423 Not Your Grandmother's Doctor Show: Bioethics and Professionalism in Television Medical Dramas

Abstract

Study Objective: Television medical dramas are tremendously popular. In order to assess the possible affect of these dramas on the perceptions of the general public and their potential value in the education of residents and students, it is first necessary to identify what is actually portrayed in these programs. The purpose of this study was to systematically analyze the bioethical and professionalism content of popular medical dramas on television. Methods: In this retrospective cross-sectional study, consecutive TV episodes of 11 popular television programs (eg, House, Boston Med, ER) were viewed to identify all incidents in the programs that involved ethical issues, as well as those involving questions of interpersonal relations or professionalism. The most recent, complete season of each TV program was analyzed (total, 186 episodes). An incident was defined as a conversation between, or actions taken by, characters that involved a bioethics or professionalism issue. Our classification scheme for bioethical incidents was adapted from a recent study by the Johns Hopkins Institute of Bioethics (19 categories); our codes for professionalism were adapted from an Association of American Medical Colleges report (18 categories). Since it was not feasible to evaluate every interaction over the course of the 135 episodes, we limited our coding to those interactions that were exceptional or conspicuously offensive. After coding, all incidents were characterized as “negative” in the sense of violating a norm or “positive” by exemplifying it. A second investigator performed a blinded critical review of a random sample of 10% of the programs to determine reliability using kappa statistics. Descriptive statistics (95% confidence intervals) and frequency tables were used describe data. Results: A total of 186 TV episodes were analyzed: 340 bioethical incidents (mean, 1.8 incidents/TV episode) and 829 professionalism issues (4.5/TV episode) were identified. The same 4 programs with the most bioethical incidents also had the most issues involving professionalism. Consent was the most frequently observed bioethical issue. Of 37 total incidents, 43% (16/37) involved exemplary consent discussions, while the remainder were inadequate, such as physicians lying to patients in order to obtain consent. There were 33 incidents of ethically questionable departures from standard practice. Most of these incidents depicted physicians acting unethically in their pursuit of a favorable outcome for a patient. The majority of professionalism issues (66%) were negative. Incidents relating to sensitivity to patient's pain, emotional state, physician integrity, risk-taking, and sex/ethnicity issues were the most frequently observed across all the series. Caring and compassion when dealing with patients was particularly noteworthy, because it is the only virtue of professionalism identified in which the exemplary portrayals outnumbered the lapses in professionalism. Conclusion: Television medical dramas contain many perplexing ethical issues and examples of egregious professionalism which, in an educational setting, could help to engage students and residents in discussions of the appropriate management of such issues. Unfortunately, the general public will inadvertently pick up on details that will shape their understanding of the medical profession - good or bad.