in their hands, yada yada yada.  Not so much information about what they actually did.  Lots of angst, but nothing to show the humor and irony that always accompanies it when you’re taking care of patients.  I was sort of grossed out by an attending neurosurgeon telling his preschoolers about his work and looking for affirmation that he was a surgical superhero.  Come on, guys.


Ooh.  I had more to say about “Hopkins” than I thought.  Frankly, it wasn’t typical of my years there or the people I trained with.  Thank goodness.  (sung to the tune of Death and All His Friends)




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