Do Doctor Dramas Make for Bad Docs?

What happens when real doctors learn from actors who play doctors on TV.

March 26, 2009— -- Doctors have long had a prominent place on the American television screen, from the concerned Dr. Welby on "Marcus Welby, M.D." to the frantic pace of "ER" to the torrid love lives of the doctors on "Grey's Anatomy."

But while attention has focused on what these shows say about physicians -- and what they lead people to expect from their doctors -- worry over what young doctors and doctors-in-training learn about their profession from medical TV shows is growing.

"I see students all the time who show up and act like their favorite doctor on TV," said Dr. Elizabeth Sinz, a professor of anesthesiology at the Penn State Milton S. Hershey Medical Center.

She noted that despite the hours upon hours of instruction that go into medical school, students will come in with notions about the health care system from their life experiences, and schools need to be prepared to address them.

"People learn from TV, they learn from reading, they learn from what I'm teaching in a lecture. It all has to come together," said Sinz.

In addition, she said, teamwork is often portrayed inaccurately, with television doctors portrayed as much more in charge than they actually are in real hospital emergency situations, where they're part of a team.

Concerns about the public portrayal of doctors, in part, led the University of Chicago to start a class this year for first-year medical students to learn more about the bad habits they may pick up from a variety of sources, not just television.

"There may be elements of the shows, especially the humor, sarcasm and jokes that are fine for TV but inappropriate for the workplace," said Dr. Vineet Arora, an assistant dean at the University of Chicago's Pritzker School of Medicine and one of the instructors for the course Medical Professionalism in the 21st Century: A Real World Approach.

"Most educators believe that medical students may pick up bad habits in the hospital from more senior doctors," she said.

A Hidden Curriculum

Arora said that med students tend to have two modes of learning -- a formal curriculum, which includes classes, and a hidden curriculum, which includes on-the-job experience, and picking up behaviors and habits, both positive and negative.

By not addressing the negative behaviors, students may feel such behaviors are acceptable as they become doctors, cautioned Arora.

"We noticed that as students progress through training ... the students are more likely to report participating in [negative] behaviors and may feel these behaviors are appropriate."

Increasingly, Arora said, even medical students come up against medical expectations influenced by TV, as they may be consulted for medical advice well before they have earned their M.D. They may also be forced to address impressions people have of them from the media.

"One cannot ignore the impact of the media and medical TV," said Arora.

While she said she does not have data on the subject, Arora said she has found anecdotally from programs the university runs for high school and college students thinking of attending medical school that among these students, medical TV shows have a huge following.

The following of medical television dramas among doctors-to-be has been under increased scrutiny in recent weeks as a study by Canadian physicians published in the journal Resuscitation showed that many medical students do not know how to insert a breathing tube into a patient properly -- and that in addition to citing poor training, many medical students also mentioned that they had learned from television medical dramas.

The authors went through two seasons of "ER" to observe the insertion of breathing pipes -- known as intubation -- in episodes and found that of the 22 times the procedure was performed in a typical situation and was visible to the cameras, it was never done properly.

"While few would suggest that medical dramas can be held responsible for physician performance, it has been previously suggested that they can significantly influence beliefs," the authors wrote.

Intubation is a particularly suspect procedure for learning through television because it is not often taught as part of the required medical school curriculum. Many doctors will not have to perform it in their specific areas, so it is typically taught during anesthesia training or in emergency medicine electives, and it is often used in emergency situations, which makes it a prime action for television.

For Doctors, Practice Makes Perfect

"Intubation is one of the many skills that physicians use with patients, and it's one of the skills where there is a life and death component," said Sinz, noting that it needs to be done both well and quickly.

For real doctors, it takes plenty of practice to get it right.

"It takes about 10 to 20 intubations to learn how to intubate someone relatively safely and relatively successfully," said Dr. William Hurford, chairman of the department of anesthesiology at the University of Cincinnati Medical Center.

In his hospital, Hurford said, students are shown a video, and are then taught repeatedly in a simulated setting before doing it for real in the emergency room, preferably under less stressful conditions, which is not always the case.

"A lot of physicians learn in a code situation," said Hurford. "We obviously don't encourage that."

Hurford noted that while he knows students watch medical dramas, they have never used what they see on TV as an excuse for an improper intubation.

"They've never given me that excuse. ... Maybe they're just too embarrassed to admit it," he said.

Real Doctors on Fake Television

But while doctors' learning in the wrong place is a newer alarm, there has long been a worry about the impression medical dramas give patients about doctors.

A 1996 study published in the New England Journal of Medicine found that successful CPR was performed on television 75 percent of the time, while even optimistic estimates suggest it will only revive someone 15 percent of the time.

The authors noted that this might give the public unrealistic expectations, although, as Dr. John Lantos told, they could never prove this.

The drama of a television show, said Lantos, a professor of pediatrics and bioethics at the University of Chicago and at the Center for Practical Bioethics in Kansas City, Mo., can help teach doctors about some medical issues, even if not the procedures.

"I use episodes from television dramas when I teach medical ethics," he said. "The concise and dramatic portrayal of ethical dilemmas allows complex issues to be introduced in compelling ways. There have been great episodes about [do not resuscitate] orders, informed consent, organ donation, experimental therapy and the like.

Using Television to Help Educate Doctors

"It is not just the 'doctor' shows, either. Medicine becomes part of the plot on other shows -- 'Law and Order,' 'Star Trek' et cetera," Lantos said.

And Lantos is not alone in taking a cue from television to teach about medicine.

Sinz serves as the director of the simulation center at Penn State Hershey Medical Center, where students learn how to handle emergency situations using sophisticated mannequins -- and are filmed doing it. They then watch the film and are critiqued on their performance.

In short, the idea is to help doctors-in-training avoid making mistakes by putting those students on television themselves.

"There is, I think, still more work to be done to see where this kind of training is going to be helpful," Sinz said.