Rather’s ‘The Real ER’ Needs Emergency Care

Emergency medicine has caught the interest of the viewing public. Witness the high ratings of NBC’s “ER,” which soundly trounced CBS’ medical offering, “Chicago Hope.” It is not surprising, then, that CBS would send its biggest gun, Dan Rather, to try to strike a blow against the apparent NBC domination of this hot topic and the prime Thursday 10 p.m. time slot.

Unfortunately, Dan and the “48 Hours” troupe were ill-prepared and there were casualties. The most obvious casualty is the credibility of Rather and CBS News. The more serious casualty is the American public who have once again been presented with a profile of emergency medicine that is erroneous, seriously misleading and would make any potential patient with even a whit of intelligence think twice about seeking care in an emergency room.

Having spent more than 20 years training emergency physicians, I had been critical of the picture of emergency medicine presented on “ER” and went public with those criticisms (“Put ‘ER’ Out of Its Misery--Quickly,” Calendar, Oct. 3). Since then, two things have occurred. First, the production staff of the show has been extremely receptive to input from myself and others in emergency medicine, including the national professional societies. Second, I have come to realize that, despite the best of input, “ER” was and is entertainment--not education, not news. As such, it is entitled to some degree of dramatic license.

“48 Hours,” on the other hand, is purportedly a news show, one based on fact. It is clear from viewing the Jan. 5 episode, most inappropriately titled “The Real ER,” that fact is quite expendable if it does not support the producer’s agenda. Ninety percent of the show dealt with the operations of a trauma center, not an ER. The doctor primarily profiled was a surgeon, not an emergency physician.

To that point, my cooler and more rational side said: “CBS can air any kind of show it wants. It is unfortunately mislabeled as being about an ER, but the presentation of a trauma center is reasonably accurate and I even sort of liked the surgeon (I unwind by playing guitar, too).” Had they left it at that, I would have simply gone away disappointed but not distraught.

But they would not leave bad enough alone. The question of how physicians are trained to work in the critical environment of an emergency department was raised. The answer, according to the physician identified as director of the ER, was that medical students were allowed to hang out for a month. The medical students’ description of their experience was, “See one, do one, teach one,” an old, but fortunately universally outdated, approach to medical education. But the ER director felt constrained to go one better, interpreting the process as more often “See one, do one, kill one .”

There are more than 100 formal residency programs in emergency medicine throughout the United States, all having to meet strict criteria of the Accreditation Council for Graduate Medical Education. Residents spend a minimum of three and often four years in structured training programs under the supervision of faculty certified by the American Board of Emergency Medicine. The hospital selected for CBS’ visit does not have a training program in emergency medicine. The credentials or the specialty of the ER director were also not addressed. But clearly he either was unaware of, or it did not occur to him to mention, that emergency medicine is a recognized medical specialty with formal training requirements and a board certification examination.

CBS chose a hospital whose provision of emergency care, while it may well be adequate or even excellent, does not reflect the structure and pattern of how emergency care is either provided or taught in the vast majority of hospitals throughout the country. Why they chose to do so is unclear. They quite simply did not do their homework.

I know about emergency medicine and I now know that CBS News does not. I can only surmise about the accuracy of their reporting in areas where I have no expertise. What other distortions and misrepresentations are being foisted on viewers simply because they make a better sound bite? Come to think of it, it all sounds more like Geraldo than Dan Rather. I used to think there was a difference.