by by Emma Berry

The little boy’s nosebleed wouldn’t stop. He needed brain surgery as soon as possible to prevent a cluster of blood vessels from killing him, but his nasal passages were too small to operate through. His mother pleaded with the surgeons: why weren’t there any instruments small enough? So the surgeons decided to invent them. When the hospital couldn’t afford the research and development, the surgeons wrote checks. With the new tools, they removed the blood vessels. The audience in the packed surgical gallery cheered—and so, one assumes, did the 14 million viewers at home, watching the episode of Grey’s Anatomy as it aired November 19, 2009.

But in the real world, we can’t rely on Patrick “McDreamy” Dempsey to cover our substantial health care costs. Americans spend more on heath care than any country in the world ($2.4 trillion last year, or more than $7,800 per capita), and its share of the gross domestic product continues to grow. Yet 15 percent of Americans remain uninsured, and many more say they have trouble paying for health care. And experts say that the model of health care celebrated by TV dramas like Grey’s Anatomy is partly to blame.
Medical dramas are not a new phenomenon. In the 1960s, Dr. Kildare and Ben Casey brought viewers into the hospital. From 1970 to 1971, ABC’s Marcus Welby, M.D. was the most-watched show on television, counting one in four Americans in its audience.

According to Joe Turow, a professor of Communication at the University of Pennsylvania who studies the effect of entertainment on health care policy, these hospital dramas focused mainly on the problems of a particular patient, and the family and emotional issues that contributed to their physical illness. M*A*S*H inaugurated the era of physician-centered show—a trend that grew in the 1980s and 1990s with shows like St. Elsewhere. Likewise, E.R., which topped the Nielsen ratings for several years in the 1990s, “quickened the pulse” of the medical drama, he said, and paved the way for the crop of doctor-centric shows that dominated the 2000s.

The genre’s popularity continues to grow. While E.R. ended its 15-season run this year, Grey’s Anatomy, House, and Nip/Tuck continue to thrive. 2009 saw the debut of at least six shows focusing on doctors, nurses, or paramedics, including NBC’s Mercy and CBS’s Three Rivers. Heroes star Hayden Panettiere has just signed on as a co-executive producer for a CW drama set at Harvard Medical School.
On shows like Grey’s Anatomy, patients serve as catalysts for the doctor’s emotional development. Witnessing a patient’s strength in the face of a painful procedure might give a doctor the kick she needs to make a decision she was avoiding. Seeing a parent reconnect with her hospitalized child might prompt a character to call her own mother. On House, patients are mysteries to figure out, puzzles whose real purpose is allowing doctors to perform mental feats. Either way, as Turow said, the “focus is on the doctors’ angst and the patients are just instruments to get that across.”

Kristin Ickes, Chief Resident in Internal Medicine at the Carilion Clinic in Roanoke, Virginia, said she was always more interested in the medicine than the drama.“I used to sit in front of the TV when I was five years old watching surgery on the Discovery Channel,” she said.

Ickes does not think people mistake medical dramas for reality; obviously, hospitals aren’t really full of young, attractive physicians with incredibly complicated sex lives. Despite what shows like House would have viewers believe, a single physician is not in charge of performing lab tests, reading X-rays, and wielding the scalpel. Nonetheless, a significant percentage of Americans—particularly low-income Americans—say they actually have learned health-related information from medical dramas, according to a 2008 study by the Kaiser Family Foundation. And they believe in the accuracy of this information.

The study suggests that medical dramas do have the power to teach. The Foundation worked with Grey’s Anatomy writers to embed a lesson about HIV transmission during pregnancy into a script, then surveyed regular viewers of the show before and after the episode aired. Before the show aired, only 15 percent of viewers knew that, with treatment, the risk of a woman with HIV having a baby infected with the virus is less than two percent. After the show aired, 61 percent responded that the risk was small.

But not all lessons from medical shows are positive. On TV, medical miracles are commonplace. Ickes said that in her experience, viewers of medical dramas often have “unrealistic expectations” about the power of medicine. Patients expect physicians to be able to solve all of their ailments—even when a patient could do far more for himself, by quitting smoking or losing weight, for example—or when those ailments are simply a natural part of the aging process.

Studies from a variety of countries show that viewers of medical dramas dramatically overestimate the effectiveness of CPR, and a 2006 study in the Journal of the American Osteopathic Association suggested those misperceptions can affect patients’ decisions about whether to be resuscitated in the case of cardiac arrest. In real life, if your heart stops beating, you’re in a lot more trouble.
Even when presented as fiction, TV shows influence the public’s perception of health care. And that can be a problem, at a time when public opinion about health care reform is critical.

Medical dramas focus on emergency situations—acute problems requiring hospitalization and high-tech intervention. And the more intervention, the better. It’s what Iowa Senator Tom Harkin—a major player in the current heath care debate—calls a “sick care” system. “The current system is all about patching things up after the fact,” he told Newsweek.

Federal law requires hospitals to provide emergency care to everyone, regardless of ability to pay, so it may not seem unreasonable that, in medical dramas, insurance rarely comes up when a patient is on the operating table. But a November 2009 study found that money still matters: uninsured patients are almost twice as likely to die after trauma than insured patients with similar injuries. Though medical dramas often deal with hot-button ethical issues -- including when to pull the plug on a comatose patient or whether to pursue aggressive but painful treatments—they rarely address cost. 

But according to Harkin, addressing costs is essential. “We spend untold hundreds of billions on pills, surgery, hospitalization and disability,” he said. “But we spend peanuts—about three percent of our health-care dollars—for prevention.”

Most of us would rather watch a physician performing open heart surgery than encouraging a patient to eat more salad. So it’s not necessarily surprising that medical dramas focus on highly-paid specialists, like Nip/Tuck’s rock star plastic surgeons or Three Rivers’ transplant team. But they diminish—or ignore entirely—the role of primary care providers who follow patients’ medical progress over years, managing chronic illnesses like diabetes and focusing on preventing others so that, hopefully, we won’t need expensive, risky procedures.

Sixty-eight percent of Americans surveyed by the Kaiser Family Foundation believe that the government needs to take some kind of action on health care reform. Experts agree that to do so, it will need to tackle rising costs, including those incurred by over-treatment. Americans agree. According to an April 2009 NPR poll, 88 percent believe that “too many patients [are] getting medical tests and treatments that they don’t really need.”

But only 16 percent believe that they had personally received unnecessary care. A November 2009 USA Today poll shows they’re reluctant to give up on measures like early breast cancer screenings, even when the clinical benefits are uncertain—and the costs are clear.
And television dramas aren’t helping, Turow argues. “There’s no discussion, or very rarely, of scarcity.” When it is brought up, “it’s often made irrelevant,” like in the case of the boy’s nosebleed. Insurers rarely appear at all, and when they do, they tend to be portrayed as villains.

After President Obama’s election, Grey’s Anatomy creator Shonda Rhimes was so elated that she told the Chicago Tribune that the show’s upcoming storylines on the show would be more hopeful. But if she really wants to help advance health care reform, she may want to do the opposite. The boy with the nosebleed needed a miracle—and he got one. But addressing health care reform will require looking at the unglamorous side: the cases in which millions of dollars are spent for a miracle that doesn’t come through. 

EMMA BERRY B’11 prefers Scrubs.