Health Care in the Time of Grey's Anatomy

It is hard to overemphasize how much I loved Grey’s Anatomy in high school. I loved it superstitiously. Due to a weird set of coincidences, I truly believed that if Grey’s Anatomy wasn’t new that week, I would have a bad week. At the time, it aired on Sunday nights, and I took it as an omen. I would show up to school Monday morning filled with dread after a rerun.

I don’t blame Shonda Rhimes for my misfortunes anymore. But hours (or, more accurately, probably days) of watching Grey's, Scrubs, and other medical TV shows has still shaped my life, if research is any indication. Several studies have shown that people who watch a lot of medical shows are more likely to believe certain things about doctors, and about healthcare.

Admittedly, these medical shows provide a skewed image of the healthcare system at best. Surely no hospital has had as many romantic pairings as the doctors on Grey’s (whose 11th season starts next month), and I have to imagine bedpan racing in the workplace is … frowned upon.

Though you might think that people are perfectly capable of separating television from reality, cultivation theory suggests they cannot, entirely. The theory goes that the social reality people are exposed to on TV shapes their attitudes toward real social reality, and it does so, of course, in subtle and complicated ways that are hard to nail down. Prevailing societal attitudes obviously influence what goes on TV, too, further complicating the relationship.

“Television, movies, books, all of these things, a lot of people like to believe they’re just fun and games, that they really don’t affect us, it’s just entertainment,” says Dr. Rebecca M. Chory, a professor in Frostburg State University’s business school who has studied TV’s influence on attitudes toward healthcare. “But the research consistently shows that’s not true.”

A 2005 survey by the Centers for Disease Control and Prevention found that the majority of primetime TV viewers reported learning something new about a disease or other health issue over six months of viewing. About one-third of viewers took some kind of action after learning about a health issue on TV.

Many medical shows have physicians consult for accuracy, and an article in the American Medical Association Journal of Ethics notes that starting with ER in the ’90s, TV shows began using more detailed medical jargon to describe conditions and procedures. But there are still inconsistencies. Treatments for patients with seizures are sometimes downright dangerous, with doctors trying to hold patients down, or put things in their mouths (they could choke). Patients tend to survive cardiac arrest more often on television than they do in real life, making CPR seem more effective than it often is.

“That can lead to a misunderstanding as to the likelihood of a patient or loved one surviving a cardiac arrest,” says Dr. David Brown, chair of the department of emergency medicine at Massachusetts General Hospital. “But it isn’t really good TV if everybody dies, right?”

What does make for good TV: Rare diseases. Injuries. Natural disasters. Which means the amount of screen time given to different conditions isn’t proportional to how common those diseases are in real life, according to a new study published in Human Communication Research. People flock to these shows, after all, first and foremost to be entertained. So less sensational, more quotidian conditions like diabetes are underrepresented.

As a result, “a fan of medical dramas … can develop a skewed perception of what are more or less prevalent health issues in the real world,” study author Dr. Jae Eun Chung, an assistant professor in the school of communication at Howard University, told me in an email. Heavy viewers of medical dramas in her study were less likely to rate cardiovascular disease and cancer as important societal issues (when they are, in fact, the top two causes of death in the U.S.), and when it came to cancer, they were more fatalistic, “more likely to say that cancer prevention is uncertain and that the disease is fatal.”

On TV, the patients that have these compelling rare diseases are played by a revolving door of guest stars. The characters we really get to know are the doctors themselves. And the way doctors have been portrayed on television has changed markedly over the years. Medical shows in the ’50s and ’60s, like City Hospital, Dr. Kildare, and Ben Casey, showed doctors as noble, infallible heroes. These shows apparently received “creative input and guidance from the American Medical Association,” according to an article in Annals of Emergency Medicine.

Starting in the ’70s and ’80s with shows like M*A*S*H and St. Elsewhere, the pendulum swung toward portraying doctors as the flawed humans they are. We’ve been firmly in the era of flaws for a while now with shows like Grey’s and House, MD (whose rude, drug-abusing titular character gets by on his brilliance). This perhaps explains why, in a 2003 study (on which Chory was an author), watching more prime-time medical shows was associated with “perceiving doctors as more uncaring, cold, unfriendly, nervous, tense, and anxious.”

“The fact that people aren’t perfect—on the one hand, that’s great for drama, but then what does that do for what people think of real life physicians?” Chory asks.

Could human portrayals help the doctor-patient relationship, by getting people to relate to their physicians? Or does the knowledge that doctors can also make mistakes weaken trust?

“I’m not sure that these TV shows really enhance empathy toward the doctor,” says Dr. Alexandra Chabrerie, a primary care physician on faculty at Harvard University. “I think doctors are still sort of expected to know everything, especially when you have [characters] like House.”

But in real life, she notes, a diagnosis doesn’t fall on one doctor’s shoulders. “It takes a whole team of doctors to come together and solve problems,” she says. “For cancer, you have tumor boards and tumor conferences that talk about what the optimal approach is.”

Studies of modern medical shows have found fictional doctors’ professionalism disappointing at best. In an analysis of 50 episodes of Grey’s Anatomy and House, researchers found that the characters handled issues involving patient consent well 43 percent of the time. “The remainder [of the depictions] were inadequate,” the study says.

The analysis also found several incidents of doctors endangering patients without being punished, sexual misconduct (of course), and disrespect. The study notes that “88 percent of disrespectful incidents in House involved Dr. House.”

But despite all the inappropriate romances, and Dr. House’s rude mouth, the analysis found that there’s one arena in which TV doctors still shine: caring for patients.

“Caring and compassion when dealing with patients is particularly noteworthy, because it is the only virtue of professionalism we identified in which the exemplary portrayals outnumber the lapses,” the researchers write.

A lot of the out-of-control unprofessionalism in these shows does seem to be in service of the patients. On one episode of Grey’s Anatomy, two female interns confront their boss in the men’s bathroom, to convince him to do a risky operation. On the goofy Zach Braff comedy Scrubs, doctors treat patients who have no insurance, and bill the procedures to the insurance of patients who recently died. Fictional doctors do often go the extra mile for their patients. (There is actually an episode of Scrubs called “My Extra Mile.”) These portrayals may be why watching Grey’s Anatomy was linked to seeing doctors as more courageous, in another study. And seeing doctors as more courageous was subsequently linked to better patient satisfaction.

All the heightened drama and medical inaccuracies aside, Chabrerie says it’s the emotional challenges of being a doctor that these shows tend to get right.

“I do think the emotional aspects get brought up more in shows like Scrubs,” she says. (She’s not the only one—a 2009 Slate article says that despite the show’s “cartoonishness,” it’s “quite in tune with the real lives of doctors.”)

“In med school, this is what we did. We lay in our beds and watched Scrubs,” Chabrerie says. “At the end of the day, we see [the same things] all the time. We lose patients all the time. It’s never easy. [On these shows], the young doctor gets really upset, and the older, wiser doctor comes in and says ‘You have to let it go.’”

As it enters its 11th season, Grey’s Anatomy is the biggest medical show still on air. Others, like Hart of Dixie and The Mindy Project, have taken the “doctors’ personal lives” strategy that Grey’s made popular and run with it, all but abandoning the depiction of any actual medical treatment. But a decade of Grey’s dominance, combined with the longevity of other 21st-century medical shows (House got eight years, Scrubs got nine, ER, 15) surely takes a toll.

When a television show becomes a huge part of popular culture, it can influence even those who don’t watch it. “Even if you’re not watching the program, it creates kind of a cultural public opinion, a dialogue about the topic,” Chory says. “You hear things from people who do watch it. There’s a long line of research saying that one way media affects us is through our personal contacts.”

Ultimately, though, Chory says that the biggest influence comes from what you watch, rather than what’s on. And shows that aren’t on-air anymore can sometimes find new life on Netflix.

“The influence of repetitive watching of those medical shows, to me, is rather subtle,” Chung says. “We may not realize that our perception and attitude changes as a result of repetitive exposure to medical dramas because often the influence happens at the unconscious level.”

Though the hospital remains a compelling setting for fictional drama, we’re past the heyday of doctor-show dominance. Their influence surely lingers, but for those who can’t get enough rare diseases, there’s always the Internet.

“For my 40th birthday, my husband got me a framed sign that says ‘Please don’t Google,’” Chabrerie says. “My patients get so freaked out.” She adds that those who fall into WebMD holes are probably some of the same people who binge-watch House or Grey’s Anatomy.

Here are some things that are true. Anytime I have the mildest bodily discomfort, I become fully convinced I am dying. I’m also extremely reluctant to go to the doctor, a combination of qualities that makes being my friend a constant delight, I’m sure. I work on the Internet. And I love medical TV shows. Are these things related? I don’t know. I’m trying not to blame Shonda here, but, you know, old habits.