People love to watch the heightened drama of the emergency room and hospital from the comfort of their own couch. They do not have to deal with the emotional stress nor feel faint from the physical sight of blood. All they see are attractive, smart doctors treating patients with ease. But this glamorized medical world is far from reality. Seldom to people recognize the moral dilemmas of medical treatment and professionalism depicted in popular medical television shows like House, M.D. and Grey’s Anatomy.
Faculty from the John Hopkins’ Berman Institute of Bioethics analyzed depictions of bioethical issues and professionalism over a full season of Grey’s Anatomy and House, M.D. and found that “the shows were “rife” with ethical dilemmas and actions that often ran afoul of professional codes of conduct” (Nauert). Informed consent was the most frequently witnessed bioethical issue. In the total of 49 cases, 43 percent were cited as “exemplary” consent, meaning that the depictions portrayed a balanced discussion with the patient about possible treatment options, and the remaining cases were classified as “inadequate” (Nauert). Inadequate depictions involved hurried, one-sided discussions and refusal of physicians to answer patient’s questions, sometimes even complete disregard for the informed consent doctrine (Nauert).
Occasionally, dismissal of informed consent seems justified by positive outcomes, as seen in the following clip from Grey’s Anatomy, when an autopsy is conducted on a deceased patient without the family’s consent: https://www.youtube.com/watch?v=0hgNQni0xdw. However, this is how the screenwriters wanted the situation to play out. In the real world, serious repercussions would obviously accompany the doctors’ rash decision.
While television’s impact on us is limited, it still has an influence on our expectations and beliefs about the world around us. It has shaped our perceptions of many careers like law enforcement and forensic science; medicine is no different. A previous study conducted by one of the co-authors of the article, found that more than 80 percent of medical and nursing students watch medical dramas on television (Nauert). What exactly are aspiring doctors learning from these shows? How do various depictions of ethical issues shape their moral perception of every day patient encounters?
As previously mentioned in other blog posts, physicians do not think informed consent is an “integral part of good patient care” (Lidz et al, 303). Perhaps the popular medical dramas are to blame.
Citations:
Lidz, Charles W., Meisel, Alan, Osterweis, Marian, Holden, Janice L., Marx, John H., Munetz, Mark R. “Barriers to Informed Consent.” Arguing about bioethics. London: Routledge, 2012. 299-307. Print.
Nauert, Rick. “Ethical Failures Found on ‘Grey’s Anatomy’ and ‘House'” LiveScience. TechMedia Network, 30 Mar. 2010. Web. 17 Feb. 2014. http://www.livescience.com/6240-ethical-failures-grey-anatomy-house.html
Hi Nina,
I completely agree with you that media does distort our view on how medicine works. Like most people, I sit at home and watch these shows and see how much time doctors spend with patients and how informed patients are. However, in real life, doctors do not have excess time to just sit around and chat with their patients. When watching TV, we usually see how situations turn out and how, at the end of the day, most everyone is healthy and living life to the fullest. Even now, some patients do prefer for doctors to make these huge decisions for their life, probably because they believe that reality will turn out like what they have seen on TV. I believe that there is a lack of education of medicine to the general public, and this needs to be rectified some how.
You raise some incredibly interesting points about these popular TV dramas that I have never considered before. Although not an avid watcher of ER type shows, I know many people who buy into the lure of emergency medicine after watching these dramas.
In my opinion, the shows focus completely on paternalism. Patients who make decisions outside of the recommendation of the doctor are patronized. They quickly become the victim of the situation, while the doctors will circumvent many moral standings to do what they believe is right. Although this is a fine line (understanding when a patient has complete information and refuses treatment rationally, or when a patient simply refuses treatment irrationally) doctors in these shows are constantly put on a pedestal. It enforces the belief that not only are the doctors always correct but also that doctors know and will act based on their recommendations. It portrays doctors as having the final say and always providing the information they believe is necessary which is not always true.
I think another issue to consider in relation to your post is the status and portrayal of doctors. Many have blind faith in their doctors which completely changes the idea of autonomy and patient relations. The media (and high barriers to obtaining a medical degree) really push the doctor over patient perspective, which shapes the idea of ethical medicine and which individual is informed to make the correct decisions.
Your comparison to House and other modern shows that depict “handsome doctors” in their lab coats was very interesting. Most of the time, I feel like the shows include doctors who are very paternalistic, and simply want to be the hero and make decisions that they believe is right. Though, in reality, the doctor knows more than the patient, it’s still extremely important that these doctors put their pride in their knowledge aside for a moment to stop and listen to the patient and what the patient wants. Though the patient may not necessarily know what’s best for him or her, the doctor needs to respect these kinds of decisions. For instance, in the clip that you posted, the two doctors who performed surgery on the deceased patient clearly didn’t put their pride aside. They felt like they needed to run tests because of the patient’s heart size, yet they did the surgery without informing nor consulting with the family.
Though doctors want to do whatever they think is right for their patients, it is important that they understand that they need to follow the law about informed consent. It must be frustrating for doctors to have to listen to their patients when they know that they are right about something, but doctors can’t let this frustration override ethical issues that could arise.
This raises some really great points. I think it’s particularly interesting the way these shows influence our point of view when we’re the viewer. Typically we are rooting for the doctor because it seems like they know what is best, and oftentimes see the patient himself or his family as obstacles to the patient regaining health. The doctor comes off as a hero. If we were on the other side of the story, though, we would want the courtesy of informed consent, and would be comforted by the doctor’s legal obligation to respect our autonomy. I think it’s so interesting that you ask how these viewpoints on TV are influencing future doctors. Right now health communications in our medical system are sub-par at best, oftentimes because we have a poorly educated community getting their medical information from a professional who has, to an extent, taught to be paternalistic and technical. Could this trend have some roots in the way the media portrays and romanticizes this particular profession?
The impact that media has on all aspects of our lives is an integral part of our daily behavior and something I think that we forget about (I’m glad you brought this up in your post). We all have experienced long waits at the doctors office with minimal interaction with the actual physician, and often enough television shows depict the same thing. Instead we, as an audience, see why physicians spend a small amount of time with patients because they’re off during a 101 things in the hospital.
What if medical dramas and television shows started to show interactions between physicians and patients in a different light? Some shows, like Elementary and Royal Pains, have more one-on-one interaction between physician and patient. This allows the doctor to become more acquainted with their patient and really get to know them In Elementary, Watson (the doctor/sober-companion) lives with Holmes to ensure he stays sober. As the series progresses, Watson’s job as the doctor decreases but you can tell how well Watson knows Holmes due to their adventures. Elementary doesn’t show the best example of physician-patient relationship, but could be the start of something new.
As an avid Grey’s fan and former House fan, I thoroughly enjoyed your post. I, like many others, am pre med and I have wanted to be a physician since I was young. These tv shows definitely shapes and skew what we think a physician should be and more so what is acceptable. Whenever I watch those shows, I always picked out qualities or habits that I perceived as positive and stored it in my memory bank for when I will become a doctor. Moreover, when I first began to become involved in the medical field both in a hospital and a physician’s office, I realized how unrealistic the shows were, but the strong-hero complex persisted. Physician are relatively smart people and have usually received praise for becoming a doctor. Additionally, many of the patients that they see are not at the same intellectual levels as themselves. So, it is very easy and almost natural for physicians to be paternalistic when it is clear that they know more than the patient. While this is not morally right, it would be frustrating to have a person question your judgement when you are trying to help them and have no intentions of harm or taking advantage of you.
I’ve never really considered the phenomenon of medical students watching these shows and what sort of impact it might have on their perception of the medical world and processes. This makes me think of the Barriers to Informed Consent article that we read (Chapter 30). At one point in the article, the author(s) briefly mention the fact that their interns, who have only been on the medical scene for a very short time, already find “the dialogue with the patient uninteresting”. This is really unsettling to hear.
I think one of the challenges that may arise as a result of med students watching these kinds of medical shows is that they get excited about the wrong aspects of medicine. In these shows many of the patients come in with incredibly rare diseases yet the doctor’s, just at the last minute, when all hope is almost lost, use their mass amounts of medical knowledge, intellect and problem solving skills to swoop in and save the day. To viewers this is always exciting, but to medical students, I think it has the potential to get them excited for the wrong reasons. They get it in their heads that this is what they want to do: be a super smart doctor who can figure out the most obscure situations and have people admire them for it. It completely leaves out the patient as a character in their work.
I find it horrifying that the interns in the article openly express their distaste for discussion of medical treatments with patients so early in their career.
In the past, when I have interned with various doctors, I find that the questions patients ask become frustrating and annoying. This is not something you see on TV shows like Grey’s anatomy. In reality, the questions consume the time that the doctor has, and this isn’t the way it should be. The only two exceptions I’ve ever seen to this were with a plastic surgeon and a holistic doctor. The holistic doctor focused on creating an environment opposite of that with medical doctors- she gave hugs, spent over an hour with almost every patient, etc. The plastic surgeon can take his time with each visit, see 10 patients in one day, and make more than a pediatrician who sees 50 patients in one day. The point of all of this is that maybe the level of respect for autonomy coincides with the amount of time that a doctor can afford to spend with a patient. Physicians most likely know that they should respect the autonomy of a patient by providing consent forms, providing thorough explanations and giving patients sufficient information about treatment. The fact of the matter is doctors won’t be paid any more for giving more time for autonomous consent to patients and nobody wants to be making less money than they could be making. In the article I found, physicians reported dissatisfaction with their patients and the “the primary source of dissatisfaction was ‘time pressure’.” This means that the physicians actually want to spend more time with their patients, but they really don’t have the time. This should be factored into the argument for issues with patient-physician relationships and respect for autonomy. Doctors have a high workload and this needs to be taken into account, too.
Dugdale, David, Ronald Epstein and Steven Pantilat.”Time and the Patient-Physician Relationship.” http://onlinelibrary.wiley.com/store/10.1046/j.1525-1497.1999.00263.x/asset/j.1525-1497.1999.00263.x.pdf?v=1&t=hry6npnr&s=db3ec6e563e4fea8ffa28d2cacb1f176972befc8
I think the impact of television and the media on bioethical decisions is an extremely interesting point that is particularly relevant in today’s society. The media has pervaded nearly every aspect of modern life. It is a sweet curse, benefiting individuals by making information widely accessible, but also spreading biased, often inaccurate information. Individuals are left with mass amounts of conflicting information to sort through, leaving them confused in a variety of situations. The questions posed, “What exactly are aspiring doctors learning from these shows? and How do various depictions of ethical issues shape their moral perception of every day patient encounters?” are two questions that do not currently have definitive answers. Because this incessant media exposure is a more recent phenomenon, the full effects of the exposure are still largely undiscovered. However, I have observed these effects on aspiring doctors in my own life. Many of my friends who aspire to be doctors, are hooked on shows like Grey’s Anatomy and House. They look up to the characters and envision their future careers to fit the mold of these fictional, unrealistic depictions of physicians. We must hope that our future doctors have the ability to distinguish fiction from reality and use their own discretion in medical cases, as opposed to what they pick up from tv and the media.
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