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Wednesday Nov 18, 2015

They're (Usually) Not Doctors, but They Play Them on TV

When I was an undergrad, I decided to pursue my emergency medical technician license at a nearby community college. I would get home from class each week just in time to watch ER. I joked with my roommates that I had to watch it as homework. I got excited when I started to understand what the doctors, nurses and others were talking about and could point out the show's medical inconsistencies and mistakes.

Helga Esteb/Shutterstock.com
Actor Ken Jeong, M.D., a former internist, arrives at a Hollywood premier with his wife, family physician Tran Ho, M.D. Jeong plays the title role in the new sitcom Dr. Ken.

Numerous medical programs have come and gone in the 21 years since ER began its 15-year run, but more often than not, TV still gets it wrong. Most medical dramas glorify and romanticize physicians' relationships with each other, nurses and even patients. These shows also manage to get so many things wrong about medicine that it leaves you wondering if the writers even bothered to have a medical team review their scripts.

Ironically, the only show in recent years that demonstrated any medical accuracy was Scrubs, a goofy comedy that did not take itself seriously.

There are a host of new medical shows making their debuts this fall. Will they be any more realistic?

  • Code Black(www.cbs.com) takes place in the Los Angeles County Hospital ER and is based on a documentary by the same name.
  • Heartbreaker(www.nbc.com) is based on the experiences of a real-life heart surgeon.
  • Chicago Med(www.nbc.com) is a sister show to Chicago Fire and Chicago P.D. that is set in a trauma center.
  • Dr. Ken(abc.go.com) is the lone sitcom among the new medical shows and features physician-turned-actor Ken Jeong, M.D., probably best known for his roles in the Hangover movies.

It's worth thinking about the impact TV medical shows may have on our patients and whether physicians should be concerned about how our profession is portrayed. Everyone knows these shows are unrealistic … right? NBC, for example, gushes that the main character on Heartbreaker has "a racy personal life that's a full-time job in itself."

Ugh.

I'm not worried that my patients think I sneaked away to supply closets for romantic escapades during my training. But could these shows be contributing to unrealistic expectations of what medicine can actually do? Do they glorify saving lives in the ER setting? Do these shows negatively impact our attempts to educate patients about the importance of primary and preventive care?

During residency, when we admitted patients and discussed their code status preferences, I often found myself wondering how TV portrayals of CPR were affecting their decisions. As the Radiolab podcast article "The Bitter End" discusses, there is a huge discrepancy between what doctors would chose at the end of their lives(www.radiolab.org) versus what patients choose. And this is largely because we know realistically what CPR does and doesn't do. One study found that 75 percent of patients on TV are successfully resuscitated(www.ncbi.nlm.nih.gov), and 67 percent survive long enough to be discharged from the hospital. The reality is that only about 40 percent of CPR administered in the hospital is successful, and a mere 10 percent to 20 percent of patients live to be discharged.

So when it comes to addressing what medicine can offer my patients, I often tell them that what they have seen on TV is not in line with what I have seen in real life.

As I watched a clip from Code Black, a comment about "saving someone's life" reminded me of friends who have said to me -- while discussing their own stressful days -- "Well, it isn't like I was saving lives like you, but … "

Our roles as family physicians are crucial as we strive to improve the health of our country. An ad for One Medical Group, which uses a novel approach to delivering primary care, came on while I was writing this very piece and wondering why there are no television shows about primary care. The answer, unfortunately, is because watching a patient sit in a waiting room or discussing Pap smear results doesn't make for an entertaining show.

The way that we as family physicians save lives is often not what our friends, family and patients might expect based on what they see on TV. And the tools we use to do it are not necessarily the CT scans, frequently excessive labs and involvement of several subspecialists that are the norm in TV dramas that fail to emphasize patient-centered care and clinical skills.

But there may be some hope for how medicine is portrayed on TV. The executive producer for Code Black, Ryan McGarry, M.D., is the ER physician who directed the documentary that the new show is based on. Before filming ever started, the show's cast went through a medical bootcamp(www.cbs.com), and the actors actually work 12-hour shifts to reflect conditions that one might experience as a resident physician or a nurse. So although the dramatic "saving lives in the ER" aspect is still present -- against the backdrop of one of the busiest ERs in the country -- at least there is an attempt at medical accuracy.

It's worth noting that the sitcom Dr. Ken does not take place solely in the main character's primary care clinic because the show also is about his role as a father and husband -- like so many of my colleagues' lives are. When he tries to make his job sound important, his wife -- a therapist -- angrily retorts that "it's family medicine, not the ER."

Although that snippet of dialogue was disappointing, the pilot episode demonstrated the true significance of having a family physician. Dr. Ken sends a patient for a colonoscopy and receives a letter of gratitude because the polyp that was removed could have been "fatal." Perhaps TV's Dr. Ken -- who in real-life is an internist married to a family physician -- will expose our patients to the importance of making health primary(healthisprimary.org).

Margaux Lazarin, D.O., M.P.H., provides comprehensive family health services, including osteopathic manipulation, at a community health center in the Bronx, N.Y. She is actively involved in teaching residents and medical students to deliver evidenced-based care to underserved communities.

Posted at 02:46PM Nov 18, 2015 by Margaux Lazarin, D.O.

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