I'm not a doctor, but I play one on TV

How show business gets health care wrong … and right

Fade in to an empty hospital room

Scene 1: Sassy Malone, Almost M.D.

(Sarah Sassy Malone, a medical student who moonlights as a hospice volunteer crime scene investigator, enters the room. A patient, Mrs. Johnson, has gone missing. Believing investigators are running late in cahoots with a killer, Sassy begins dusting for fingerprints and collecting DNA with the handy kit she keeps for emergencies like these. Suddenly, she hears stirring in the supply closet across the hall.)

SASSY: Who’s there?

(The door opens and Sassy sees Nurse Jennifer Jones who is carrying a handful of supplies who has been making out furiously with medical student Riggs McGhee.)

RIGGS: Who are you? The supply closet police?

SASSY: I’m trying to solve a case, Riggs. Here, Nurse Jones, can you help me make yourself useful for a change and send these prints to the forensics lab?

RIGGS: How long will it take to find out what happened to who kidnapped Mrs. Johnson, Sassy?

SASSY: Forensics tests like these can take days, maybe weeks. A matter of minutes. Then we’ll have our killer.

RIGGS: How do you know she was killed?

(Sassy turns away. Close-up on her face …)

SASSY: I found blood by the door. Well, I think it was blood. I was able to quickly detect that it was red Mrs. Johnson’s blood. It was type B and I detected traces of the drugs she was given yesterday.

(Two investigators enter the room. They nod scowl at Sassy and Riggs.)

SASSY: As usual, you’re late, boys.

RIGGS: Yeah, guys, you should stay out of that donut shop. Too much sugar can cause diabetes.

OK. So, Sassy Malone, Almost M.D., isn’t a real TV show. The idea of a crime-fighting medical student able to procure DNA test results in the blink of a commercial break is preposterous. Of course, it’s the sort of storyline most Americans swallow every night on shows like “Grey’s Anatomy” and “CSI.”

To the average TV viewer, scenes like these are purely entertainment. Does it matter that surgeons greet ambulances on “Grey’s Anatomy” and treat patients trapped in wreckage instead of trauma docs? Seriously, what other plot device could the show’s writers use to have the main character drown and be revived miraculously after being seemingly dead for an entire episode?

But to health professionals, the way health care and science are portrayed onscreen isn’t always a joke, especially when storylines affect perceptions of diseases and how science works.

“There is a phenomenon known as ‘The CSI Effect,’” says Bruce Goldberger, Ph.D., director of toxicology and a professor of pathology, immunology and laboratory medicine in the UF College of Medicine. “The highly popular series has had a significant impact on the practice of forensic science and the prosecution of crimes.  On TV, cases are investigated, solved and prosecuted in an hour. In real life, it takes much longer — weeks, month or even years.

“For a victim’s family members, what they see on TV is not necessarily accurate. Family members now have greater expectations based on what they have seen on TV. This includes the time it takes to turn a case around. Juries have similar expectations, often expecting testing that is not necessarily needed to prosecute a case”

Although most folks realize TV and movies are just entertainment, the reality is most viewers spend more time with “House, M.D.” than their own physicians. And aside from the supply closet shenanigans and endless traumas, not all of what appears on the screen in false. Most shows and movies now have technical advisers who help them grasp lingo and stage believable scenarios, says Paul Doering, M.S., a distinguished service professor of pharmacy practice in the College of Pharmacy. So is it so surprising then that a viewer can walk out of a movie theater affected by what they have seen?

“TV has an enormous influence on how people view these things,” says Liam Holtzman, D.O., a UF assistant professor of emergency medicine and associate medical director of the Shands at UF emergency department. “If people are lucky, maybe they’ve never been to the emergency department, and TV is all they know about the health-care system.”

Doering says most folks outside of health and science like to think they’re “peeking behind the curtain,” when they watch the drama unfold.

“As long as people are able to distinguish reality from fiction, it’s (not a big deal). I like ‘CSI,’ and I just deal with the inaccuracies.”

The patient effect

For UF health experts, one of the biggest transgressions a television producer or moviemaker can commit is an inaccurate portrayal of a disease and its symptoms.

“If things are being portrayed inaccurately or misrepresented by description, that is potentially dangerous to people. It is, to an extent, medical education for the patient because people tend to internalize what they see and read, for better or worse,” Holtzman says. “That is probably the biggest thing I would like to see portrayed accurately.”

A 2003 article in the journal Sociology of Health & Illness showed that “ER” viewers found the show to be not just entertainment, but also an information source. And a 2002 study in the European Journal of Medicine found an association between watching medical dramas and overestimating survival chances following CPR.

Of particular concern for health-care providers is how mental illness is portrayed. For every  movie that gives an accurate depiction of mental illness, such as “A Beautiful Mind” and “The Aviator,” there are many more that stigmatize these disorders and could keep patients from getting treatment.

Often, when talk shows cover these diseases, only the most extreme cases are shown, affecting how people perceive these conditions, says Marie-Claude Laplante, Ph.D., a research assistant professor of clinical and health psychology in the College of Public Health and Health Professions.

“That is sad because we are talking about real-life problems,” says Laplante, who works in UF’s Fear and Anxiety Disorders Clinic. “As many as 26 percent of people struggle with mental disorders.”

A 1999 U.S. Surgeon General report cited stigma as the biggest barrier blocking research and treatment of psychiatric illnesses.

“TV and movies do great harm in promoting culturally sanctioned 14th-century prejudice against people with a mental illness and the health-care providers who treat them,” says Bruce Stevens, Ph.D., a professor of physiology and functional genomics in the UF College of Medicine who has studied the molecular biology of mental illness. “Reinforced stigma stops patients and their caring family members from seeking effective treatment in the first place. Stigma prevents legislative funding of research advances and community resources for the mental illnesses. And stigma allows disparities in insurance coverage for physical illnesses versus mental illnesses of medical origin.”  

Pharmaceutical ads on TV also seem to negatively affect patients, experts say.

“The advertising of drugs is really making people believe there is a pill for everything,” said Sandra Seymour, Ph.D., A.R.N.P., an associate professor in the College of Nursing. “In reality, everything can’t be fixed by a pill. People come through the door with (a drug name) written down, saying, ‘I want this.’ We have to explain that if we prescribe medication it is because it is best for whatever we’re treating.”

Nursing stereotypes

The fifth greatest film villain of all time, according to the American Film Institute, is Nurse Ratched, the seemingly tyrannical nurse in “One Flew Over the Cuckoo’s Nest.”

That’s just one of the portrayals of nursing that have affected people’s inaccurate perceptions of nurses over the years, says Karen Miles, Ed.D, R.N., a clinical associate professor and associate dean for academic and student affairs in the College of Nursing.

“People still say, ‘Oh, she’s a real Nurse Ratched,’” Seymour says with a laugh.

Watching movie credits, Miles says she often wonders why doctors are often used as consultants while nurses are not. This could be one explanation for why nursing advocates say the profession is frequently misrepresented in the media.

Example No. 2: The male nurse. In many movies or television shows, men either aren’t portrayed as nurses or they’re ridiculed, such as Ben Stiller’s character in “Meet the Parents.”

“We have more and more men coming into nursing school,” Seymour says.

Another aspect nurses hope to see portrayed better is the nurse’s role in general. Too often, movies and TV show nurses more as “handmaidens” to doctors rather than as important members of the health-care team.

“On some of the TV shows I see, you still get that parameter that the doctors are in charge and the nurses are following,” Miles says. “That isn’t our perception of nursing, and it isn’t what we’re teaching our students.”

“Nor is it what we’re legally held accountable for,” Seymour adds. “We are legally held accountable for our actions. If a physician tells me to give a drug, and I knew that was not the right medication and I didn’t say it, it’s my license that goes down the tubes.”

Getting it right

But it’s not all catchy pharmaceutical jingles and daring docs to the rescue. TV and movies get it right, too, and can be powerful educational tools.

“For many people (watching movies is) more powerful than reading a book because it relies less on imagination and more on other senses,” says Nina Stoyan-Rosenzweig, director of medical humanities in the College of Medicine.

In her narrative medicine classes, Stoyan-Rosenweig shows medical students films to spur discussion about issues related to medicine. A goal of the class is to help students see health care through the patient’s eyes. Movies such as “The Diving Bell and the Butterfly,” about a man with locked-in syndrome who dictated his memoir by blinking, and “Hilary and Jackie,” about a cellist with multiple sclerosis, help illustrate these points, she says.

“A lot of what we talk about is the patient’s story and to listen to the patient’s story and not make judgments,” she says.

Also, more TV and movies seem to be leaning more toward accuracy in entertainment than ever before, says Doering, who has worked with the Entertainment Industries Council, a company that helps writers get health-care information correct. He’s helped fiction writers and collaborated on a scenario for the Lifetime show, “Strong Medicine.” The group also awards shows and movies for their accuracy, too.

“Right now the public is just hungry for health news, but it’s a very confused audience to write for,” Doering says. “It’s not a very sophisticated audience. Health literacy is pretty low.”

TV shows and movies occasionally collaborate with advocacy groups to incorporate educational messages about health care in programs and to raise awareness about diseases. “House, M.D.,” recently collaborated with the National Alliance on Mental Illness to raise awareness of how media-generated stigma damages treatment efforts, said Stevens, a representative of NAMI’s Gainesville chapter.

Even when entertainment takes liberties, at least it inspires patients to ask questions and introduces what Seymour calls “teaching moments.” Stoyan-Rosenzweig agrees, saying even when she shows her class movies that don’t “get it right” it can teach critical-thinking skills.

With regard to the public’s perception of forensics, though, little can be done now to offset the effects shows like “CSI” and “Law and Order” have had on juries, Goldberger says.

“It’s the No. 1 show, millions watch it every week,” says Goldberger, who visited the show’s set two years ago and has a signed photo of the cast. “I admit CSI is very entertaining. I watch it, although not on a regular basis.”