Intensive ScaresBMJ 2003; 327 doi: https://doi.org/10.1136/bmj.327.7412.454 (Published 21 August 2003) Cite this as: BMJ 2003;327:454
- Rahul Rao, consultant/honarary senior lecturer in old age psychiatry and clinical tutor ()
BBC 1, 14 to 28 August at 9 pm
In the 21st century, media coverage faces tough challenges. As far back as the 1880s, the US newspaper publisher William Randolph Hearst defined news as “anything that makes the reader say, ‘gee whiz!'” However, it is tempting for reporters to turn investigative reporting into lurid sensationalism, as they have tended to do in parts of this series.
Intensive Scares, a set of three weekly programmes, focuses on the clinical consequences of acute hospital care. The programmes have attempted to portray real-life experiences by letting people tell their own stories as much as possible. Any expert opinion is confined to a minimum, and only then within a clinical context.
The first episode, “Heart Ache,” opened with the line “When you go into hospital for heart surgery, you don't expect to get brain damage.” It then looked at the day to day experiences of four people who had undergone heart bypass surgery and whose mental health, it claimed, had been affected. Interspersed with these accounts was the optimism of the team researching how to minimise the likelihood of any brain damage.
Heading the team is Professor Stanton Newman of University College London Hospitals, who has a unique interest in the mental health consequences of coronary bypass surgery. His description of plaque formation and the mechanism of embolism was clear and understandable, as was his description of an arterial filter incorporated within the heart/lung machine to reduce the number of emboli to the brain.
It was a shame, therefore, that the programme used so many acronyms (such as HITS–high intensity transient signals), which risked losing the lay viewer. By the end of the programme, the viewer was left with the message that “brain tissue doesn't repair” and that the devastating effects on the lives of people undergoing heart surgery is very much in their own hands. Harrowing scenes showing cardiac arrest during surgery and the commentary “vital signs flatline, as if he was dead” added more to a sense of drama than to public understanding, and appeared alarmist.
The second episode, “Born Pre,” which looked at the effects on the brain of premature birth, offered viewers both a similar and different approach to the first episode. It was similar in that it highlighted the long term effects of brain injury; it was different in its instillation of hope.
The programme concentrated on the development of four people born prematurely. Ten year old Heather Parrish can see only the top half of images and lacks depth perception. For Heather, walks along the high street or up escalators are immensely challenging. Twenty-two year old John Forbes cannot remember anything he experiences. The programme elegantly described the damage to his hippocampus and its clinical consequences following his premature birth. There were some almost surreal observations, such as how a regular visit to London remained, for John, a new experience each time. Gowan Hackett is four and a half and still plays on his own. He does not make social overtures, shows stereotyped behaviour, but has not yet received a “label” from doctors to allow his mother to seek the help she needs.
Gideon Odubayo appears as alert and capable as any other 12 year old. To his mother, his development has been nothing short of a miracle. Gideon was born with a bleed in his brain, and his mother had little hope of her son developing “normally.” Yet somehow his brain made the necessary connections that enabled this to happen. Somehow, his brain has “rewired” itself.
The scene then shifted to the use of intensive rehabilitation for developmental problems. There was a sense of hope in this episode that the involvement of specialist hospital services could make a difference to the quality of people's lives.
The third episode, “Killer Bug,” seems strangely different from the other episodes. The approach is reminiscent of that of a science fiction film, although the programme takes reasonable care to give a factual account of events. The bug in question is methicillin resistant Staphylococcus aureus (MRSA), but there is no attempt to explain how this term originated.
The programme coherently describes the nature of the bacterium, with powerful and sometimes extreme examples of its effects on people's lives. It painfully details the poignant and graphic account of one man's experience of MRSA. His bilateral below-knee amputations remain a constant reminder of the extent of the destruction that the bug can cause. There is a compelling description of a cat and mouse type battle between man and bug, as hospital staff painstakingly attempt to improve detection and prevent transmission.
The title of this series–Intensive Scares–is apt in that the programmes give a rather fatalistic view of hospital care. Although the second episode was well balanced, the first was unduly sensationalist, as is the third. There is little about the positive effects that hospital services have on improving the lives of people in the face of ever-increasing public expectations.
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