Friday, June 22, 2012

Medical Pitfalls Authors Fall Into

It's my pleasure to welcome Jordyn Redwood as our guest today on Crime Fiction Collective. She and I have hung out together at the Citizen's Police Academy and driven across town to attend a series of lectures on sexual homicide. Some might say we're strange, but I'm betting that the readers of this blog understand our friendship and how we choose to spend time together.

Jordyn is a pediatric ER nurse by day, suspense novelist by night. Her debut medical thriller, Proof, examines the real life possibility of DNA testing setting a guilty criminal free. It has been endorsed by the likes of Lynette Eason, Dr. Harry Kraus, and Rick Acker to name a few. You can find out more about Jordyn by visiting her blog: and website:


One of the reasons I created my medical blog for authors, Redwood’s Medical Edge, was to right some of the wrongs in published works—traditional and self-pubbed—that caused me to want to toss the book aside and move onto to something else.

A reader, even one who primarily reads fiction, wants to trust you as an author. Part of building that trust is doing your research to make sure the details are authentic. The more close to real life you write, the more believable your fiction is. Strange, right?

So, as a medical professional of almost twenty years, these are a few author type pitfalls that will signal to me that an author has not done their research and I begin to wonder what other details of the ms they’ve been loose with.

1. Referring to an ECG as an EKG: This is relatively common and you’ll likely be given a pass on this because as medical professionals communicate with one another—we still will say “EKG” but the correct terminology is ECG. An ECG comes from electrocardiogram and is when we attach patches to your chest to look at the electrical activity of your heart.

2. Use of needles: There are instances where needles are still used. Primarily, they are used for starting IV’s, giving intramuscular (IM) injections, suturing and for drawing up a medication from a medication vial. However, what’s left in place after an IV is started is not a needle but a plastic catheter. Giving medications through an IV line is done with a blunt tipped plastic “needle”. I don’t know of a hospital that doesn’t use “needleless systems” that are designed to reduce needle stick injuries among healthcare professional. Be sure you’re referring to the right type of equipment for your scene.

3. Anatomical Issues: These are the most annoying because they are the easiest to research on your own. I’ve seen in published novels where the spleen is on the right side (it’s on the left), and the clavicle referred to as a scapula (your collar bone versus your shoulder blade.) Easiest way to determine where a certain organ/bone is would be to Google search specifically—“what side is the spleen on?”

4. HIPAA Violations: Which stands for the Health Insurance Portability and Accountability Act. This is the law that governs patient privacy and is the notification you likely receive (and subsequently throw away) each time you visit a doctor that dictates how your health information is shared. Let’s look at an example—I take care of a neighbor’s child in the ER during a shift. If my husband calls me at work, I can’t say, “Hey, Kim is here with her daughter. She broke her arm.” This is a violation of HIPAA. Now, I can share that information if Kim says I can do so but she has to give permission. Types of HIPAA violations I’ve seen in published novels? A nurse giving patient information to a reporter—this is a huge no-no. All information released to the press is done through the public relations office. This is drilled into every medical professional’s head from the get-go. A medical person giving info to a spouse. And from real life, a local news station that shot an interview where the patient tracking board was in the backdrop. All big no-no’s.

5. Injuries that heal too quickly: Sure, you want conflict and sometimes conflict means someone taking a bullet or being in a car accident or any number of ways you want to injure and maim a character. The problem usually is after the injury. Your hero that took a bullet to the arm is easily shooting with it the next day with subsequent ease. Make sure whatever injury your character suffers, the result of the injury is reflected in the manuscript. If you break your femur, you will not be running the next day.

What medical inaccuracies have you seen in published fiction?

Dr. Lilly Reeves is a young, accomplished ER physician with her whole life ahead of her. But that life instantly changes when she becomes the fifth victim of a serial rapist. Believing it's the only way to recover her reputation and secure peace for herself, Lilly sets out to find--and punish--her assailant. Sporting a mysterious tattoo and unusually colored eyes, the rapist should be easy to identify. He even leaves what police would consider solid evidence. But when Lilly believes she has found him, DNA testing clears him as a suspect. How can she prove he is guilty, if science says he is not?


  1. Great tips, Jordyn. Off the top of my head, I can't think of any. But sometimes I'm fooled since I don't already know much about the medical field! :)

  2. I recently read a book by Jan Burke written prior to HIPAA, and the amount of medical information spilled momentarily took me out of the story. But then so did the fact that the characters had to keep finding a phone to make a call.

    It was a terrific story by a talented author, but those two little details would be nice to clean up for a re-release.

    By the way… I found out yesterday that PROOF earned a starred review in Library Journal. Congratulations, Jordyn!

  3. Great information! The privacy issue had me thinking about my last few stories. But with obvious criminal cases, I think medical professionals are obligated to share information with the police. But now I'm looking into it.

    Thanks for blogging with us. Your book looks terrific.

  4. Really god information Jordyn. I can tell you HIPPA, while very necessary, can be a major frustration for police and CSIs. Long gone are the days when we can just walk up to a nurse or doctor and just get a briefing on a patient (even if they are a victim or suspect in a crime). Now we have to either get a warrant of get permission from someone with medical power of attorney or just wait until autopsy. That's assuming the victim can't physically speak to us of course which sometimes happens temporarily while they are in surgery or something. Great law but it does create an obstacle that can be annoying and writers can use that to build a little suspense. Of course if the victim dies then the Coroner or ME will have full access to medical records. Thanks for sharing the info.

  5. Jessica,

    Thanks for your comment!

    Peg-- Thanks for the LJ mention. I still can't hardly believe they loved Proof that much to give is a starred review.

    LJ-- You are correct. Medical people are obligated to report certain injuries to the police. Those involving stab wounds (with a clear intent to harm-- not accidental), gunshot wounds, and child abuse injuries if we feel the child should be immediately removed from the home. Also, we can involve the police in dog bite injuries if the family wishes to press charges.

    Tom-- I get your frustration with HIPAA. It even makes it hard for us to take care of our own patients if you can believe it. In the pediatric setting-- we tend to give information fairly readily to the police. Maybe it is because they are a minor that it is a little different and it is often a child abuse case. I appreciate your insights into HIPAA as well!

  6. Your last point really resonated with me. In my first novel, my character fractured a rib in a scuffle. When I went to re-release the book, it dawned on me that she didn't show a lot of residual effects, so I edited it to just bruise the area, and to add some reminders of the soreness when she was trying to do something physical.

    Good post.

  7. Thanks for joining us here, Jordyn! And thanks, Peg, for hosting Jordyn here. As a freelance editor who specializes in editing thrillers and other crime fiction, all of this info is useful to me. I recently edited a novel where a woman got repeatedly struck in the head forcefully with an iron (the kind you iron clothes with), but didn't suffer a concussion and wasn't monitored for a possible concussion. What do you think of that?

    Thanks for your opinion!

  8. Nice to have you with us, Jordyn!

    Medicine is probably one of the most challenging aspects of fiction writing for me. I try to avoid getting into ailments or injuries that are too over my head, for fear of making the kinds of mistakes you've mentioned (and probably more).

    That's why I prefer to kill off my characters, rather than prolong their agony. I'm a twisted but benevolent author ;)

  9. Fascinating!
    Thank you for dropping by, Jordyn!

  10. Gayle,

    Looks like you made some good choices in your editing.


    Wow-- getting struck in the head with an iron multiple times. OUCH.

    It will be hard to post a detailed answer here. I'd be happy to chat with you more if you'd like to e-mail me.

    People who are concussed will develop symptoms (usually) in a few hours. However, we don't really keep you in the ER to "see" if you'll develop symptoms.

    We evaluate the patient at the time with a good neuro exam and if everything is good-- we're likely to discharge the patient home. I think this characters injuries would be concerning for laceration and depressed skull fracture because of the pointed end of the iron.

    If the patinet is currently symptomatic-- we're more likely to hold onto them for several hours to see if these symptoms clear.

    Adult ED's are more likely to CT someone's head who is symptomatic. In kids-- we want to limit the amount of exposure to radiation (particularly to the brain) a child receives. We are more apt to wait...

    Not sure this answer helped--- let me know.

    I have some editors following my blog-- maybe it could be a resource for you too.

    Andrew-- if you ever need a medical hand-- you let me know. Peg can attest to the fact that I really do like to help answer writing related medical questions. Maybe I can save the lives of a few of your characters.

  11. Thanks for your detailed answer, Jordyn. In this book, there was no hospital or medical personnel involved, due to a remote location, but I just thought the victim's colleagues and friends would/should have been keeping an eye on her for a possible concussion?

    I'll definitely start following your blog!

    Thanks for your help!

  12. Yes, good point. If she starts having symptoms: dizziness, lightheadedness, confusion, vomiting (more than one episode)-- balance issues. They should think something is going on with her head related to the repetitive beating with the iron episode.

    Good thoughts.

  13. Loved reading this. My daughter laughs at me for things I notice because I'm a nurse. Movies drive me nuts. A recent movie (which I really liked) had the girl wake up from major surgery after tremendous loss of blood and she was in a regular room with a single IV (not on a pump) - which never dripped! LOL And immediately alert, of course!

    Books are a little easier to overlook a few things since every detail isn't given anyway (people rarely go to the bathroom, for example, or deliver a placenta!). There was one thing that really bugged me in a novel a few months ago - of course, now I can't remember what it was! LOL

    Great post, and I came and "stalked" it even though it wasn't a giveaway! :-)

  14. Great information. I'm with Drew - I also try not to get too technical in areas where I have limited knowledge. I've read novels that stretch my credulity too far with their hard-core main characters who never seem afflicted by their injuries.


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