Greetings from the MetroGen Hospital writing cave where I’m Carina Alyce, a real-life, full-time medical doctor and indie romance author.
I am here today to talk about things you should know before you type a single sentence about doctors – and the most common mistakes that you should avoid.
Look, I understand that way more authors have watched episodes of Grey’s Anatomy than have read Gray’s Clinical Photographic Dissector of the Human Body. However, on behalf of the three-quarter million doctors and six million nurses in the US and Canada who just threw your book across the room because a character asked for a ‘STAT MRI’, I have a prescription for you.
It might be a bitter pill to swallow, but wash it down with my dose of snark and call me in the morning.
(If you’re wondering why you should listen to me, I started out as the radiology secretary and infant nursery photographer, worked through college as a nursing home aid, am triple board-certified, and have worked in the ER, Pulm Critical Care, Labor and Delivery, and I have NOT ONCE had sex in a call room!)
Here are ten of the mistakes I see most often in fictionalized hospitals:
1. No foreign born doctors appear, ever.
In the US, approximately one in four doctors was born in another country. In Canada, it’s slightly under one in five. When did you read a book or watch a TV show that acknowledged that one in seven US doctors are of Indian descent? That next overhead page had better be for Dr. Agarwal.
And I hope the person making the overhead page is the excellent Filipina charge nurse because . . .
2. Doctors are the only staff at the hospital.
We’re actually rare birds and are vastly outnumbered by everyone else. Your hospital should be populated with a large number of people who are not doctors. Do you have nurses, respiratory therapists, physician assistants, dieticians, social workers, midwives, technicians, transport, janitorial staff, cafeteria workers, admit clerks, and security? Even a single surgery will have one surgeon, two surgical technicians/assistants, a certified nurse anesthetist or anesthesiologist, circulating nurse, scrub nurse, and a medical assistant.
About surgeons and the OR. . . .
3. Surgeons delivering babies.
Oh heck no! Surgeons avoid pregnant patients like the plague. (Technically, surgeons also avoid the plague and would page infectious disease specialists.) The only doctors who deliberately deliver babies are OBs, outside of some family medicine docs. C-sections are primarily an OB-only skill. You cannot give your doctor a new specialty as the plot demands.
If every OB is home with food poisoning, here’s my order of delivery preference: FM doctor, ER, and then paediatrics. No surgeons, but I’d call every single Labor and Delivery nurse in the hospital who could walk you through a C-section.
Remember, C-sections actually leave scars . . .
4. No scars for anyone.
One week after your character’s big dangerous surgery, they feel fine and have healed without a scar: BIG NO. All surgeries – even plastic surgeries – have scars, bruising and pain. There will be different types of stitches (called sutures) versus glue versus staples. Even a boring cut that leads to stitches in the ER will get a scar. Don’t even get me started on patients who have brain surgery without getting their hair cut off! Any area that is going to be operated on is shaved with an electric razor before surgery – which makes a hairy chest a problem.
True story: As a medical student I had to shave a patient’s afro just before surgery. They gave me the dinkiest electric razor ever, and I was tasked with that job because the real doctors were busy . . .
5. Doctors who are never seen ‘doctoring.’
Resident trainees are limited to 80-hour work weeks, and no more than 28 hours of work in a row. Attending physicians don’t have an upper limit. Unsurprisingly, we never call in sick, and we spend most our time in the hospital – not clubbing, not in a penthouse apartment. Your characters can meet at the coffee cart, hospital cafeteria, hallway, hospital gym, doctors’ lounge, callroom, basement, and elevator. If your doctor is living a Christian Grey existence, they are probably not a very good doctor.
I wouldn’t trust him to put an IV in me. Actually, I wouldn’t trust ME to put an IV in anyone. . .
6. Dcotors putting in IVs/getting their own labs/giving vaccines/taking vitals.
Doesn’t happen. Remember the other people in the hospital? A tech or nurse is doing all those things under my instructions. Your typical ER doc is doing stitches, lancing boils, spinal taps, needle chest decompressions, and intubations. Must I mention NO ONE does surgery in the ER?
While we’re on the topic of labs I’m not drawing . . .
7. Labs always immediately available no matter how crazy the lab sounds.
Your DNA test will be available in an hour . . . and fourteen days. You can get a complete blood count, a basic metabolic panel, a blood gas, a urine pregnancy test, and a cardiac troponin in less than thirty minutes if you have a big lab in the ER, though.
Same thing goes for radiology. X-rays and CTs are easy to get in the ER – but not an MRI.
No doctor runs faster than a speeding bullet, nor can they bend the space time continuum . . .
8. Your doctor cannot be an eighteen year-old genius like Doogie Howser.
To practice independently in the United States or Canada, you need a four-year college degree, four years of medical school, and a completed residency. The shortest residencies are three years and longer ones can last eight years, which doesn’t include fellowship. Surgeons will be over thirty when they finish their residency in five to seven years. To be the best in their field, it’ll be at least a decade, and they won’t be chief until they are almost fifty unless someone murders every senior member of the surgical faculty first.
Maybe they died of psittacosis . . .
9. Every single horse is a zebra (or in the surgeons’ case, pigeon-borne hypersensitivity pneumonia.)
I understand the temptation to use this super special diagnosis to cement what an intelligent-expert-smarter-than-everyone superhero your doctor is . . . but didn’t you read #8? Septic shock, ruptured appendix, and acute hemorrhage sound pretty dangerous without diagnosing someone with cerebral paragonimiasis (lung fluke in the brain) because they ate wild boar at a Renaissance fair three months ago.
On that, your doctor isn’t coming to your house like House MD did. Ever. We don’t make house calls unless we can fit a pharmacy and a code cart the size of refrigerator in our messenger bag.
And about codes . . .
10. Codes done wrong.
Repeat after me. Do NOT shock asystole – aka flatline. Do not shock pulseless electrical activity. You can shock V-fib and V-tach. We don’t use paddles anymore. Instead, we use sticker-like pads that stay attached to the chest. (I don’t care how cool paddles look, it’s so 2002).
We do yell ‘clear’ because no one wants to get electrocuted, but we don’t use STAT, ASAP, or urgent. You’re coding someone, everything is automatically STAT. If you pick one medicine to give, pick epinephrine. It’s part of the code medications for asystole, pulseless electrical activity, V-fib, and V-tach. Epi is given IV, never in the muscle, and definitely not stabbing someone in the heart – Pulp Fiction is wrong.
Bonus round: Chest compressions are performed in two minute rounds with frequent staff switches. Punching someone in the chest doesn’t work no matter what happened on Grey’s Anatomy last night.
Still with me? Congratulations, you can now write all medical scenes like an expert . . . okay, not really but this should help! If you have questions, I’d recommend joining the Trauma Fiction FB group where these discussions are kind of their thing. (I hang out there on occasion, but I’m mostly busy working and releasing one MetroGen romance a month.)
Carina is giving away free copies of her book High Risk to the first five people who enter the promo code MEDIC100 at checkout! Quantities are very limited, so grab yours now!
Carina Alyce is the pen name of the Amazon best-selling author and full-time triple board-certified physician who started writing dramatic medical romances after twenty years in the trenches of health care. She promises she never had sex in a call room – the mattresses are not comfortable – or had a fistfight with a patient – though she did work as a fight doc at the Octagon. Her stories are sexy, snarky, and real with all the romance and drama of the lives of our first responders.
She writes the MetroGeneral Downtown series that tackles the personal and professional challenges facing our front-line providers. You’ll find her stories have the drama of Grey’s Anatomy, the comedy of Scrubs, the sexiness of Outlander, and the medical details of Forensic Files. They feature fast, witty dialogue, strong women with goals, and quirky ensemble casts.
When not working or writing, she is a brown belt in judo, an avid reader, and an attending surgeon in stuffed animal veterinary medicine for her six kids. (No one trusts her husband’s medical skills because he’s just a lawyer.) You can follow her at carinaalyce.com/newsletter or see her dance and make Grey’s Anatomy jokes on TikTok at https://www.tiktok.com/@carinaalyce
Lots of family physicians delivery babies in urban settings and many family physicians do C-sections (both in rural and urban settings). I’d suggest updating your article.
This was great! I haven’t written a doctor character yet — def not a contemporary one — but I’ll keep this in mind!
FYI Carina, 10% of family medicine docs do deliver babies, not limited to rural areas, and many do c-sections. Our work is essential in many communities. Every family medicine residency program has FM trained faculty who deliver (a requirement by ACGME), and residents are expected at a minimum to deliver 40 babies (many, including myself who plan to practice FM w/OB, far exceeding this). I’d be hard pressed to find an ER doc in my hospitals (urban underserved area) who has delivered more than 10 babies. What you wrote is super super ignorant!
Great article, Carina. Even though you didn’t mention anesthesiologists once 🙂 Word limits are a problem, but I would trust an obstetric anesthesiologist, who has watched thousands of C-sections and is quite good with their hands, to do a C-section if all the OBs were home with leprosy. The “my character does everything from starting the IV to reading the MRI and performing the surgery” is a frequent and way-annoying trope. Thanks for dispelling it!
Love, love, LOVE the Trauma Fiction group on Facebook!