Abstract
Introduction
Over the past many years, medical drama television shows have established their own niche as a genre within popular culture. Many have become household names, including ER, Grey’s Anatomy, and House. In the mid-1990s, “ER” attracted more than 30 million viewers a week; at its peak in 1998, it attracted 47.8 million weekly viewers. 1 As the popularity of medical television shows has grown in recent years, the implications they have on viewers and how these depictions of medical care on television might impact patient perceptions has become even more consequential. The literature has demonstrated that expectations of the health care experience may be influenced by television dramas set in the hospital. For example, viewers of medical television dramas may develop unrealistic perceptions of the daily events and activities involving patients and staff at their hospital. 2 In addition, studies have shown that depictions of patient outcomes have been misrepresented in ways that do not mirror reality. For example, in a 1996 report on cardiopulmonary resuscitation (CPR) on television, it was concluded that the survival rates in medical television shows are significantly higher than the most optimistic survival rates in the medical literature, leading the viewing public to have unrealistic impressions of medical care. 3 Similarly, other studies have identified the presence of erroneous and unreliable information displayed with respect to rates of operative errors and errors in medical diagnosis, 4 CPR survival rates, 5 natural disaster frequency and mortality, 6 acute pain management, 7 and medical procedures. 8
The concept of a multidisciplinary team (MDT) in health care has been an emerging practice within medicine. The core function of an MDT is to bring together a group of health care professionals from different fields to determine a patients’ treatment plan. 9 While MDTs vary across specialty and institution, they can consist of physicians across various specialties as well as specialized nurses, dietitians, psychologists, and social workers. 9 The literature has shown that the multidisciplinary approach has been extremely effective at managing pediatric patient populations. In a literature review aiming to understand the benefits and outcomes of an MDT approach in pediatric rehabilitation, it became evident that a team-based approach can decrease illness anxiety, improve emotional functioning, empower both patients and their caregivers, and allow for streamlined communication and coordinated medical care between various specialties. 10 Thus, studies have demonstrated that MDTs have a positive impact on parental stress level, family perception of medical team communication, and the ability of medical care teams to pool skills and resources for the support of both pediatric patients and their families, all enhancing standard of care practices. 11
To our current knowledge, the display of multidisciplinary teamwork and its characterization on medical television dramas has not yet been studied. In addition, MDTs as they relate to the care of pediatric patients specifically has not yet been discussed. Our aims were 3-fold: to determine the depiction of pediatric MDTs in a select number of medical television shows, to examine whether medical television dramas are accurately identifying the team members who are responsible for the care of pediatric patients in real life, and to investigate if these shows are accurately displaying the appropriate roles and responsibilities of these team members. We hypothesize that essential members of the pediatric MDT will not be shown on these medical television dramas, and that their expected roles will be mischaracterized.
Methods
This was an observational study of 8 medical television shows (Table 1). Four shows that aired in 2008 and 4 shows that aired in 2018 were selected, hoping to account for potential changes represented over the course of time. The first 10 pediatric patient encounters depicted in each of the 2008 seasons of Grey’s Anatomy, ER, Scrubs, and House and in the 2018 seasons of Grey’s Anatomy, Chicago Med, The Good Doctor, and New Amsterdam were independently viewed and analyzed by 2 investigators. Our sample of medical television dramas were chosen because they were considered popular and spanned the decade of time being examined.
Medical Television Shows and Corresponding Descriptions Included in This Study.
A standardized Microsoft Excel data collection spreadsheet was created by the authors (EK, AD, BH), and 2 investigators independently viewed and scored each episode in our sample utilizing this spreadsheet. In order to standardize data collection methods as best as possible, all 3 investigators gathered to view a practice episode. This involved viewing the episode while actively entering observed data points into the standardized spreadsheet, modeling the practice of how to view an episode and how to make decisions regarding entering information. After this trial run, official data collection began.
Two investigators independently viewed and abstracted the following data for each encounter: demographics of the patient, involvement of the MDT (physician [attending/resident], medical student, nurse, advanced practice provider, pharmacists, speech/occupational [OT]/physical therapy [PT], social work, Chaplain, Child Life specialist), and description of the roles/actions taken by those team members. The beginning of an encounter was identified when a pediatric patient was first displayed on the screen. Once the encounter began, each health care member displayed interacting with and providing care to the patient was documented. Information from patient encounters was only noted if it was directly observed or verbalized. After all episodes were viewed and data was abstracted, the 2 investigators responsible for those episodes would meet to review what they observed and the information they documented to identify any discrepancies. If discrepancies were found to be present within the 2 evaluators’ data, a discussion was had, scenes were reviewed, and a consensus was made. If 3 or more distinct roles were displayed within a patient encounter, it was denoted that an MDT was in fact depicted.
Descriptive statistics were calculated for all variables. The study was considered exempt by the Institutional Review Board at Penn State University.
Results
Analyses were performed on 80 patient encounters. Of these 80 patient encounters, 21 of 80 (26%) depicted an MDT. Based on our sample, depicted pediatric patients were often adolescents (53%) and white (69%), with equal depiction of male and female patients (Table 2). As seen in Table 3, attending physicians were present in 93% of encounters (74/80), resident physicians were present in 41% of encounters (33/80), and nurses were shown in 51% of encounters (41/80). There were no depictions of medical students, advanced practice providers, pharmacists, Child Life specialists, OT/PT/Speech therapists, Chaplains, or social workers in our sample of medical TV shows.
Demographics of Pediatric Patients Depicted in the 80 Encounters Documented.
Team Members Depicted or Involvement Verbalized in 80 Pediatric Patient Encounters.
The most common action depicted for attending physicians and resident physicians was “communicating with patient/family,” and the most common actions depicted for nurses were “administration of medication/treatment” and “assisting with surgery” (Table 4).
Actions Taken by Various Medical Professionals Depicted and Their Number of Occurrences.
Table 5 shows the depiction of actions that fall outside the accepted roles and responsibilities for attending physicians, resident physicians, and nurses, with the most common being attending and resident physicians “restraining a patient” and physicians/nurses “performing procedures without consent or without supervision.”
Actions Displayed by Various Medical Professionals That do not Fall Within Their Appropriate Jurisdiction of Practice and Their Number of Occurrences.
Discussion
The objectives of this study were threefold: to determine the depiction of pediatric MDTs in a select number of medical television shows, to examine whether medical television dramas are accurately identifying the team members who are responsible for the care of pediatric patients in real life, and to investigate if these shows are accurately displaying the appropriate roles and responsibilities of these team members. As we had anticipated, medical television dramas in our sample rarely depict the full spectrum of MDTs, especially with the roles and responsibilities of medical students, advanced practice providers, pharmacists, Child Life specialists, OT/PT/Speech therapists, Chaplains, and social workers. Rather, they are concealing the full scope of what a health care team consists of and who takes care of our pediatric population. This may be a result of inconvenience and lack of resources. Displaying the entire scope of what a care team involves requires additional actors, money, and more airtime within an episode. In addition, spending airtime to focus on accurately displaying the full scope of an MDT might be considered uninteresting and dull when television shows are focused on capturing the attention and admiration of one’s audience. Therefore, the opportunity for the public to have an accurate understanding of what a pediatric care team might look like is limited. Of the 8 seasons evaluated, not one took the opportunity to show or verbally reference vital members of the care team including PAs, NPs, social workers, pharmacists, medical students, Child Life volunteers, and therapists of all kinds.
To highlight one role in particular, hospital pharmacists play a vital role in making complex medication decisions in the pediatric setting. 12 Pediatric medical calculations require heightened vigilance, and safety is optimized when hospital pharmacists are fully integrated into and have streamlined communication with the rest of the team. 12
Another role patients commonly interact with are mid-level practitioners, the term used to refer to advanced level practitioners including nurse practitioners (NPs) and physician assistants (PAs). Both NPs and PAs in the inpatient setting hold roles and responsibilities that might include patient assessment, history and physical examinations, and rounding with the MDT. 13 Research has shown that in many hospital settings, mid-level providers are an integrated member of the team who contribute positively to patient care. 13
There are unintended consequences of not including these members in such popular medical television shows. First, there is misunderstanding and sometimes parental fear when there are many different individuals responsible for the care of a child. Lack of awareness of the various roles may lead to confusion and mistrust. In addition, if patients and their families understood the extent of what various team members could offer, questions might be better streamlined, and communication might be more effective. Overall, this would lead to safer care and improved health outcomes.
In addition, we not only saw the lack of diversity of the health care team displayed, but also noticed the mischaracterization of various roles. This can be dangerous because it allows for the idea that it is safe and appropriate for team members to be practicing beyond their scope to be accepted. For example, we saw attending and resident physicians carrying out jobs that fall under the purview of a security guard. Restraining patients and stepping outside the bounds of hospital protocols misrepresents their scope of practice. We also noticed resident physicians making medical care decisions and performing medical procedures without supervision. This lack of oversight perpetuates the already existing concerns that patients and families have regarding the resident trainees. It allows the general public to believe that this happens on a regular basis in the real-world and prevents trusting relationships to form between resident doctors and their patients.
As we look to the future, we can learn from and work to address the findings our study has elucidated. Striving to clarify the misconceptions displayed by these popular medical television shows will be no easy feat, but there are countless opportunities for education. First, we must work to better address misconceptions and confusions that arise in the hospital when patients and families are working with this multifaceted and complex team. In addition, because the information provided by these television shows serve as the foundation of knowledge most patients have when it comes to the innerworkings of a hospital, we must continue to find ways for medical professionals to liaise with television production companies and ensure that medical consultants for television shows are up to date on current practices.
Similar to all research studies, ours has limitations. First, we only investigated 7 distinct shows, reviewing 8 separate seasons. These shows are each unique with various contexts, and therefore, our results may not be generalizable to other shows. In addition, our sample size was limited to 80 patient encounters, which also restricts generalizability. Finally, despite using a standardized data collection sheet and having all investigators view a few trial episodes to discuss best practices for being consistent in data collection, there is a degree of subjectivity when it comes to collecting this kind of information. Recognizing certain team members that are displayed on the screen when they are not named can result in slight discrepancies in the data recorded. In addition, information regarding actions taken by various roles can be subject to individual interpretation. Subjectivity in recording responses was mitigated by having 2 investigators independently collect data and then convene with a review of that data.
Our findings demonstrate that critical members of pediatric MDTs (medical students, advanced practice providers, pharmacists, Child Life specialists, etc) were not depicted in the television shows studied. Furthermore, several role misrepresentations were identified.
The inaccuracies and inconsistencies in the depictions of MDTs may lead to confusion and unrealistic expectations by viewers of medical television shows, and hamper efforts to provide safe, high-quality care.
Author Contributions
All authors (Elizabeth Kane, Alaina Demalis, Briana Heinly, and Robert P. Olympia) contributed to the study conception and design. Data collection was performed by Elizabeth Kane, Alaina Demalis, and Briana Heinly, and data analysis was performed by all authors. The first draft of the manuscript was written by Elizabeth Kane, and all authors reviewed and commented on previous versions of the manuscript. All authors read and approved the final manuscript.
Footnotes
ORCID iD
