New study sets the stage for debate over the use of popular programs to prompt classroom discussions among medical and nursing students
A medical student and faculty directors from the Johns Hopkins Berman Institute of Bioethics analyzed depictions of bioethical issues and professionalism over a full season of two popular medical dramas-"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.
The authors of the review, available in the April issue of the Journal of Medical Ethics, say they were well aware that their findings would end up stating the obvious. But they nonetheless wanted to provide data that would shed light on the relationship of these depictions on the perceptions of viewers, both health professionals and the general public.
"I think the utility in our study is that it provides a starting point for a discussion," says fourth-year medical student Matthew Czarny, a researcher at the Berman Institute. "In no way are we saying that these shows are educational in and of themselves."
An earlier analysis by the co-authors, along with fellow Berman Institute faculty member Marie Nolan, Ph.D., found that more than 80 percent of medical and nursing students watch television medical dramas. That study also concluded that the programs may prompt students to think and talk about bioethical issues.
In analyzing the second seasons of "Grey's Anatomy" and "House," Czarny counted 179 depictions of bioethical issues, under 11 different topics, ranging from informed consent to organ-transplant eligibility to human experimentation.
Berman Institute Director Ruth Faden, Ph.D., the Philip Franklin Wagley Professor of Biomedical Ethics, and the institute's deputy director for medicine, Jeremy Sugarman, M.D., the Harvey M. Meyerhoff Professor of Bioethics and Medicine, designed the study, helped develop the coding and ensured the quality of the findings.
Given the vivid portrayals of clinical practice and bioethical issues in medical dramas - albeit through storylines that sometimes stray into the realm of outlandish - the co-authors began systematically eyeing the programs in the genre several years ago to assess the nature and extent of the depictions.
"Grey's Anatomy," now in its sixth season on ABC, is one of the most watched prime-time television series in the country and chronicles the lives of five surgical interns and their attending and resident physicians. "House," which airs on Fox and is also in its sixth season, follows the medical maverick Dr. Gregory House and his trainees, as they diagnose and treat only the most difficult cases.
Informed consent was the most frequently observed bioethical issue. Of 49 total incidents, 43 percent involved "exemplary" consent discussions, while the remaining instances were "inadequate." In general, exemplary depictions portrayed "compassionate, knowledgeable physicians participating in a balanced discussion with a patient about possible treatment options."
Conversely, inadequate depictions were "marked by hurried and one-sided discussions, refusal by physicians to answer questions" and "even an entire lack of informed consent for risky procedures," the authors state.
They also tallied 22 incidents of "ethically questionable departures from standard practice," most of them depicting doctors endangering patients unnecessarily in their pursuit of a favorable outcome. "In almost all of these incidents (18 out of 22), the implicated physician is not penalized," the authors note.
Czarny, the study's lead author, recalled an episode of "Grey's Anatomy" in which an intern forged an attending physician's signature. "When this is discovered, the attending seems somewhat grateful that that was pursued," Czarny said. And he cited another egregious example from the show, in which an intern administers medical care while intoxicated.
The study also examined 400 incidents of professionalism, which included interactions among professional colleagues, as well as those with patients. The authors limited their count to incidents they defined as either "exemplary" or "egregious."
"Incidents related to respect were the most frequently observed across both series, and depictions were largely negative," the authors concluded. The next most commonly observed departure from professionalism was sexual misconduct, with 58 incidents notched by the second season of "Grey's Anatomy" and 11 in "House."
Out of 178 interactions between professionals, across all issues, the authors deemed just nine exemplary in nature.
Acknowledging that both series are intended for entertainment purposes, the Berman Institute group said none of the findings were unexpected. And because the study was a content analysis, the authors did not set out to determine the value of these medical dramas as educational tools.
Rather, their goal was to inform discussions about whether medical dramas should be shown in a classroom to spur conversations about ethics and professionalism among medical and nursing students.
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