Dear ‘ER’: Thanks for the Introduction

1994. Some emergency physicians were still in high school back when NBC’s show “ER” debuted, introducing the world to CBCs, difibrilators and George Clooney’s five o’clock shadow. Fifteen years, five Emmys and gallons of fake blood later that staple of Thursday night programming finally came off the air this spring. Twelve EPs, from a textbook writer to an ED chairman, reflect  on how the show impacted their lives and changed an entire specialty.

In 2003, during the show’s 10th season, Judith Tintinalli, MD, author of the ubiquitous textbook that bears her name, had a chance to appear as a physician “backgrounder” on the show, giving her a unique perspective on the cultural icon and its affect on the specialty of emergency medicine. by Logan Plaster
 
“If you were knocked out and brought onto the set of ER and then regained consciousness, you would think you were in a real emergency department,” says Tintinalli, who flew out to Burbank for a taping at the invitation of Joe Sachs, the show’s executive producer. Sachs, who still works a couple shifts a month as an emergency physician at UCLA, has been keeping the show accurate since midway through its first season. And according to Tintinalli, his attention to detail couldn’t be more obvious.

“When you get inside the studio it is uncanny how realistic it is. They had this typical kind of tile, they had stretchers, they had real equipment – it wasn’t like plastic models of a monitor or defibrillator. They had real I.V.s and real tubing.” Just don’t try to take the elevator, she laughs. “It’s a hoot; the elevator didn’t go anywhere. You get on, the doors would close, you wouldn’t go anywhere, and then you’d get off and go another direction.”

In addition to having the right props, an EP sat next to the director during every take, watching for clinical mistakes. “X-rays weren’t backwards and maneuvers weren’t grossly abnormal,” recalls Tintinalli. “(The EP) can just stop the shooting, and I saw them do it.”

The acting transported Tintinalli back to the real ED as well, in ways she hadn’t expected. “The nurses looked like nurses, they walked like nurses. The doctors hung their stethoscopes around their necks like doctors do. It was amazing. You could mistake them for the real thing without a doubt. When you’re working clinically, you’re on a mission. You have a goal to everything you’re doing. The actors were able to mimic that as though they understood the business of medicine.”

Union rules kept Tintinalli from having a speaking role in the episode, but that was just fine by her. Instead, she played a physician in the background of a scene. “As a backgrounder you have your cues,” remembers Tintinalli. “I was writing on a chart and sort of talking to my colleagues, and we had to know exactly when to walk in and walk out of the set. And we did that for, I don’t know, four hours. It was great fun!”

But all good things – from overly dramatic love triangles to fake C-sections –  must come to an end. For Judith Tintinalli, the show has left a lasting impression. She watched as it educated the public about the role of the ER during a critical moment in the nation’s understanding of health care. For the community it also “raised the expectations and the standards of the population to understand what kind of care to expect.” ER taught audiences that the emergency department is a unique place requiring a unique set of skills. What’s more, the show demonstrated that without the right training, emergent cases could go very, very wrong. General concepts, sure. But essential in bringing a young specialty into maturity. The show also portrayed physicians and nurses as real people, adds Tintinalli, arguably doing more to boost health care PR than any public service announcement in the past 15 years. “I think it really helped the image of the medical community.” 

 

Mike Silverman, MD
ED CHAIRMAN
In the fall of 1994, I was three months into my EM residency. Over the next couple of years as Dr. Greene’s character developed and became a household name, many patients identified my role as his and often referred to me as “Dr. Greene.” It wasn’t so bad to have patients think of me in that light. As the show’s writing got better, I sometimes thought they used great lines when they talked to families about death and critical issues. I’m sure I’ve taken the theme of some of these conversations and incorporated them into my own conversations with patients.

 

 

Michael Carius, MD
PAST PRESIDENT OF ACEP
Fortunately or unfortunately, I am of the generation that was already practicing EM when the show ER began. In those days we struggled with an identity of our new young specialty, both in terms of the house of medicine and public perception. While the show stretched reality – they managed more acute, critical patients in one hour than my ED managed in a week – it provided a not totally inaccurate view for the public into our world. As such, many issues were brought to the public that might not have ever found a vehicle, such as the importance of residency training and board certification, the plight of the uninsured, the homeless, the revolving door for the psychiatric patients, the lack of availability of on-call specialists and the list goes on. ER has done more for our specialty in a PR sense than any other vehicle; it has made heroes out of us. Regardless of how accurately we have been portrayed, it has served us well.
Did I mention it was entertaining? My wife, a long-time emergency nurse, and I have enjoyed watching it and are sorry to see it go.

 

 

Louise B. Andrew, MD, JD
PAST PRESIDENT OF AAWEP
I confess to being witness to the official ACEP protest against the show title, reflecting as it did a misnomer we had fought hard to suppress over the previous 15 or so years. Also, I well remember watching the first episode (from a 15-year-old script) at an AAWEP meeting and laughing at all of the medical inaccuracies portrayed. When I was Council speaker, however, I met Lance Gentile who would later ask me for show ideas. I would broadcast the request to the council and members would send in anecdotes, many of which would be compressed to form a single episode. (ER) certainly did put us on the map and influenced a generation of students in favor of EM.

 

Ricardo Martinez, MD
Former Administrator, NHTSA
ER changed my life dramatically. When I first arrived in D.C. and began meeting Congressmen, a common question was what exactly was an emergency physician? Are you a surgeon or internist? Will you go on to do something else? And, why, oh why, would a physician be in the Department of Transportation? It was a tough sell. Luckily, about a month after I was sworn in, the show ER debuted and within months the stature and credibility of being an EP improved dramatically, providing a firm foundation for discussing issues and building relationships around the issues of automotive safety, injury prevention, and EMS. It became clear that motor vehicle injuries were a major public health problem, and EPs were on the front line. This growing glow on EM allowed us to reach out and ensure that every press event or panel included emergency professionals.  Within a year or two, EPs were well recognized for their role in society and sought out for their expertise in a variety of national policy issues. The rest, as they say, is history.