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Effects of watching "Dr House"

Discussion in 'Psychiatry' started by Nemanja P, Nov 26, 2011.

  1. Nemanja P

    Nemanja P Moderator

    Jul 24, 2011
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    He badgers, belittles and berates his patients. He deliberately deceives his colleagues and his boss, and he often bends hospital rules (and the law) to suit his purposes. He self-medicates with booze and (illegally obtained) painkillers. And he makes for excellent TV.

    Dr. Gregory House, the cantankerous main character of Fox's medical drama House, M.D., played by British actor Hugh Laurie, is no portrait of compassion or medical ethics. (To wit, the show's website loads to a sound track of some of his more offensive remarks, including, "Is it still illegal to perform an autopsy on a living person?") Yet however offbeat or unethical his approach, he is wildly popular with audiences worldwide — and with future medical professionals.

    A 2008 survey of medical and nursing students conducted by researchers at the Berman Institute of Bioethics at Johns Hopkins University found that 65% of nursing students and 76% of medical students watch the program. According to the same survey, published in the American Journal of Bioethics, students are also mad about ABC's Grey's Anatomy — another medical drama that portrays doctors behaving in less than professional ways — with 80% of nursing students and 73% of medical students following the sexual, romantic and occasionally medicine-related escapades of surgical residents at the fictional Seattle Grace Hospital.

    To most viewers, especially those in medical training, it's clear that such TV dramas only vaguely resemble legitimate medical environments. Indeed, in the 2008 survey, medical and nursing students said they did not draw any significant professional lessons from the programs. But the study's authors questioned whether mere exposure to the shows — and the slippery ethics presented in them — may still subtly affect doctors' or patients' attitudes toward the practice of medicine.

    To begin answering that question, three authors of the 2008 survey reteamed to conduct a follow-up study to measure the frequency and nature of ethical missteps and unprofessional behavior presented in House and Grey's Anatomy. The results, published in the April issue of the Journal of Medical Ethics (JME), suggest it's a good thing Drs. House and McDreamy practice medicine only on TV.

    Researchers cataloged 179 depictions of bioethical dilemmas in 50 episodes of House and Grey's Anatomy that aired between fall 2005 and spring 2006. Of those, 49 involved obtaining informed consent for treatment from patients or their loved ones. In some instances (43%), the characters behaved according to professional codes of conduct, but in most cases (57%) they missed the mark completely — as when TV doctors failed to obtain any consent at all for a procedure or brazenly lied to patients to get them to sign off (two scenarios particularly common on House).

    Researchers also noted 22 incidents in which fictional doctors deliberately veered from standard practices, endangered patients unnecessarily or disregarded their own medical ethics. In one episode of Grey's Anatomy, the character Dr. Isobel Stevens deliberately harms her heart patient (who is, hello, also her boyfriend) in the hopes that his worsened condition will bump him up higher on the heart-transplant list.

    In a separate category, researchers examined portrayals of professional behavior on the two shows. Not surprisingly, exemplary behavior was uncommon. Just 5% of 396 interactions between medical colleagues and fewer than one-third of doctor-patient interactions conformed to real-life professional standards. Further, as researchers cataloged the various incidents depicted, they found they had to create a whole new category for sexual misconduct, which they primly concluded is "clearly a breach of professionalism."

    But the question is whether dramatic devices on television have any bearing on the perceptions of real-world viewers. If past research on the impact of entertainment is any indication, it wouldn't be surprising if they do. One study in 2007 identified what has become popularly known as the "CSI effect": because of the public's increasing familiarity with technology and the importance of scientific evidence — due in part to media coverage of real scientific advances as well as the trumped-up technology on TV shows like CSI — juries have become more demanding of forensic evidence in courtrooms. In the study of more than 1,000 people who had previously served on juries, many said they would vote to acquit if no such evidence was presented, even if they otherwise believed the defendant to be guilty. A 2009 report by the National Academy of Sciences further found that the CSI effect was helping to foster a misguided sense — even among judges and lawyers — that forensic evidence is infallible.

    Does this effect translate to the field of medicine? Past research suggests that TV docs can sometimes serve as educators. A 2007 study looked at the effect of a single episode of the long-running medical drama ER on viewers' understanding of their own health. Researchers from the University of Southern California found that an episode in which a teen girl was diagnosed with high blood pressure and encouraged to eat more fruits and vegetables appeared to edify the audience, resulting in self-reported healthier eating habits and a better understanding of hypertension and weight issues among surveyed ER viewers.

    In some cases, people may grasp health information better when it's presented as fiction rather than fact. A study published in the January issue of the journal Human Communication Research found that college-age women who had watched a drama involving teen pregnancy were more likely to report in a poll two weeks later that they planned to use birth control regularly, compared with those who had watched a news report on the topic. (The same effect wasn't seen in men who watched the drama, however.)

    Still, a co-author of the new JME study, Ruth Faden, who is the director of the Berman Institute of Bioethics, says there isn't much evidence to support a negative "House effect" in real-life medical settings. She cites a 2002 report in the European Journal of Emergency Medicine as the closest to showing misconceptions about medical-procedure expectations derived from fictionalized TV depictions: in that study, researchers surveyed 820 young adults about their TV-consumption habits, knowledge about cardiopulmonary resuscitation (CPR) and their expectation of survival of a patient who undergoes CPR in the hospital. The survey found that people who watched medical dramas were more likely than people who didn't to overestimate survival rates for patients needing CPR.

    But when it comes to real-world situations involving medical ethics, the issues are usually not as clear-cut. So while viewers of Grey's Anatomy may find Seattle Grace's medical staff to be frivolous and unprofessional, Faden doubts they believe "doctors and nurses are regularly as discourteous or indifferent as some of the characters." Faden admits to being a fan of House. "As a normal watcher myself, I don't think most people come away thinking there are lots of Dr. Houses out there," she says.

    Rather, she says the high drama in TV hospitals probably does little more than spur dinner-table conversation about the ethics of medicine, possibly including complex topics like end-of-life care and access to health care — "big questions that we face in our society," Faden says. Indeed, to encourage such useful conversation among the public, she and a group of colleagues recently formed an initiative to get TV and movie producers to collaborate with medical ethicists when creating content. "From our standpoint as scholars in bioethics, we see great opportunity," she says. "The thing about scripted television shows is how frequently they appear, coming out 20 and 25 times per year. They engage millions of people around the world, so the opportunity for bringing public attention to these issues is enormous."


    SOURCE 'House' Effect: Are People Misled by TV Doc Dramas? - TIME


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  2. Egyptian Doctor

    Egyptian Doctor Moderator Verified Doctor

    Mar 21, 2011
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    Thanks Nemanja :D

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