Possibly the Most Hysterical Thing I've Ever Read In a Medical Journal

I feel so badly pouncing on this when really it's so much more ideal for the blogs of my emergency physician friends. the Annals of emergency Medicine October 2005 issue published an Article titled "The Next Generation of Emergency Medicine Reality Television". It's possibly the funniest thing I've ever seen in a Bona Fide medical Journal (if you consider EM medicine???). Props to Jeffrey Freeman who wrote the piece. Truly Mad my friend, I love it. Please excuse me for publishing it here. I have no money, really, I promise, none. Forgive the EM joke, that's mine, figures right?

As any emergency physician knows, it is normal to ride through the hallways of the hospital doing CPR atop the chest of a dying patient while shouting out orders to nurses at the top of their lungs—at least on television. And, while miracles occur in emergency departments (EDs) every day (such as a specialist coming in to see a patient), they are not always sufficiently dramatic for prime time. Like it or not, the American public learns more about emergency medicine from the television than from their personal experiences. ER has just finished 10 seasons; Trauma: Life in the ER has finished 7. Since it's only a matter of time before these shows fade from the airways, a replacement will soon be necessary. In this era of reality television, something that will grab the public attention and let them feel the true grit of today's ED is needed.

The following are reality television proposals for the next generation of emergency medicine viewers:

The Resident—A powerful and omniscient residency director starts with 12 emergency residents and each week fires one resident and gets all the remaining residents to work the extra shifts vacated. The last resident working gets hired to a large contract management group, but not as a partner.

Joe Emergentologist—Ten patients compete for the attention of Dr. Joe, the only physician working in a small rural ED. Each hour, Joe transfers off 1 patient to an alternate facility. Imagine the patient's surprise when it's finally revealed that Dr. Joe is only a moonlighting first-year dermatology resident, with no experience in any ED. Will the last patient standing still accept the loving care that Dr. Joe offers when they find out the truth?

Waiting Room Survivor—Twelve patients are stranded in an isolated, barren waiting room, and triage is closed. Who will survive? Without water or food, they have only their wits and the will to survive. Each week a patient is voted out of the waiting room. As they form tribes and win challenges, they struggle for the ultimate goal: any available treatment room.

ER Jeopardy—In this game show variant, 3 emergency physician contestants try to guess a patient's diagnosis, but the answer to every question is another question. Categories of answers include such puzzlers as: “What Language Is That?,” “Nominal Aphasia,” “Geriatric Confusion,” “In2bated,” and “Toxic Delirium.” Losers get sued, and the winner gets no actual cash or prize, but does get to come back for another shift and the satisfaction of a job well done.

The Mole—A high-volume ED, and one of the staff is sabotaging patient care. The Mole changes lab results, erases orders, and gives wrong doses; each week another abbreviation is cut from the list of accepted abbreviations. Can the emergency physician find the Mole before another patient calls their attorney? Sponsored by the Institute of Medicine.

Patient Extreme Makeover—A team of top-notch support services: social worker, physical therapy, occupational therapy, and dental hygienist, take a frequent ED visitor each week and work their wonders. Consultants are called in for bariatric surgery and laser tattoo removal; clothing is donated from the local thrift store. The patients return after their complete makeover with a new chief complaint, and the ED staff can't recognize them until they ask for Dilaudid…

The New Price Is Right—Forty-five million uninsured audience members are invited to the television studio ED waiting room, where 4 contestants are chosen to possibly win some medical care. To win, they've got to guess the price of industry-sponsored drugs and medical procedures. Those who guess closest are invited to a final showcase, where they try and guess the complete cost of their medical treatment before succumbing to their disorder. “Come on down!”

The Simple, Poor Life—Two consultant physicians, both from fabulously wealthy subspecialties, are sent to live and work in an ED for a month. Each week they are given a different job, from unit clerk through transport and housekeeping. Can they get through one last shift without getting their clothes dirty? A laugh a minute…

Who Wants To Be a Millionaire?—Two physician CEOs compete for an ED contract, trying to underbid and underpay their employee emergency physicians without going over the contract price. Three lifelines are given: “Noncompete clause,” “Restricted access to billing information,” and “Call a Friend.” Winner gets a million dollars and retires early from medicine.

American Idle—Each week, 12 patients wait hours for lab and radiograph reports while their medical conditions deteriorate and inpatient beds are unavailable. Radiologists and audience members can text message their vote for favorite patient to be admitted.

And finally, Fear Factor—This could be the ultimate ED program. It's apparent that the potential for an endless series of reality-based episodes of pain, terror, and inedible food is available. Just like a career working shifts in any ED.

Note 1: If anyone wants to consider hiring an emergency physician as television producer, please contact the author immediately.

Note 2: JCAHO has reviewed this article and would like to remind emergency physicians who shout out orders while performing CPR while riding stretchers down hallways, that for verbal orders, please verify the order by having the person receiving the order “read-back” the complete order. Thank you.