by John Gever

As portrayed on popular television shows, physicians frequently deal with vexing ethical dilemmas — perhaps more often than occurs in real life, researchers said.

Doctors on TV also sleep around a great deal, with each other and with patients, and behave unprofessionally in a host of other ways, reported researchers at Johns Hopkins University in Baltimore who analyzed the content of a full season of “House M.D.” and “Grey’s Anatomy.”

“Our results indicate, perhaps unsurprisingly, that television medical dramas are rife with depictions of bioethical issues and egregious deviations from the norms of professionalism,” wrote bioethicist Jeremy Sugarman, MD, MPH, and colleagues in the April Journal of Medical Ethics.

“They contain exemplary depictions of professionalism to a much lesser degree,” the researchers added.

Previous studies have examined TV medical shows for their faithfulness to actual practice, or lack thereof, but none have focused exclusively on their portrayals of bioethical challenges and physicians’ adherence to standards of professionalism, Sugarman and colleagues explained.

So they decided to analyze the content of all medical drama series broadcast on the major networks in the 2005-2006 television season.

There were four such series, but the researchers excluded “ER” because that season was not available on DVD, and they omitted “Nip/Tuck” because it seldom showed the physician characters at work. Also, it “frequently included extremely outlandish situations.”

That left them with “House” and “Grey’s Anatomy,” with 24 and 26 episodes, respectively. In both cases, the shows were in their second season.

In those 50 episodes, issues of informed consent came up 49 times, the researchers found.

Sugarman and colleagues also identified 22 instances of “ethically questionable departures from standard practice,” defined as endangering patients unnecessarily or acting unethically in pursuit of a favorable outcome.

Fans of the two shows probably won’t be surprised to learn that “House” — particularly its eponymous star — was guilty of both infractions more frequently than the characters in “Grey’s Anatomy.”

The informed-consent category counted “exemplary” examples as well as those in which the ethics of consent were trampled, and actually 43% of the instances were of the first type.

But the Hopkins researchers found that failure to respect informed consent was more common in “House,” in which patients undergo procedures without any effort to obtain consent and in which physicians lie to patients to obtain “consent” (the quotation marks belong to Sugarman and colleagues).

In both shows, physicians who committed some type of ethically questionable act were hardly ever punished (four of the 22 incidents).

Other bioethical issues raised in these shows included confidentiality (18 instances), the right to refuse treatment (14), equitable access to healthcare (12), truth disclosure (9), human experimentation (9, of which 8 were on “House”), and healthcare professional training (7, all on “Grey’s Anatomy”).

The researchers also found that the physician characterers often behaved unprofessionally with each other and with patients.

In all, across the 50 episodes of both programs, there were 396 instances involving issues of professionalism. Only 5% of those involving interactions between professionals, and 28% of those involving patients, were classed as “exemplary.” The remainder all showed lapses in professional standards.

Sugarman and colleagues coded professional interaction events within each episode for five dimensions: caring and compassion; integrity in dealing with patients; showing respect to colleagues and patients; sexual misconduct; and the type of interaction for each event (involving only other professionals or involving patients).

As one might expect from a show about the lives of interns and residents, “Grey’s Anatomy” featured many more examples of sexual misconduct than “House” — 58 to 11 for interprofessional events, and 27 to 6 for interactions involving patients. But 21 of the events involving patients on “Grey’s Anatomy” were part of a running story line with an intern romantically linked to a patient, spanning seven episodes.

Characters on “House” more often showed disrespect for patients (though not for other professionals) and violations of integrity and responsibility standards for interprofessional and patient-professional interactions alike.

Sugarman and colleagues noted that, although the two shows differ in important respects, both tended to show professionals treating each other more familiarly than may occur in real-life hospitals.

The researchers acknowledged that these shows are intended as entertainment and not documentaries. Nevertheless, patients and even professionals themselves may take what they see on TV as the norm.

Sugarman and colleagues were not especially troubled by the handling of bioethical issues on the two programs.

“As in clinical practice, many of the ethical issues considered in these medical dramas do not lend themselves to easy moral resolution,” they wrote. “The unresolved and vexing nature of some of the ethical issues portrayed, as well as the complex depictions of professionalism, may be more likely to engage viewers in moral reflection than to shape their opinions in any particular direction.”

The researchers noted significant limitations to their analysis: the subjective nature of their codings and classifications and the lack of any data on the extent to which the shows affected viewer beliefs and attitudes.

Nevertheless, Sugarman and colleagues suggested that these shows, incorporated into a structured program, “could help to engage students in discussions of the ethical handling of [professional] issues when confronted in the practice of medicine.”

John Gever is a MedPage Today Senior Editor.

Originally published in MedPage Today. Visit MedPageToday.com for more ethics news.