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Friday
Feb052010

Substituting Schmaltz for Substance: Another Look at "Inside the O.R."

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The Today Show’s unusually chipper and risk-washed coverage of the live cesarean section was not without its share of critics (transcript here). I ultimately chose to close comments on the posts and swore to myself to get out of the business of discussing any kind of broadcasted births. Even if the focus is off the family and the mother, it just doesn’t feel possible to word things in a way that doesn’t sound critical of them as well.

The internet removes the ability to discuss people hypothetically, as we’re all only one degree removed from each other now and I think it’s realistic to assume that people are Googling their own names in a very non-hypothetical manner. However, birth is a very sensitive topic for a variety of reasons whereas, say, catheter ablation of atrial fibrillation is not quite so volatile.

A different Today Show “Inside the O.R.” segment was discussed on the Dr. Wes blog.

The NBC Today Show aired a segment on the Stereotaxis robotic system for performing catheter ablation of atrial fibrillation using magnetically-steered ablation catheters yesterday (video here). It sure generated a lot of buzz around our hospital. While I share the reporters enthusiasm for all the gadgets and gizmos (what doctor-engineer wouldn’t like such neat toys?) the enthusiasm should be tempered with a strong dose of reality regarding this technology and any atrial fibrillation procedure.

Another blog, CardioBrief, described the segment.

The 6-minute segment was relentlessly upbeat. The TV producers pulled every trick in the book to overcome the inherent difficulty of portraying a hard-to-explain disease like AF and an even harder-to-explain procedure like catheter ablation. Instead of making any effort to truly educate their viewers, the producers took the easy route. Arruda, staring at a bank of large display monitors, might as well have been playing a video game, for all anyone watching might have known. And the reporter, NBC Medical correspondent Dr Nancy Snyderman, substituted schmaltz for substance and presented the “heartwarming” story of the patient, a great-grandmother, accompanied by stirring music and sentimental images.

Although the procedure was still in progress (and in fact Arruda had not even finished the mapping portion of the procedure), Snyderman said that “thanks to technological advances in cardiology Dr Arruda will be able to fix Bernice’s heart.” The patient was also well trained and thoroughly on message: in a clip filmed before the start of the procedure she said, “I’m excited and I’m not afraid.”

Just in case anyone hadn’t somehow caught the positive message, Snyderman told her viewers that the patient’s life (even before the procedure was finished) now ”has new promise thanks to a dedicated physician, a world-class medical center, and extraordinary medical advances…”

Snyderman then said the success rate of the procedure is 85%, but that wasn’t quite good enough for Arruda, who informed Snyderman that ”the success rate is 85-90% with this particular technology.” As if that wasn’t upbeat enough, Snyderman then reassured her audience that ”the radiation risk is minimal.”

Finally, Snyderman promised her audience that “we’ll follow-up in a few months, but by all accounts… we expect her to do really very very very well.”

The blog’s author, medical journalist Larry Husten, offered a commentary:

Watching this short segment reminded me of one of those pictures in a child’s puzzle book where the reader is asked to find everything that’s wrong in the picture, and the longer you look the more wrong things you find. Even after staring at the picture for several minutes you’re still surprised when you realize the man walking across the center of the picture has only one leg.

Husten goes on to question the ethics of broadcasting a live medical procedure, noting that even if one feels that it’s ethical, it’s “irresponsible to report it with this kind of relentless, upbeat mindlessness.”

Furthermore, Husten notes that there is no evidence in the literature to support touting an 85-90 percent success rate and that presenting this statistic to the general public, “many of whom may have AF, or may know someone who has AF, is completely irresponsible.” He calls catheter ablation an impressive medical advance that comes with a lot of caveats and that perhaps the best time to interview a physician about a procedure is not when they are in the middle of that procedure.

Husten’s commentary could practically be used verbatim for the cesarean segment as well, applicable in particular to these statements and dialogue:

Nancy: I want to underscore one other thing Meredith. This is a cesarean section that was scheduled. This was in no way done for The Today Show. This was orderly, routine and scheduled for this timeframe just the way these are supposed to go and, as happens at countless hospitals all over the country, an extraordinarily healthy birth. That is a robust little baby boy.

 

Meredith: Dr. Azizi, what percentage of deliveries these days are by c-section?

Nancy: Well, let me go ahead and ask Dr. Goldberg. [Walks to surgical field] How many operations, uh, deliveries are done by section as opposed to vaginal?

Dr. Goldberg: It depends a little bit across the country but it can range anywhere from 25 percent to about 30 percent. 

Nancy: The indications are baby to big, mom in distress…

Dr. Goldberg: Or baby in distress is a common one, or if a mother has had a cesarean section before.

Nancy: The fact that you’re sewing up the uterus and you’ve made an incision that is crossways instead of vertical, does that mean that if Carrie gets pregnant again and the baby is a normal size, she can have a vaginal delivery?

Dr. Goldberg: Absolutely, absolutely.

 

Nancy: I want to underscore again that while Carrie has been a phenomenal trooper, she was scheduled to have a cesarean section this morning because in both of their families, babies run big and she was past her due date and those are two indications that a cesarean section is a lot safer than having a vaginal delivery. This little baby was born without a hitch, weighing in at ten pounds. At this hospital, it’s busy most days and in fact, they have about 5,000 deliveries a year.

Like these medical bloggers state, the Today Show coverage was missing a strong dose of reality, rendering the segment irresponsible in its widespread dissemination of inaccurate information to the public. This was not an “extraordinarily healthy birth,” nor was it “without a hitch.” A nulliparous woman had major surgery on live television at a hospital with a 42 percent cesarean section rate and the public now thinks that a family history of big babies and being past an undisclosed amount of time past an estimated due date are clinical indications for an elective cesarean. There might have been other reasons for the surgery but the ones disclosed by Snyderman were vague at best.

The fact that, as Nancy Snyderman said, “[t]his was orderly, routine and scheduled for this timeframe just the way these are supposed to go and, as happens at countless hospitals all over the country” is more often a problem than a medical miracle.

 

 

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Reader Comments (11)

It's very good to know that it's not only birth advocates that have mixed (to say the least) feelings about this whole cheery Today Show series. Thanks for sharing this!

February 5, 2010 | Unregistered CommenterDou-la-la

I'm also glad that the series is getting attention elsewhere as well.

I wonder whether they are actually "live" or on some sort of time delay, also. Otherwise, I cannot imagine them broadcasting any major complications live. What would happen if the baby in the section had been cut or the mother started bleeding heavily? Would they continue to broadcast cheerily, ignoring or not even knowing what was going on behind the curtain? What if the woman in the heart procedure suffered a complication during the performance, which is surely not unheard of?

Finally, why is everyone so dang glib about all this? Medicine is medicine, and important, and awesome, and powerful, and dangerous. Why heart procedures and surgeries designed to save mothers and babies are now "entertainment pieces" is beyond my comprehension.

February 5, 2010 | Unregistered CommenterANaturalAdvocate

First and foremost I think it has to be said that the Mother Carrie and Josh the Dad, are very very brave for allowing this segment to be produced. I have found unfortunately that whatever one's ideas about how a television show will treat your life story. They are more inclined to "schmaltz" it up and add silly clichés about the red sox, and to mangle up the truth of the seriousness of surgery and confuse viewers with a mix of happy emotions because luckily and fondly a beautiful baby emerges- without serious complications.

When you read the transcript- the almost comical gestures put forth by Dr. Nancy make it as if I expect at any moment for Eric Idle and the other Monthy Python players to come waltzing through the OR doing the ministry of silly walks sketch while they take over the surgery turning it into a semi- musical humming and then singing “Every Sperm is Sacred” from “The Meaning of Life”. Her actions just as Husten points out show such ethical shakiness it is incredible with this televised MORNING DRIVE TIME c-section and the atrial fibrillation piece described by Larry Husten. What is next Dr. Nancy, an embalming? Yes let's go there an embalming of a newly deceased, good looking, Today show viewer before Hoda and Kathie Lee-and after Matt, Meredith and Al’s morning stroll on the 30 Rock plaza .

Being someone who has lived through two very necessary c-sections and one very serious gastro surgery- there was no worse feeling then when I was wheeled into the OR and for a brief moment I thought- oh my god, I could die. I now know that you can be that “one” risk. It is not ever a given that you, your baby, your Mom etc. will survive a routine medical procedure. I never thought, “Oh my god I wish the Today show was here chirping away.” Surgery even routine is not perfect- I knew instinctively to pull my husband close and say I love you JUST IN CASE. Dr. Nancy is not doing America any favors with these segments. She is also disavowing the good work going on in Boston around actual, normal routine birth with the help of midwives and nurses in hospitals, birth centers, and in homes by showing a hospital that has such a downright alarming c-section rate. They should be showing America what they are doing to foster safe and sound routine births not surgical births that take on an air of a casual gathering. The operating room is serious- epidurals are serious, complications with and at birth are deadly serious. What exactly is she trying to accomplish by chirping it up- or downplaying cardiac surgery. I am glad to see- it's not just me who objects!
I would respect the Today show so much more if they would find a REASONABLE middle ground of presenting health related information especially about birth.

February 5, 2010 | Unregistered CommenterBarbara-Jean

Yep. There have been times I have refrained from writing about medical issues that are portrayed in the media, because I was afraid that readers would think I was judging the patient, instead of the issue. One example is the Duggars who have their own reality show about having 18 kids. They recently delivered a 25 weeker, all captured on camera. I have abstained from posting on this TV portrayal of prematurity,in an effort to not offend the patient. But in reality, prematurity is not a Made for TV movie, and should not be treated as a "miracle" or schmaltz over. So, the question remains. As a blogger, do we risk offended a few, to bring the truth and reality to the many?

February 5, 2010 | Unregistered CommenterReality Rounds

I think one needs to be cognizant of the families in any story in the media at all times. I defriended a birthinista for dissing Casey Duggar on their FB thread.(not that that is some nobel peace prize gesture) I'm like Really?! It's okay in one breath to give her an f-ing emmy for feeding breastmilk because that is laudable but in the next breath diss her for what has been the basis for her life..... having a huge family. (?) I think we have gone off the absolute deep end with the public criticism of birth choices. I understand why- I get it- with the trampling of patients' rights, the practice of defensive medicine and unscrupulous practice that has permeated unregulated home birth midwifery- I get the hyperbole. I however think it is becoming so extreme that people don't realize they sound mental...absolutely looney tunes. I am trying so hard to evaluate my own comments like never before. It is not constructive and people will easily defeat even the best of arguments if we sound nutso.

Okay, here is a question to pose- is it acceptable to have a waiting period or does it become a non-sequitor. Like if we all wait for weeks from now then revisit the Today show revolving medical procedure segment does it lose its effectiveness as an educational tool? I sorta think not as Discovery Health Channel is a constant string of shows on all sorts of health issues. I think the thing about media portrayal of the up to date story of the minute is the timing- but how do we balance the need to ride the wave of the media zeitgeist with the needs for us to be ethical and not build our "movements" on the backs of others based on debasing their personal story/choices or worse their human tragedy.

February 5, 2010 | Unregistered CommenterBarbara-Jean

I am heavyhearted on the glibness of Cesareans this morning. My SIL just had a Cesarean not two hours ago. Details remain vague but I'd guess that it wasn't really necessary. And the worst thing is, although I am also hopeful that her recovery goes well, especially since she has a 13 month old little one to care for as well as her newborn, all I can think is that "her number was up." One in three women gets cut. This was her third baby, and the other two were vaginal births. Her number was up. I'm happy to have a new nephew, but I'm also tremendously depressed.

February 5, 2010 | Unregistered CommenterJill

Reality Rounds and Barbara Jean... you've really defined the struggle. And my answer is, "I don't know." And I guess I'll refrain until I do know because it's not like I'm wanton for stuff to write about. It's easy to be misunderstood and I think this is one area that I don't want to be in the grey.

I think what's hardest about dealing with the media coverage is that I keep feeling the need to reiterate that I really trust that women are making decisions about their health care, their pain relief, and their births that work for them. And if I feel like I need to add a disclaimer after every sentence that I'm just trying to step back and take a look at cultural scripts or the way the public consumes information and not stomp on someone else's decisions based on a very superficial blip of information that's been filtered through multiple editors, then I'm clearly not expressing myself accurately.

February 6, 2010 | Registered CommenterJill

If the intention is to mislead the public about what constitutes a medical indication for a c- section, then they've done a great job. Maybe that was the goal.

February 7, 2010 | Unregistered CommenterAnon

If doctors are giving patients faux reasons to have procedures, then we can't trust that they are making any decisions other than to go with their doctor's advice.

February 7, 2010 | Unregistered CommenterAnon

In general I like birth shows/stories, but everytime I see a c-section on t.v. I always have the same thought looking at the mother hidden behind a curtain, the baby being taken from her belly to a table she (usually) can't see, checked over, bundled up, and then, finally, taken for a brief 'cheek' snuggle with mother: "look at all those people who saw the baby before the mother!" In this segment (which I actually turned off before the end), which appeared to be live or only briefly delayed that thought was upgraded to "think of all the thousands if not hundreds of thousands of people who saw the baby before the mother!"

February 7, 2010 | Unregistered CommenterJespren
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