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.