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Interview by Mary Ellen Schneider
“Code Black,” the award-winning documentary about working in the ED at Los Angeles County Hospital, opened in theaters in 40 US cities this summer.
It’s the film debut for emergency physician Ryan McGarry, who both stars in and directs the feature-length documentary. It highlights the thrills and challenges of working in a busy ED through the eyes of senior residents, including Dr McGarry, who completed his training while working on the film. The young doctors start the film as fresh-faced idealists in the “C-Booth” trauma bay at LA County Hospital, the famed birthplace of emergency medicine. Later they move to the county’s newly built hospital, which, though state-of-the-art, lacks some of the camaraderie of the original ED.
“Code Black” was the Best Documentary winner at the Los Angeles Film Festival and the Hamptons International Film Festival. And it was the Audience Award winner at both the Starz Denver Film Festival and the Aspen Filmfest.
Dr McGarry, who is now an attending physician at New York-Presbyterian Hospital in New York City, discussed why he made the film and how it is likely to impact the health care debate.
Question: What inspired you to make this film?
Dr McGarry: As documentaries go, this one was kind of an accident in the sense of its narrative development. I set out to capture what I thought was a phenomenally intense, and in some ways, dated and brutal trauma bay. At this point, most people associate modern health care with a lot of sterility and technology and white and blue spaces that are kind of contained. And this shows the opposite. This looks like battlefield medicine. To my surprise, it was working very well. Of course, at the time I was a young medical student, so my basis for evaluating that matured along with the film. As time went on, we migrated from the old L.A. County Hospital to a newer space. So in the course of filming, they closed down an 80-year-old structure in favor of a brand new, billion-dollar, shining, technology-laden palace. What we found was that as we were brought up to speed on modern health care, and of course regulation, the care became much more complicated.
Question: What do you want the audience to take away from the film?
Dr McGarry: It’s hopefully a primer for health care discussion that has not yet existed. There are plenty of films that ride the political undertones of health care very well and, I think, if anything, they seem to keep people in their camps. They don’t really bring people to the middle. They may make discussion more satisfying for people who are politically charged, but from the provider’s point of view, I’m not sure if they get us anywhere. “Code Black” does not have a call to action, as they call it in the documentary world. That’s on purpose. What we’re hoping for is for people to watch it and be a bit more primed when we talk about health care. My prediction—this could be wrong—is that the real discussion for the next quarter-century, as we improve access with the [Affordable Care Act], is going to be the patient-doctor connection and some deregulation. There are just too many barriers right now. The equation is too complicated. The healing and listening that people want are not happening.
Question: So would you like to see policy makers ease up on some of the health care regulations?
Dr McGarry: We all want safety. But as a scientist would say, these regulations ought to be evidence based. What we know as physicians is that any evidence-based truth is a hard thing to prove, period. I think a lot of these regulations are well intentioned. Nobody doubts that. But yesterday, the Joint Commission visited our hospital. Everybody was working hard on a shift trying to move patients through, trying to provide both quick and safe care, and one of the things that [the regulators] were watching out for was keeping the employee bags and coffee off the computer desks. Meanwhile, I have patients with chest pain, patients with stroke, patients with fractures, who are not getting the attention they need because we’re totally focused on pleasing the federal regulators that our bags and coffee aren’t out.
Question: The film is from the perspective of young doctors and talks a lot about their initial idealism. Do you think the messages in the film will also resonate with older doctors?
Dr McGarry: One of the more surprising aspects of “Code Black” is the nostalgia factor, that fact that both physicians who have been working for a while and those who have become administrators watched this film. We thought it would be offensive to them—especially people from private hospitals, whom we are sort of tough on in the movie. We thought that they would find us a little unrealistic and idealistic. Interestingly, they all watched it and they said, “I long for the day in my residency when all I had to worry about was just getting the science right, getting that patient connection right.”
Question: Working in C-Booth was a great experience for ED physicians in training. Can you ever recapture that feeling in the new, heavily regulated environment?
Dr McGarry: One thing we wouldn’t want to return to would be the lack of privacy. The biggest aspect of C-Booth that probably we wouldn’t be proud of is the lack of privacy. I’m definitely for privacy and for a dignified experience. After that, I feel like things are quite undefined. I think we have expectations that technology, in particular, is a huge answer to medicine. But we know it can be expensive and it can be dangerous. And in the case of electronic medical records, it certainly doesn’t make things faster. We know that every institution that has gone from paper charts to an EMR has found not just an immediate slowing of care, but a permanent slowing. And yet there are benefits with being able to quickly look up old medical information. But what about when my patient is waiting 20 minutes for pain medicine because it takes almost that long to get them in the computer, pull up the order, select the medicine, and go through all these stupid hard stops that are built in? Before, I could just write it down on a piece of paper, communicate it to the nurse, and get it done. If you’re the one in pain, is [the EMR] worth it? I don’t know.
Question: How did you find the time to make this movie?
Dr McGarry: There were a lot of consequences. I probably pushed it from a health perspective. I really found myself in a unique position as both a filmmaker and subject. For almost 3 years, I would do every ounce of my residency and then would race from the hospital to the edit room and would live and breathe it for 3 years. You would imagine there’s a cost to that. Lost a girlfriend. Didn’t sleep. Happily, I came through without any major damage, but that’s a heck of a lot of emergency medicine.
Question: What are you doing next? Are you working on another film and how are you balancing your new project with your day job in medicine?
Dr McGarry: This is a different game than it was in residency. I have an option for a scripted series, so basically it means that producers have identified it as a viable project for a fiction series like you would see on HBO. That’s in active development. We just shot a 3-minute spot with the New York and L.A. ballets, which involves these dancers in the old abandoned general hospital. As far as balancing all this, I’m so lucky in that Cornell/New York-Presbyterian and Dr Neal Flomenbaum have been incredibly supportive of me, allowing me to be full time there but with the work flexibility to jump on these projects as they come.
On Twitter @maryellenny
Interview by Mary Ellen Schneider
“Code Black,” the award-winning documentary about working in the ED at Los Angeles County Hospital, opened in theaters in 40 US cities this summer.
It’s the film debut for emergency physician Ryan McGarry, who both stars in and directs the feature-length documentary. It highlights the thrills and challenges of working in a busy ED through the eyes of senior residents, including Dr McGarry, who completed his training while working on the film. The young doctors start the film as fresh-faced idealists in the “C-Booth” trauma bay at LA County Hospital, the famed birthplace of emergency medicine. Later they move to the county’s newly built hospital, which, though state-of-the-art, lacks some of the camaraderie of the original ED.
“Code Black” was the Best Documentary winner at the Los Angeles Film Festival and the Hamptons International Film Festival. And it was the Audience Award winner at both the Starz Denver Film Festival and the Aspen Filmfest.
Dr McGarry, who is now an attending physician at New York-Presbyterian Hospital in New York City, discussed why he made the film and how it is likely to impact the health care debate.
Question: What inspired you to make this film?
Dr McGarry: As documentaries go, this one was kind of an accident in the sense of its narrative development. I set out to capture what I thought was a phenomenally intense, and in some ways, dated and brutal trauma bay. At this point, most people associate modern health care with a lot of sterility and technology and white and blue spaces that are kind of contained. And this shows the opposite. This looks like battlefield medicine. To my surprise, it was working very well. Of course, at the time I was a young medical student, so my basis for evaluating that matured along with the film. As time went on, we migrated from the old L.A. County Hospital to a newer space. So in the course of filming, they closed down an 80-year-old structure in favor of a brand new, billion-dollar, shining, technology-laden palace. What we found was that as we were brought up to speed on modern health care, and of course regulation, the care became much more complicated.
Question: What do you want the audience to take away from the film?
Dr McGarry: It’s hopefully a primer for health care discussion that has not yet existed. There are plenty of films that ride the political undertones of health care very well and, I think, if anything, they seem to keep people in their camps. They don’t really bring people to the middle. They may make discussion more satisfying for people who are politically charged, but from the provider’s point of view, I’m not sure if they get us anywhere. “Code Black” does not have a call to action, as they call it in the documentary world. That’s on purpose. What we’re hoping for is for people to watch it and be a bit more primed when we talk about health care. My prediction—this could be wrong—is that the real discussion for the next quarter-century, as we improve access with the [Affordable Care Act], is going to be the patient-doctor connection and some deregulation. There are just too many barriers right now. The equation is too complicated. The healing and listening that people want are not happening.
Question: So would you like to see policy makers ease up on some of the health care regulations?
Dr McGarry: We all want safety. But as a scientist would say, these regulations ought to be evidence based. What we know as physicians is that any evidence-based truth is a hard thing to prove, period. I think a lot of these regulations are well intentioned. Nobody doubts that. But yesterday, the Joint Commission visited our hospital. Everybody was working hard on a shift trying to move patients through, trying to provide both quick and safe care, and one of the things that [the regulators] were watching out for was keeping the employee bags and coffee off the computer desks. Meanwhile, I have patients with chest pain, patients with stroke, patients with fractures, who are not getting the attention they need because we’re totally focused on pleasing the federal regulators that our bags and coffee aren’t out.
Question: The film is from the perspective of young doctors and talks a lot about their initial idealism. Do you think the messages in the film will also resonate with older doctors?
Dr McGarry: One of the more surprising aspects of “Code Black” is the nostalgia factor, that fact that both physicians who have been working for a while and those who have become administrators watched this film. We thought it would be offensive to them—especially people from private hospitals, whom we are sort of tough on in the movie. We thought that they would find us a little unrealistic and idealistic. Interestingly, they all watched it and they said, “I long for the day in my residency when all I had to worry about was just getting the science right, getting that patient connection right.”
Question: Working in C-Booth was a great experience for ED physicians in training. Can you ever recapture that feeling in the new, heavily regulated environment?
Dr McGarry: One thing we wouldn’t want to return to would be the lack of privacy. The biggest aspect of C-Booth that probably we wouldn’t be proud of is the lack of privacy. I’m definitely for privacy and for a dignified experience. After that, I feel like things are quite undefined. I think we have expectations that technology, in particular, is a huge answer to medicine. But we know it can be expensive and it can be dangerous. And in the case of electronic medical records, it certainly doesn’t make things faster. We know that every institution that has gone from paper charts to an EMR has found not just an immediate slowing of care, but a permanent slowing. And yet there are benefits with being able to quickly look up old medical information. But what about when my patient is waiting 20 minutes for pain medicine because it takes almost that long to get them in the computer, pull up the order, select the medicine, and go through all these stupid hard stops that are built in? Before, I could just write it down on a piece of paper, communicate it to the nurse, and get it done. If you’re the one in pain, is [the EMR] worth it? I don’t know.
Question: How did you find the time to make this movie?
Dr McGarry: There were a lot of consequences. I probably pushed it from a health perspective. I really found myself in a unique position as both a filmmaker and subject. For almost 3 years, I would do every ounce of my residency and then would race from the hospital to the edit room and would live and breathe it for 3 years. You would imagine there’s a cost to that. Lost a girlfriend. Didn’t sleep. Happily, I came through without any major damage, but that’s a heck of a lot of emergency medicine.
Question: What are you doing next? Are you working on another film and how are you balancing your new project with your day job in medicine?
Dr McGarry: This is a different game than it was in residency. I have an option for a scripted series, so basically it means that producers have identified it as a viable project for a fiction series like you would see on HBO. That’s in active development. We just shot a 3-minute spot with the New York and L.A. ballets, which involves these dancers in the old abandoned general hospital. As far as balancing all this, I’m so lucky in that Cornell/New York-Presbyterian and Dr Neal Flomenbaum have been incredibly supportive of me, allowing me to be full time there but with the work flexibility to jump on these projects as they come.
On Twitter @maryellenny
Interview by Mary Ellen Schneider
“Code Black,” the award-winning documentary about working in the ED at Los Angeles County Hospital, opened in theaters in 40 US cities this summer.
It’s the film debut for emergency physician Ryan McGarry, who both stars in and directs the feature-length documentary. It highlights the thrills and challenges of working in a busy ED through the eyes of senior residents, including Dr McGarry, who completed his training while working on the film. The young doctors start the film as fresh-faced idealists in the “C-Booth” trauma bay at LA County Hospital, the famed birthplace of emergency medicine. Later they move to the county’s newly built hospital, which, though state-of-the-art, lacks some of the camaraderie of the original ED.
“Code Black” was the Best Documentary winner at the Los Angeles Film Festival and the Hamptons International Film Festival. And it was the Audience Award winner at both the Starz Denver Film Festival and the Aspen Filmfest.
Dr McGarry, who is now an attending physician at New York-Presbyterian Hospital in New York City, discussed why he made the film and how it is likely to impact the health care debate.
Question: What inspired you to make this film?
Dr McGarry: As documentaries go, this one was kind of an accident in the sense of its narrative development. I set out to capture what I thought was a phenomenally intense, and in some ways, dated and brutal trauma bay. At this point, most people associate modern health care with a lot of sterility and technology and white and blue spaces that are kind of contained. And this shows the opposite. This looks like battlefield medicine. To my surprise, it was working very well. Of course, at the time I was a young medical student, so my basis for evaluating that matured along with the film. As time went on, we migrated from the old L.A. County Hospital to a newer space. So in the course of filming, they closed down an 80-year-old structure in favor of a brand new, billion-dollar, shining, technology-laden palace. What we found was that as we were brought up to speed on modern health care, and of course regulation, the care became much more complicated.
Question: What do you want the audience to take away from the film?
Dr McGarry: It’s hopefully a primer for health care discussion that has not yet existed. There are plenty of films that ride the political undertones of health care very well and, I think, if anything, they seem to keep people in their camps. They don’t really bring people to the middle. They may make discussion more satisfying for people who are politically charged, but from the provider’s point of view, I’m not sure if they get us anywhere. “Code Black” does not have a call to action, as they call it in the documentary world. That’s on purpose. What we’re hoping for is for people to watch it and be a bit more primed when we talk about health care. My prediction—this could be wrong—is that the real discussion for the next quarter-century, as we improve access with the [Affordable Care Act], is going to be the patient-doctor connection and some deregulation. There are just too many barriers right now. The equation is too complicated. The healing and listening that people want are not happening.
Question: So would you like to see policy makers ease up on some of the health care regulations?
Dr McGarry: We all want safety. But as a scientist would say, these regulations ought to be evidence based. What we know as physicians is that any evidence-based truth is a hard thing to prove, period. I think a lot of these regulations are well intentioned. Nobody doubts that. But yesterday, the Joint Commission visited our hospital. Everybody was working hard on a shift trying to move patients through, trying to provide both quick and safe care, and one of the things that [the regulators] were watching out for was keeping the employee bags and coffee off the computer desks. Meanwhile, I have patients with chest pain, patients with stroke, patients with fractures, who are not getting the attention they need because we’re totally focused on pleasing the federal regulators that our bags and coffee aren’t out.
Question: The film is from the perspective of young doctors and talks a lot about their initial idealism. Do you think the messages in the film will also resonate with older doctors?
Dr McGarry: One of the more surprising aspects of “Code Black” is the nostalgia factor, that fact that both physicians who have been working for a while and those who have become administrators watched this film. We thought it would be offensive to them—especially people from private hospitals, whom we are sort of tough on in the movie. We thought that they would find us a little unrealistic and idealistic. Interestingly, they all watched it and they said, “I long for the day in my residency when all I had to worry about was just getting the science right, getting that patient connection right.”
Question: Working in C-Booth was a great experience for ED physicians in training. Can you ever recapture that feeling in the new, heavily regulated environment?
Dr McGarry: One thing we wouldn’t want to return to would be the lack of privacy. The biggest aspect of C-Booth that probably we wouldn’t be proud of is the lack of privacy. I’m definitely for privacy and for a dignified experience. After that, I feel like things are quite undefined. I think we have expectations that technology, in particular, is a huge answer to medicine. But we know it can be expensive and it can be dangerous. And in the case of electronic medical records, it certainly doesn’t make things faster. We know that every institution that has gone from paper charts to an EMR has found not just an immediate slowing of care, but a permanent slowing. And yet there are benefits with being able to quickly look up old medical information. But what about when my patient is waiting 20 minutes for pain medicine because it takes almost that long to get them in the computer, pull up the order, select the medicine, and go through all these stupid hard stops that are built in? Before, I could just write it down on a piece of paper, communicate it to the nurse, and get it done. If you’re the one in pain, is [the EMR] worth it? I don’t know.
Question: How did you find the time to make this movie?
Dr McGarry: There were a lot of consequences. I probably pushed it from a health perspective. I really found myself in a unique position as both a filmmaker and subject. For almost 3 years, I would do every ounce of my residency and then would race from the hospital to the edit room and would live and breathe it for 3 years. You would imagine there’s a cost to that. Lost a girlfriend. Didn’t sleep. Happily, I came through without any major damage, but that’s a heck of a lot of emergency medicine.
Question: What are you doing next? Are you working on another film and how are you balancing your new project with your day job in medicine?
Dr McGarry: This is a different game than it was in residency. I have an option for a scripted series, so basically it means that producers have identified it as a viable project for a fiction series like you would see on HBO. That’s in active development. We just shot a 3-minute spot with the New York and L.A. ballets, which involves these dancers in the old abandoned general hospital. As far as balancing all this, I’m so lucky in that Cornell/New York-Presbyterian and Dr Neal Flomenbaum have been incredibly supportive of me, allowing me to be full time there but with the work flexibility to jump on these projects as they come.
On Twitter @maryellenny
