Bang! The ER’s doors explode open. Gunshot victim. Just a child. Bodies move in slow mo-tion. The clock ticks. Seconds seem like hours. “We’re losing a lot of blood here! We’re losing him!” Tears drip from mom’s face. Her son’s eyes lock with hers. The patient goes limp. The doctor shrieks: “Don’t you die on me, damn it!” In a split second, everything goes black.
Such a scene may unfold on TV screens in millions of living rooms across the nation. Doctor dramas, a prime-time staple for generations, propel viewers into the life of fictional doctors and patients. But some experts say that for medical students, it can be more than entertainment: It forms an informal curriculum, whether students realize it or not.
From the 1960s until today, not a year has gone by without a medical show gracing the small screen. From earlier shows like “Ben Casey” and “Marcus Welby, M.D.” to contemporary shows such as “ER,” which con-cluded its run earlier this year, to “Grey’s Anatomy,” “House, M.D.” and “Scrubs,” there’s no indication that the genre will die off anytime soon.
Testament to medical programs’ massive success was the blockbuster, award-winning show “ER,” which just ended its monumental 15-season run. It has launched the careers of a number of stars including George Clooney (who also appeared in a short-lived 1980s medical comedy, ironically called “E/R”).
“I think that one reason for the enthusiasm and interest in medical shows is their depictions of intense med-ical experiences,” says Dr. Vineet Arora, an assistant dean at the University of Chicago Pritzker School of Medicine.
Classroom learning forms the “explicit” curriculum, and medical TV programs provide the “implicit” curricu-lum, Arora says. In a course she teaches, she plays clips of “ER” illustrating doctor–patient interaction to med-ical students, and the class discusses the scenes afterward. She leads the first-year course “Medical Profes-sionalism in the 21st Century: A Real World Approach,” along with Dr. Shalini Reddy, an associate dean for student programs, and Dr. Jeanne Farnan, an assistant professor in internal medicine.
Studies support Arora’s assertion that the shows do have an implicit effect. One such study examined how much “ER” contributed to medical student socialization as well as entertainment. Students may acquire the at-titudes and beliefs of television physicians that are similar to qualities and behaviors gained through caring for patients, wrote Dr. Michael O’Connor in the Journal of the American Medical Association in 1989.
“Depictions of the controlling attending, arrogant surgeon or blundering medical student are often realized on ‘ER,’ forcing students to confront their own preconceptions of their profession,” wrote O’Connor, then a student at the University of Washington School of Medicine.
Medical dramas have inspired countless viewers to become doctors, Arora says. Students laugh at the inaccurate medical aspects of the shows, but studies say some of the clinical situations can resonate with them.
As society has changed, the shows have changed as well. Early medical programs portrayed physicians as larger-than-life figures, heroes with the ability to heal nearly any condition, no matter how dire.
A prime case of a fictional doctor portrayed positively was Dr. Marcus Welby—who was so beloved that some described the folksy 1970s character as “America’s family doctor,” says Dr. Jon Hallberg, an assistant professor in the department of family medicine and community health at the University of Minnesota. He was also creative director of the university’s recently discontinued Center of Arts in Medicine.
Today, fictional doctors are often portrayed as flawed individuals. Often they are even anti-heroes. A perfect example is the brilliant but Vicodin-addicted, misanthropic and belligerent Dr. Gregory House in “House, M.D.”
When House butts heads with the hospital administration (only to save the patient’s life, of course), the doctor usually wins. Physicians from older shows, too, often had the gumption to question authority, and got what they wanted.
But fictional doctors don’t have the concerns real doctors do. They aren’t concerned about paying back student loans or battling to get Medicare claims reimbursed. And real-life office managers don’t offer comic relief.
Considering the high ratings of “ER,” Arora says it must have increased interest in emergency medicine. Medical drama offers everything that makes for compelling TV, such as life and death struggles, mystery and romance. And the shows are flexible: Hollywood has portrayed them as westerns (“Dr. Quinn, Medicine Wom-an”), comedy-dramas (“Scrubs”), child genius stories (“Doogie Howser, M.D.”) and forensic medical dramas (“House, M.D.”) with commentators comparing House to Sherlock Holmes.
Episodes of medical shows often revolve around a social issue or moral dilemma such as gang violence, euthanasia, domestic violence, child abuse, poverty or abortion. They feature one-in-a-million-type cases that frequently showcase the shocking and bizarre: disfigurements, cryogenics, murderous doctors, etc.
Positive results for medical procedures on TV are higher than in reality. Some studies go as far as saying these shows disseminate medical “misinformation.” While long-term survival rates after cardiopulmonary resuscitation were 67 percent on late 1990s medical programs “ER,” “Chicago Hope” and “Rescue 911,” real-life CPR survival rates were 14.7 percent, according to media researchers Gregory Makoul and Limor Peer at Northwestern University. Their research appeared in a chapter in the book Cultural Sutures: Medicine and Media. Peer now focuses on the media at Yale University.
As for relatively common instances of TV docs performing unusual procedures in last-ditch attempts to save patients’ lives, Dr. Julian Jakubowski, a third-year resident at St. Barnabas Hospital in the Bronx, specializing in emergency medicine, clarifies that “we don’t practice experimental medicine.”
Experts say the turning point toward the modern portrayal of TV doctors, and patients, came from the spin-off of an acclaimed movie released in 1970, a dark comedy about combat doctors practicing during the Korean War.
“The fundamental change came with the show ‘M*A*S*H’ that inverted the formula in previous shows, where doctors can be God-like figures,” says Joseph Turow, a professor at the University of Pennsylvania School for Communication. An up--date is planned for his 1989 book, Playing Doctor: Television, Storytelling, and Medical Power.
“On ‘M*A*S*H’ you were in a war zone and patients were the side issues, and to keep sane, the doctors acted wacky,” Turow says. “Instead of focusing on the patient, the show focused on the doctors.”
Patient-centered medicine it is not. In real life, patients are the first priority. They aren’t so important in medical shows. “In ‘ER’ and the same with ‘Grey’s Anatomy,’ with the relationship between the doctor and the patient, you learn more about the doctor’s personal angst and don’t have as much time to deal with patients,” he says.
The increasing focus on the doctors’ love lives in “ER” disappointed some. “In the beginning it was a lot more medical,” said Tom Valente, director of the Master of Public Health program in preventive medicine at the University of Southern California Keck School of Medicine.
“I remember seeing the first episode and the level of medical information of real-world cases,” said Valente, who was interviewed by TNP when “ER” left the airwaves. In unpublished comments about the show, he said “it became more of a soap opera.”
And when patients are featured, they are usually a hassle.
This was indicated in Makoul and Peer’s aforementioned study of the 1996–1997 seasons of “ER” and “Chicago Hope.” They found that on “ER,” 13.3 percent of patients were seen as crazy or irrational, 10.8 per-cent as anxious or afraid, 10.1 percent as demanding or annoying and 10 percent as unconscious or dead. On “Chicago Hope,” they were far less crazy, but nearly twice as annoying, just as scared, and about the same portion were inert.
Real-life medical students and residents are well-aware that doctor dramas are unrealistic. And usually they aren’t the inspiration for students to enter medicine.
Neha Manikonda made her decision to become a physician long before watching medical programs. From shadowing EMTs to volunteering at hospitals in her high-school years, the difference between TV and reality is stark, says the sophomore in the University of Alabama at Birmingham Early Medical School Acceptance Pro-gram. She characterizes much of what’s depicted on the shows as “totally ridiculous.”
Yet watching these shows was not without some utility. In some perhaps more truthful depictions of being a surgeon, the depictions made Manikonda stop and think about the specialty. “I got a chance to see how competitive surgery was,” she says, but emphasized that watching a TV drama would not decide the specialty she chooses. “It made me think I would probably not want to be a neurosurgeon and deal with the pressures.”
Shows hire medical experts as advisers to ensure the details are as accurate as possible. And research shows that viewers gain at least some kind of real medical information from watching. One child even saved someone’s life after claiming to have learned the Heimlich maneuver from watching a medical drama.
Jakubowski says that he could understand why viewers could confuse depictions of medical procedures on these shows with reality. Jakubowski says he has wondered how much of what he has seen on crime dramas was actual police work.
As far as reality in the medical field, “Scrubs” is by far Jakubowski’s favorite doctor show. The show reso-nated with him because the central character, Dr. J.D. Dorian, started the show’s first season as an intern, and Jakubowski started watching the show at about the same time his own internship began.
“I think of the similar experiences,” Jakubowski says of watching Dorian go through what he, himself, was going through, “and I still think of the very first episode and how he was petrified and how he was over-whelmed, and I remember how I was terrified.”
Jakubowski had a lot of sympathy for the character because of the turmoil experienced by the residents “and nurses getting mad at you for whatever reason. It’s kinda funny to see.”
The show led him to witness the awkward progression of becoming a competent doctor as Dorian pro-gressed to the position of attending physician in the show’s later seasons.
The balance of humor and seriousness in “Scrubs” portrayed the humanistic side of medicine, he says. For instance, the anxiety of telling patients bad news or coping with the first time a patient dies.
However, “House” has little to do with reality, he says. As far as an actual depiction of doctors, “I don’t know anyone who would break into your house to find out what’s wrong with you.”
They come up with “wacky diagnoses,” and House’s belligerence with patients would not be tolerated in real life. “For the most part, you can’t be a doctor and be obnoxious to patients.”
Much of the non-medical aspects of medical shows are even less believable, Jakubowski says. “They can do anything they want in the script and believe what they want, like residents sleeping with attendings, and think that’s cool.”
For the record, “Residents sleeping with their attendings would not be kosher,” he says. “And it’s not kosher to sleep with your patients.
“When patients ask whether our experiences are like the TV shows, I and my colleagues laugh,” he says. “I say I make it a point not to sleep with my co-workers.”
Even in perhaps the most speculative of television genres, science fiction, it seems health problems will still remain centuries from now. In at least one show, doctors will still possess human frailties and will only be able to do so much to save patients. To this end, Dr. Leonard “Bones” McCoy on “Star Trek” exclaims to his starship captain: “Damn it, Jim, I’m only a doctor!”
Steve Woo is associate editor of The New Physician.
Direct comments about this topic to tnp@amsa.org.