Medical events or interventions in the movies always seem to add to the drama. Blood, bullet removal, life saving injections, chest compressions, more blood, murderous toxic substances, heart attacks, broken bones, heroes coughing blood, more blood. It is startling though to observe just how many gross or fundamental medical errors are committed. There is much wailing and gnashing of teeth from the cheap seats or from indignant medical colleagues – “Who advised on that movie ? Doesn’t Tom Cruise know how to use a defibrillator ? Has David Hasselhof actually seen a drowning victim ?” I guess that the answer is – they don’t have to! It is after all “just a movie” and in sheer fictional entertainment sense, under no obligation to be medically accurate. The producers are not providing public first aid training and no-one should be rushing out to stab needles into the hearts of drug overdose victims after watching Pulp Fiction anyway. Just because Indiana Jones grabs a knife and cuts the bite wound to suck out poisonous snake venom doesn’t mean it is either effective or a good idea. And if Dr Handsome Hero in ED Drama 101 grabs a laryngoscope in his right hand (‘cos he’s right handed – not realising that the device is strictly a left-handed medical device) then is it such a faux pas ?

Still, it is fun to unpack some of the more heinous medical blunders and provide a small therapeutic dose of realism – who knows, some Hollywood producer may hire me (for a small fortune) to advise on the next blockbuster. Watch those movie credits (for the name in the fine print) carefully next time.

So speaking of Missions Impossible – patients do not sit up, speak, stand and run after the bad guys minutes after being defibrillated. Understand what has just happened. The rhythm generator or pacemaker of the heart was not sending an effective signal to the cardiac muscle, which had then taken on a feeble, “attempt to beat on its own” survival strategy and was shivering like a jelly as opposed to pumping like a bodybuilder – thus the defibrillator (as Mr Bean correctly identifies) was required to reboot the pacemaker and allow normal business to resume. A flat line on the ECG Ms Roberts (as opposed to the wavy peaks and troughs of the fibrillating death rhythm) is usually a dead patient or an electrical lead has come off.

Needles in hearts are not recommended, in spite of successes for Uma and Robert (aka Sherlock Holmes). And in spite of advice you may receive to the contrary from 70 year old cardiothoracic surgeons. Shoving a long needle through the chest wall into the heart can puncture the lung coverings (causing a life threatening pneumothorax), or damage the electrical conduction system, or lacerate a coronary vessel (you would normally suffer a heart attack if one of those vessels gets blocked and now you slice it open with a needle).

The inaccurate movie medicine often extends to amateur surgery. Good guy or bad guy gets shot and all that seems to be required is a liberal sprinkling of alcohol (often including a glug for the surgeon to steady his or her hand) and a probing of the wound and the offending bullet is usually miraculously retrieved. The character always then seems to make a rather rapid recovery. So to be clear – bullet retrieval is not the aim of the game. Bullet wounds or ballistic injuries cause significant tissue damage as a function of their passage and the cavitating wave of energy that accompanies the projectile.

Maybe it’s the sound effects that we have become so accustomed to? That crunching and yet somehow satisfying click as the hero relocates his dislocated shoulder and then five minutes later, that arm is curiously fully functional. You should know that joints seldom make that (or any) sort of sound when being manipulated and dislocations are usually accompanied by torn ligaments and other supporting structures, requiring lengthy repair or rehabilitation.

So rather than being a wet blanket (an acceptable strategy for immediate large area burn management by the way) armchair critic – let’s just enjoy the movie shall we. Dr House was a fun series anyway and if dramatised medicine can lend some realism to the silver screen, then ……action.