The Grey’s Anatomy Effect: When TV Warps Perception, Proactive Communication is Key

David Propst, PA-C, a physician assistant with Wilson Medical Group in Wilson, North Carolina, once had a patient with end-stage renal disease who wondered when Propst could print him a new kidney.

Propst was confused until the patient told him he’d seen it on a television show, except the patient “thought it was for real.” As it turns out, season 10 of the popular medical television drama Grey’s Anatomy featured a storyline in which Ellen Pompeo’s Dr Meredith Grey 3D prints a newborn heart to help with a delicate procedure. Although Dr Grey never transplanted the heart, surgeons do sometimes use 3D printed model organs in planning difficult procedures, and implantable 3D printed organs actually are likely on their way. But they are not quite here yet, contrary to what this patient believed.

Although this instance likely involved the patient misunderstanding what happened on the show, the problem of patients coming into clinics and hospitals with incorrect or outright bizarre ideas about medical conditions and procedures because of what they’ve seen on television is as familiar to medical professionals as physicians hooking up is to Grey’s viewers.

Most research on the topic has focused on CPR rates. In a 2015 study published in Resuscitation, Jaclyn Portanova, PhD, and colleagues examined how CPR survival rates differ between real life and on Grey’s Anatomy and House, another popular medical drama.¹ Across 91 episodes in which CPR was performed 46 times in-hospital, nearly always by physicians, 69.6% of patients immediately survived. Most (71.9%) survived until hospital discharge, for an overall survival rate of 50%. But in real life, only half as many (24.8%) adults survived to discharge after receiving in-hospital CPR in 2016, according to the American Heart Association.² This disparity hasn’t improved much since the topic was first studied more than 2 decades ago by Susan J. Diem, MD, and colleagues.³

“Inaccurate TV portrayal of CPR survival rates may misinform patients and caregivers and influence care decisions made during serious illness and at end of life,” wrote Dr Portanova and colleagues.

But the problem extends well beyond inaccuracies about CPR survival rates. Another study by Rosemarie O. Serrone, MD, and colleagues viewed 269 episodes of Grey’s Anatomy and found substantial differences for other outcomes.4 Based on 290 television patients and 4812 patients from the National Trauma Data Base, 22% of television characters died compared with 7% in real life after traumatic injury. Although only a quarter of real-life patients went straight from the emergency department to the operating room, 71% of television characters did — it’s more dramatic, after all.

Yet only 6% of television patients ended up in long-term care compared with 22% of real patients, and half of television patients spent less than a week in the hospital compared with 20% of real patients (P <.0001 for all).⁴ Television clearly turned up the drama (higher mortality and surgery rates) while glossing over the less glamorous real experiences (longer hospital stays and long-term care), potentially cultivating “false expectations among patients and their families,” the authors wrote.

Indeed, Bruce Lee, MD, an associate professor at Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland, tweeted in response to a social media query about these television vs real-life misconceptions that “patients frequently underestimate how long it takes to recover from a procedure. On TV, patients often look like they are attending a dinner party after surgery or a procedure.”

The Pervasive Grey’s Anatomy Effect

The scrutiny of Grey’s Anatomy in particular has lent the term “Grey’s Anatomy effect” to the disconnect between real-life and television medicine, but it results from many shows and even films, such as the famous adrenaline-in-the-heart scene in Pulp Fiction that patients believe reflects reality, as Claire Zagorski, a paramedic with Austin Harm Reduction Coalition in Texas, tweeted. Communications and sociology professors have explored the phenomenon as well.

Jae Eun Chung, PhD, from Howard University’s School of Communications, examined the underlying mechanisms of this effect and how television influences a broader range of viewer’s health beliefs by surveying 11,555 people.5 “Findings suggest that heavy viewers of medical dramas tend to underestimate the gravity of chronic illnesses such as cancer or cardiovascular disease and undermine the importance of tackling these issues,” Dr Chung wrote. “Heavier viewers of medical dramas, compared to lighter viewers, also tend to take a more fatalistic perspective about cancer.”

In some ways, resolving misconceptions about cancer might pleasantly surprise patients. Oncologist Suneel Kamath, MD, a fellow at Northwestern’s Feinberg School of Medicine in Chicago, Illinois, tweeted, “Most patients hear ‘chemo’ and think [they’re] going to vomit all day and be bedridden like on television. But tons of patients never vomit once on chemo. I’ve had patients bike miles to work and to their appointments with me while on chemo.”

In contrast, Dr Chung wrote, “confusion and fatalistic views resulting from cumulative viewing of medical dramas may prevent individuals from seeking health professionals when their health is at risk.” And unrealistic expectations can color how people perceive their experience, such as birthing mothers.

“TV portrayals of labor and delivery totally underestimate the latent phase of labor,” tweeted Sophie Palmer, MD, a resident in obstetrics/gynecology at the University of Alberta, Edmonton, Canada. “Sometimes people think that as soon as they start to feel any contractions, they will be admitted to [labor and delivery] and have their baby soon thereafter. Latent labor is a marathon that can take days.”

Not understanding how care teams and medical division of responsibilities work can also affect how patients perceive the quality of their care, pointed out Ann Young, MD, a pediatrician at Texas Children’s Hospital in Houston. “Patients don’t realize that doctors have very different specialties and their expertise doesn’t overlap,” she tweeted. “If I tell a patient a surgeon is coming to answer their questions, they will then ask me all the surgery-related questions thinking I should know because I’m a doc.” She said she blames this misconception on House, “where every doctor on the show is apparently a nurse, tech, radiologist, oncologist, anesthesiologist, code team member, [emergency department] doc, and more. Patients don’t realize things happen incrementally and because of a huge team of docs, techs and RNs.” They also don’t realize that doctors don’t typically place intravenous lines, set up pumps, or perform other common nursing tasks, others noted.

Even the top government doctor in the United States isn’t immune to misperceptions, albeit often amusingly so. “My patients think I have an operating room in the White House, and when POTUS isn’t assisting me with surgery, I’m in my office at the Capitol with [Senate Majority Leader Mitch McConnell] and [Speaker of the House Nancy Pelosi] stamping warning labels on cigarette boxes and wine bottles,” tweeted US Surgeon General Jerome M. Adams, MD, MPH.

Clear Communication Is Essential

Although some shows get it right (both Palmer and others noted the realism of the BBC show Call the Midwife), they appear to be the exception. One problem is lack of communication within the US healthcare system, which “lacks a formal mechanism for communication risks and benefits of CPR,” noted Dr Portanova and colleagues. This statement easily applies to the risks and benefits of other medical treatments and procedures too, as Zackary Dov Berger, MD, PhD, an associate professor of medicine at Johns Hopkins pointed out when he tweeted, “Our system is so mindbendingly opaque, byzantine and often pointless that patients grab onto any information they can get — because they often don’t hear anything from their doctors.”

Physicians, meanwhile, may not even realize that a patient has a misconception until the patient or a family member has become upset because things did not occur the way they expected based on what they had seen on television.

Sometimes the misconceptions are minor, such as simply not realizing that a fracture and broken bone are the same. When Elizabeth Murray, MD, a pediatrician in emergency medicine at Golisano Children’s Hospital in Rochester, New York, shows parents a child’s broken wrist or ankle in the X-ray, they often worriedly ask if it’s fractured. “I explain that a fracture is the medical name for a break and then ask why that word is particularly concerning to them,” she told Medical Bag. “Usually the response is something along the lines of that’s the term they hear on TV, or of people needing an operation after a fracture.”

Both Dr Murray and Scott Krugman, MD, vice chair of pediatrics at the Herman & Walter Samuelson Children’s Hospital at Sinai in Baltimore, Maryland, described the most difficult and concerning misunderstandings as those arising from sexual assault or abuse cases. “We know that in the overwhelming majority of cases of child sex abuse, children will have a normal physical exam, so we have the conversation that ‘It’s not like what we see on the crime shows where they say the doctor took a look and this or that must have happened,’ ” Dr Murray said.

Just as heartbreaking are the parents who fear their daughter has been abused because they don’t understand how hymens work. “Once we talk about anatomy and that no girl would ever get their period if there wasn’t always a hole, parents are reassured, but it’s sad that they went through an emotional rollercoaster because of myths and so many people’s concerns about speaking honestly about our bodies,” she told Medical Bag.

Dr Krugman, too, finds himself frequently telling parents, “It’s not like CSI.” Television portrays sexual assault cases as fast-paced investigations that are solved quickly with apparently easily accessible DNA. “The reality, especially for child sexual abuse in prepubertal girls, is that there is rarely evidence on the child’s body unless they are evaluated within 24 hours of the abuse,” Dr Krugman told Medical Bag. “Most evidence comes from clothes and sheets, and it takes months to years to get a result. Because of the infrequent evidence hits, plus 95% chance of a normal exam, in the vast majority of cases we rely on the child’s disclosure.” (And unfortunately, in real life, many children aren’t believed by the person to whom they initially disclose the abuse, sometimes even including clinicians.)

Proactively Addressing Misconceptions

So what’s the solution? Television producers and writers aren’t likely to change their storylines and practices any time soon — they’re in the business of turning up the drama. That leaves it to clinicians to be proactive about identifying and correcting misconceptions developed from television shows. The best step physicians can take is simply to ask patients about any health beliefs they have based on television, religion, or cultural beliefs. “Once you know where they are coming from you can better address the issue,” Dr Krugman said.

In some areas, such as palliative care, this kind of proactive discussion may be particularly beneficial to patients. “As a palliative care physician, families deal with the unrealities of life extension,” tweeted Paul Rousseau, MD, from Wake Forest School of Medicine in Winston-Salem, North Carolina. “Granted, we can prolong ‘life’ in the [intensive care unit], if you want to call that life, but families deal with an inability to understand why their loved one can’t recuperate and live longer like on TV.”

Rebecca Melvin, EMT-P, a trauma education coordinator for TraumaOne Flight Services at the University of Florida Health Jacksonville, agreed. “TV portrays dying in either a rather dramatic manner or quietly falling asleep. This creates confusion when a family is confronted with a loved one who is going through the dying process and doesn’t fit the ‘TV’ narrative.”

Even “reality” shows can warp how people think about a disease or recovery process and require proactive reeducation. “The Biggest Loser grotesquely embodied everything wrong with modern-day diet culture, and then served it up to tens of millions of viewers worldwide, and in so doing, perpetuated incredibly negative stereotypes about people with obesity,” Yoni Freedhoff, MD, an obesity physician and associate professor of family medicine at the University of Ottawa, told Medical Bag. “It taught the world that scales measure more than just gravity, that they measure health, happiness, success, effort, and self-worth. It taught people to believe that intense, vomit-inducing exercise was the key ingredient to weight management, and it taught people that those who ‘fail’ do so because they just didn’t want it badly enough.”

As founder and medical director of the nonsurgical Bariatric Medical Institute, Dr Freedhoff spends a lot of time in his office and online⁶ correcting misconceptions of people who embark on behavioral intervention programs for weight loss, including how long the process can take and what realistic goals are.

“It also led viewers to believe that incredibly rapid and extreme weight loss was safe and achievable, which, in turn, set them up for disappointment, despite at times incredible improvements to their health and quality of life, but with subtotal weight loss,” he said. “Intellectually, it’s not difficult for patients to embrace the notion that their best weight, the term we coined and use, is whatever weight they reach when they’re living the healthiest life that they actually enjoy. Emotionally, however, it’s at times difficult for them to let go of Biggest Loser-style expectations.”

Clinicians have enough on their plates without correcting misconceptions about television, yet not considering this misbeliefs and proactively addressing them can lead to more pain down the line. “I think you just have to describe the reality and ask if they have any questions or misconceptions,” Dr Krugman said.

References

1. Portnova J, Irvine K, Yi JY, Enguidanos S. It isn’t like this on TV: Revisiting CPR survival rates depicted on popular TV shows. Resuscitation. 2015;96:148-150.
2. American Heart Association. CPR & First Aid. Emergency Cardiovascular Care. Accessed April 1, 2019.
3. Diem SJ, Lantos JD, Tulsky JA. Cardiopulmonary resuscitation on television — miracles and misinformation. N Engl J Med. 1996;334:1578-1582.
4. Serrone RO, Weinberg JA, Goslar PW, et al. Grey’s Anatomy effect: television portrayal of patients with trauma may cultivate unrealistic patient and family expectations after injury. Trauma Surg Acute Care Open. 2018;3(1):e000137.
5. Chung JE. Medical dramas and viewer perception of health: testing cultivation effects. Hum Comm Res. 2014;40(3):333-349.
6. Freedhoff Y. I’m an obesity doctor. I’ve seen long-term weight loss work. Here’s how. Vox. https://www.vox.com/2016/5/10/11649210/biggest-loser-weight-loss. May 10, 2016. Accessed April 1, 2019.

This article originally appeared on Medical Bag