Thursday, October 23, 2008

"It's Just a Movie!"

My family has learned not to watch TV shows or movies that depict therapists or social workers, at least not while I'm in the room. Why? Because I tend to rant about how inaccurate the portrayals are, and how they usually involve major ethical breaches. Think about it. There's a litany of examples, from Prince of Tides to What About Bob? to The Bob Newhart Show, where the therapist crosses obvious boundary lines into the realm of ethical misconduct that would surely cause license loss, if not jail time. When I'm done ranting (if anyone's left in the room) usually someone will say "it's just a movie" or "it's good TV."

But it's much more than the obvious ethical breaches I'm ranting about today. There are many more subtle misrepresentations happening "for dramatic effect" on a daily basis. Let's examine two. First: resuscitation. On TV and in movies, patients survive, often without apparent side effects, about two-thirds of the time. In the real world, patients survive about 15% of the time, and usually have cracked ribs or other wear and tear to show for it. So, where's the harm in a little "dramatic license?" Like it or not, people believe what they see in the media. When I sit down with patients and families to discuss Advance Directives and Do Not Resuscitate (DNR) orders, they are usually shocked to hear the realities of resuscitation. For those lucky enough to learn early, ask questions, and get a realistic impression of what resuscitation really entails, this knowledge leads to reconsideration of care wishes in many cases. For those who complete Advance Directives at home, how many of them have an expectation of care skewed by media representations?

My second example: the miraculous recovery. You see it all the time on TV and in the movies. The patient in a coma for years wakes up with no adverse effects. The evening news trumpets the news without once reporting the staggering odds against such a thing. What do these misrepresentations do, overtly or covertly, to the average person's expectations for care? Do they create a level of false hope unsupportable by facts? If so, is that a problem?

I believe they do create false hope, and that it is a problem. Citing the case of Meredith Grey from the TV show Grey's Anatomy, a family chose to maintain their mother on life support. Interestingly, it wasn't until they saw depictions of Terry Shiavo that they were reminded that mother, having seen news stories on that case, had remarked as how she didn't want to be kept alive by machines. Ironic? Sure. TV informed both the decision to prolong, and the decision to withdraw. Dr. Ryan, in that article, suggests that TV is not to blame, asking if you would turn to Law & Order for legal advice? While I appreciate his suggestion that the onus of informing patients about reality lies with the physician and other treating professionals, I still think there is a real issue at hand.

I'm not so naive as to think that TV networks and movie studios will do anything that's not motivated by money, and ethical or realistic portrayals of end of life care don't often draw big crowds of viewership. No one is going to suggest that Hollywood is a hot bed of ethical behavior. Still, is it too much to ask that they acknowledge in some fashion the real-world ethical implications of their actions? How about this: a boilerplate text or voice-over disclaimer at the beginning or end of the program, like on a pack of cigarettes or a pharmaceutical commercial? "Warning: events depicted are purely fictitious and in fact, very few people survive resuscitation and most that do have severe complications." Is that too much to ask?

1 comment:

Kelly Hills said...

Nice to see someone else with similar complaints, Lorn! :-) The problem with Dr. Ryan's suggestion, though, is that there is a confirmed and noted "CSI effect". People may not "turn" to Law and Order or CSI for legal advice, but they certainly take what they see on those shows and integrate them into their life and "knowledge". And knowledge is an insidious thing. If you see someone process DNA results inside 24 hours often enough, you "know" (without being able to pinpoint where this learning happened) that DNA results take 24 hours.

Now sit that person on a jury and see how they react to the idea that DNA results can take weeks, if not months. They're not going to think that this is normal given backlog and etc, they're going to think the lab is incompetent. Because they "know" better.

We have no reason to suggest this isn't happening in medicine, either. (And at least completely casually and anecdotally, it is.) What we need is for someone to pull together the funding for a study. (And if there are any takers, hey, I'm nosy and know this subject backwards and forwards... ;-) ).