COMMENTARY

Did Grey's Anatomy Get It Right for Women With Heart Disease?

Melissa Walton-Shirley, MD

Disclosures

February 02, 2018

Kudos to Grey's Anatomy writer Elisabeth R. Finch and director Nicole Rubio. They used their platform to educate millions of viewers on nearly all the obstacles women face on their journey to a diagnosis of acute coronary syndrome (ACS). The February 1 episode, "(Don't Fear) the Reaper," featured fictional character and general surgeon Miranda Bailey, a high-stress, middle-aged, overweight African American female with "indigestion."  Correctly, the writer couched Bailey's intuition and expertise as a physician in the shadows of her femininity, a known marker for poor outcomes and failed diagnoses.

The Perils of Denial

Bailey initially dismissed her symptoms as "indigestion."  Altruism trumped self-preservation when, from her emergency department (ED) gurney, she took the time to phone her son to see how his presentation went at school.  She jumped off her sick bed in the middle of her MI to help code a neighboring patient. (Yes, melodrama at its finest, but women often endanger themselves while going to extremes to help others, so Grey's still gets points for this one.) She refused to bother her husband because he was at his (more important) work. She avoided the ED at the hospital where she works because she didn't want to appear weak if her diagnosis was confirmed or hysterical if it was refuted.   

Gender Bias at Its Worst

After she was initially denied a cardiology consult by the ED physician, it required an adrenalin-charged hissy fit of a scene to make a pompous male cardiologist appear. Predictably, he refused to believe she was sick and refused to offer further testing. In a seemingly incredulous story line, a psychiatrist was consulted to punctuate the stereotype of the malingering female whose symptoms are most certainly due to stress. The psychiatrist courteously assessed Bailey as she insisted her heart was being damaged while they spoke.  Her flopping on the floor in the midst of cardiogenic shock would be the hammer that would hit these bumbling television characters over the head with the correct diagnosis.

Professional Gender Bias

The traditional male professional in the white coat would not believe the vamped-up, beautiful young surgeon friend of the family who suggested a less invasive key-hole procedure as opposed to the larger median sternotomy approach  (emphasizing that brains and traditional American beauty apparently can't coexist in the same human). It took his physician golf-buddy male counterpart to convince him to allow that approach. Even when Bailey nearly codes again after the procedure, female shouts for an intraaortic balloon pump (IABP) are ignored until the male friend of the family makes the same request.

What They Got Very Right

We are treated to Bailey's coronary angiogram with an obviously tight lesion in the mid-left anterior descending artery (again, kudos for a real angiogram of the correct vessel). The camera zooms in on the ED telemetry showing mild ST elevation just before Bailey is whisked away to the operating room. They acknowledged that getting a groin stick could be uncomfortable.     

What They Got Very Wrong

Though Bailey makes repeated requests for a "cardiac stress test," which is backed up by her female colleague, I would have never entertained a stress test for this scenario. She should have been taken directly to the cath lab. In my experience, most male cardiologists are not pompous but rather caring and thoughtful.  We usually don't do an IABP in the ED, though occasionally I've entertained it.  Many would cry for "radial first" in the cath lab arena. The ST elevation was a bit anemic as opposed to the tombstoning of acute coronary occlusion after the procedure. Finally, Bailey looked a little too good immediately postop. 

With Gratitude

All in all, given just 6 hours of ED time as described in this 1-hour episode of television drama, the Grey's Anatomy cast, writer, and director used their platform for the greater good, a welcome change from going for the cheap joke or the shock factor. More important, they showed Americans the obstacles women face in achieving a diagnosis of heart disease. I hope viewers file away this information for future reference.  I hope providers subconsciously think, "I never want to be that kind of provider." Equally important, let this episode remind us to never dismiss our own symptoms.  

February is American Heart Month. While we are busy caring for others, we should let this episode of Grey's Anatomy remind us that we ourselves may need to consider a simple CT coronary artery calcium score, echocardiogram, stress evaluation, lipid profile, and blood sugar. Let's stop walking by all those blood pressure cuffs hanging on our walls or standing at our patients' bedsides and actually take the time to sit down, rest 10 minutes, and stick our arm in one.  Let's never dismiss nagging symptoms and what they may represent.

Did Grey's Anatomy get it right? For raising awareness, they certainly did and then some.
 

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