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Big Sick
Lionsgate/Amazon Studios
NITTY GRITTY

An ER doctor on what “The Big Sick” gets wrong—and why medical accuracy matters in Hollywood

Esther Choo
By Esther Choo

Associate Professor, Center for Policy & Research in Emergency Medicine at Oregon Health & Science University

Tonight my husband and I watched The Big Sick, a hilarious and touching romantic comedy directed by Michael Showalter. It’s the best movie I’ve seen in years—even given what I’m about to write.

The plot centers on the romance between a Pakistani-American man, Kumail, and a white woman, Emily, and the tension between their budding relationship and Kumail’s obligation to his traditional Pakistani family. I’m an Asian woman married to a white guy, and right away I loved how spot-on the cultural tensions were. So far, so good.

But then Emily gets sick and goes to the hospital, where she remains for much of the movie. And since I am a physician and like things to make sense, I spent a lot of time squirming over the medical inaccuracies. At one point, my husband (also a physician, and sympathetic to my agony) turned to me and whispered, “Why didn’t they hire a medical consultant for this?”

Most of the inaccuracies would have been easy for a doctor to fix, given one hour alone with the original script and a red pen. Kumail has to pretend to be her husband to give permission for the doctors to place Emily on a ventilator. When healthy young people are sick, the rule of thumb is to do everything needed, automatically; we would not wait on a next of kin’s permission. The patient’s chart, flashed on the screen, should have indicated she was admitted to the “MICU” (the medical intensive care unit) instead of the “SICU” (surgical intensive care unit), since she did not have a surgical problem. The word “procedure” should have been used to describe a thoracentesis—a process in which a needle is used to remove excess fluid from the lungs—instead of “surgery.”

And while I was so happy to see a female physician in charge, attending physicians do not introduce themselves by saying, “I’m the ATTENDING PHYSICIAN.” They just say, “I’m the physician caring for your family member,” or maybe, “I’m the physician in charge.” I’m a real-life “attending physician,” and just typing that made me feel like a huge tool.

Wardrobe: I have an issue with you, too. The attending physician should not have been wearing running shoes. Shoes with fabric soak in blood, urine, and other bodily emissions in unpleasant ways. A real attending doctor would be wearing Dansko clogs, unless she were on an administrative day and not anticipating any messes, in which case she would be wearing Tieks.

Hollywood often gets simple medical stuff wrong. I remember watching George Clooney, on the television drama ER, put his stethoscope on the wrong way. The comedy Scrubs once showed an appendectomy incision being made in the left lower quadrant, the opposite side of the location of the appendix. Hollywood doctors – but not real doctors – inject morphine directly into a wound, rather than into an IV line. They run to provide a shock to the heart when the cardiac monitor shows a flat-line rhythm, which doesn’t respond to defibrillation. They show people in comas who are not on breathing machines. Medical foibles like this are so common that doctors have made a kind of sport of exhaustively listing medical inaccuracies on TV and in movies.

I should probably suspend my disbelief and just enjoy the entertainment. I’m sure that beyond the 12 million healthcare workers in the US (not to mention the millions of people who are medically savvy due to their own illness or the illness of their family members), there are plenty of people not bothered in the least by the hundreds of little inaccuracies. But on the other hand, there are a number of reasons why it’s important to get the medical details right.

First, a greater obsession with clinical facts would translate to the audience as an indicator of quality—just as it does with well-researched legal, financial, and political dramas. Inaccuracies can be more than just distracting: They can ultimately threaten the credibility of a movie or TV show. When lean, exquisitely crafted storytelling is alternated with sloppiness in the medical scenes, it feels like a lost opportunity to present a fully realized product, and makes the audience wonder what else in the movie is not told honestly. And insofar as movies wish to capture the depths of human experience, authentic depictions of health scares and tragedies are elements that illustrate the most raw and vulnerable moments of the human condition. Shouldn’t they be treated with care and attention?

Furthermore, medical accuracy doesn’t need to be sacrificed for the narrative arc. My friend, the prolific and acclaimed author Emily Franklin, occasionally sends me an outline of a plot that hinges around a medical condition that she hasn’t yet identified. Given certain parameters – say, the manifestations and time course of an illness – I can almost always find a clinical scenario that fits her storytelling needs. Disease and health care are endlessly complex, thus endlessly moldable into storylines without requiring too much creative license. Within my limited experience, I’m skeptical that medical accuracy has to be sacrificed routinely for the sake of the narrative.

In fact, I would argue that adhering to clinical accuracy would enhance storylines, because caring for the very ill is inherently dramatic. In The Big Sick, instead of rolling Emily off to what looked like a sterile operating room to be placed on a ventilator, the code team should have crashed into her room to intubate her—which is how things actually play out in the hospital. I’ve been on that code team many a time. The family gets shoved to the periphery or asked to leave the room. The scene can be sudden, chaotic, loud, confusing, pressured, and messy. It would have fit the tension in the movie at that point perfectly, while also being true to what happens in the hospital when a patient is decompensating.

Finally, there’s much to be gained for everyone if the house of medicine engages more closely with the studios of Hollywood. Increasing the credibility of what is portrayed on the big screen calibrates the expectations of the public. In a study published in the New England Journal of Medicine, TV physicians were observed to revive people from cardiac arrest about 75% of the time, nearly 15 times the actual survivable rate of cardiac arrest. It’s no wonder that when families hear that their loved one died, their expectation is that we get them back. Our collective consciousness is wired for success in this scenario, not the almost inevitable failure. The expectation amplifies their tragedy. This is why physicians should see medical consulting for TV or movies not as an opportunity to make money or leave medicine, but more as a public health service that we offer as part of our existing jobs.

I hope everyone watches The Big Sick. It’s awesome. It is only because of the deeply authentic way it captured the beginning of a relationship and cross-cultural dynamics that I so badly wanted the authenticity to extend to its clinical setting. And I look forward to a future wherein filmmakers and doctors work together to create captivating stories that also feel utterly honest—down to the last medical detail.

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