TV Doctors Bring Unethical Behavior to Prime Time

WEDNESDAY March 31, 2010 -- In a hospital in Seattle, a doctor overly involved with a patient attempted to worsen that patient's condition so she could go higher on the list of people eligible for an organ transplant.

Fortunately, the physician was fired and, even more fortunately, the incident was completely fictitious, having been an episode in season 2 of the popular television show Grey's Anatomy.

But as far as entertainment goes, this was just one example of egregious behavior -- involving both ethics and professionalism -- that is apparently "rife" with on-screen medical professionals, say researchers at Johns Hopkins reporting in the April issue of the Journal of Medical Ethics.

As it turns out, the second season of both ABC's Grey's Anatomy and Fox's House, featuring the famously misanthropic Dr. Gregory House, were filled with episodes of lying, forgery, drunkenness and making health-care decisions without asking the patient's permission.

"This study was designed to see with what frequency these extraordinarily popular shows are depicting ethical issues in clinical medicine and also professionalism," said study co-author Ruth Faden, director of the Johns Hopkins Berman Institute of Bioethics.

The frequency with which ethical dilemmas arose on both Grey's Anatomy and House were "noteworthy," she also said, adding, "There were instances of pretty outrageous behavior on the part of doctors." Just one example: a physician on Grey's tried to induce a seizure in a patient so she would be transferred to another unit.

Although the Hopkins researchers haven't looked at the impact of these depictions (that's the next step) on viewers, one expert said the findings could be worrisome.

"Things that tend to find their way into popular entertainment tend to be more titillating or provocative. Millions of viewers are not going to tune in to check kids' tonsils over and over again. Things that provoke attract viewers," said Dr. Chris Cargile, associate chair of psychiatry and behavioral science at Texas A&M Health Science Center College of Medicine in Bryan-College Station.

But Cargile was surprised at how entire episodes, rather than incidents within an episode, dealt with issues of ethics and professionalism. "These were broad themes talked about commonly in the news media, such as access to health care, which makes up the fabric of our consciousness, of what we wrestle with," he said.

Another expert noted that even those in the medical profession might be swayed by the content of such shows.

"It's not surprising what they found, of course -- these are shows with dramatic license. But it's also true that a lot of people watch these and they learn things from them and take them as the real thing," said Susan Lederer, chair of medical history and bioethics at the University of Wisconsin School of Medicine and Public Health in Madison.

"It's especially concerning that medical students, nursing students and other professional students see these because, in some ways, it might be more persuasive than some of the modeling they get in their own rounding or education," she added.

According to the paper, the vast majority of medical and nursing students do watch these types of dramas.

The most common ethical issues seen on these shows involved informed consent. Generally, discussions around these topics were portrayed well, although doctors did occasionally manipulate the truth so as to ensure the patient's consent.

Many of the incidents of professional malfeasance went unpunished, the researchers noted.

In the area of professionalism, said Faden, "There was no question that there were more instances where doctors were behaving below the line than above the line." This included sexual encounters of one type or another. Dr. House, of course, was the worst offender, accounting for 88 percent of disrespectful incidents in that series.

On the other hand, the authors observed many instances where medical professionals showed "exemplary" caring and compassion.

"I do think it's valuable to have the documentation but I'd like to know what kinds of interventions does this mean we need to do," Lederer said. "If we can document that medical or nursing students are really observing this, what can we do as educators to counteract that?"

The gap between fictional, onscreen medicine and real-life hospital care can produce false expectations, she said. For example, on television shows, cardiac pulmonary resuscitation seems to work all the time, Lederer said, and families are surprised when it doesn't work in real life.

"These are very powerful and very persuasive [depictions]," she said. "We know that patients, families and doctors are also very much influenced by Hollywood. That's how we learn a lot of things."

More information

There's more on medical ethics at the American Medical Association.

Posted: March 2010


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