TV doctors' flaws become bioethics teaching moments

Gregory House, MD, has an unusual view of right and wrong. On several occasions, Dr. House has ordered underlings to break into patients' houses to search for clues to an elusive diagnosis. He once triggered a seizure -- against a patient's will -- to confirm a diagnosis of the rare metabolic disorder acute intermittent porphyria.

Dr. House is the fictional protagonist of Fox TV's "House," a medical mystery drama that last year drew an average 16.2 million viewers weekly. The bad-boy antics that made the master diagnostician a hit with American viewers also have made him popular among medical students, according to a December 2008 study in The American Journal of Bioethics.

The survey of nearly 400 medical and nursing students at Johns Hopkins University in Maryland found that 76% of doctors in training watch "House" and 73% watch ABC's hospital soap opera "Grey's Anatomy." Nearly 40% watch NBC's "ER" and one in five tunes in "Nip/Tuck," which airs on the FX cable network. Eighty-five percent of medical students said they watched a medical drama in the prior year.

All that TV viewing presents an opportunity to bioethics teachers, according to several commentaries published alongside the survey. In fact, Jeffrey P. Spike, PhD, argued in an AJOB article that Hollywood's dream factory can help educators better engage medical students in bioethics discussions. He said a small but growing number of medical educators is warming to the idea of using TV doctors as a teaching tool.

"There should be no shame in admitting that sometimes professional scriptwriters can write a better script than a small team of doctors and ethicists working in isolation at a medical school as if it were a cottage industry," said Spike, associate professor in the Florida State University College of Medicine Dept. of Medical Humanities and Social Sciences. "They are trained to create gripping or entertaining scenarios that will grab people's attention."

Spike uses ABC's "Scrubs" because its humor disarms students. And its length -- 22 minutes without commercials -- allows time for discussion in an hour-long class. He also teaches a fourth-year elective in which students examine medicine-related movies from a bioethics perspective.

"If students start talking about whether something is realistic or unrealistic, at least they are talking," Spike said.

Matthew J. Czarny, a third-year medical student at Johns Hopkins and first author of the AJOB survey, said TV's misbehaving physicians are good fodder for classroom analysis.

"The point of our study wasn't that we should be really concerned with what people are seeing," Czarny said. "It's just that medical and nursing students are seeing these things and they should provide a good starting point for ethics discussion. There is no question that with a lot of these shows you get better entertainment if people aren't handling the ethical issues well."

A self-described "House" junkie, Mark R. Wicclair, PhD, explained in his AJOB article that he uses clips from the show to prod bioethics discussions. "What I find useful about the series is that instead of just browbeating students and giving them the party line, I show them some of the excerpts, and it forces them to think about what the reasons are for the various rules about getting informed consent and protecting patient confidentiality," said Wicclair, a philosophy professor at West Virginia University and adjunct professor of medicine at the WVU and University of Pittsburgh medical schools.

The Liaison Committee on Medical Education, which accredits U.S. and Canadian schools, has no standards for using TV shows or movies in bioethics teaching.

But some physicians are skeptical about employing TV doctor dramas in the classroom. Fictional encounters could set up students for disappointment, said Howard Trachtman, MD, a pediatric nephrologist at Schneider Children's Hospital at North Shore in Manhasset, N.Y.

"Using these shows as educational vehicles could be doing students a disservice by promoting unrealistic views about the ways in which to be a doctor, the speed with which problems will be handled, even the attractiveness of patients," Dr. Trachtman said. "No matter where they come from, [real people] are more complicated than characters in TV shows."

Medical students seem able to put the Dr. Houses of the small screen in perspective. While most said the shows broach ethical issues, such as professional misconduct or end-of-life care, only one in seven students said TV medical dramas were an "important" source of bioethics information. Course work, scholarly journals and even family ranked as more important influences.

"The power of TV dramas to portray ethical issues is strong, but the power of medical dramas to shape the way [medical students] think about these things is not very strong," said Arthur R. Derse, MD, PhD, director of the Medical College of Wisconsin's medical humanities program. "They have already been shaped through friends, family, religion, culture and newspapers."