The House Effect: Are Real Patients Misled by TV Docs?

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FOX / Everett

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."

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