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Canada Archives Canada Published Heritage Direction Du Branch Patrimoine De I'edition Medical Professionalism and the Fictional TV Medical Drama House MD Sarah Lolley Biomedical Ethics Unit McGill University, Montreal A thesis submitted to McGill University in partial fulfilment of the requirements of the degree of Master's of Science in Experimental Medicine with a Specialization in Biomedical Ethics © Sarah Lolley 2008 Library and Bibliotheque et 1*1 Archives Canada Archives Canada Published Heritage Direction du Branch Patrimoine de I'edition 395 Wellington Street 395, rue Wellington Ottawa ON K1A0N4 Ottawa ON K1A0N4 Canada Canada Your file Votre reference ISBN: 978-0-494-51305-7 Our file Notre reference ISBN: 978-0-494-51305-7 NOTICE: AVIS: The author has granted a non­ L'auteur a accorde une licence non exclusive exclusive license allowing Library permettant a la Bibliotheque et Archives and Archives Canada to reproduce, Canada de reproduire, publier, archiver, publish, archive, preserve, conserve, sauvegarder, conserver, transmettre au public communicate to the public by par telecommunication ou par Plntemet, prefer, telecommunication or on the Internet, distribuer et vendre des theses partout dans loan, distribute and sell theses le monde, a des fins commerciales ou autres, worldwide, for commercial or non­ sur support microforme, papier, electronique commercial purposes, in microform, et/ou autres formats. paper, electronic and/or any other formats. The author retains copyright L'auteur conserve la propriete du droit d'auteur ownership and moral rights in et des droits moraux qui protege cette these. this thesis. Neither the thesis Ni la these ni des extraits substantiels de nor substantial extracts from it celle-ci ne doivent etre imprimes ou autrement may be printed or otherwise reproduits sans son autorisation. reproduced without the author's permission. In compliance with the Canadian Conformement a la loi canadienne Privacy Act some supporting sur la protection de la vie privee, forms may have been removed quelques formulaires secondaires from this thesis. ont ete enleves de cette these. While these forms may be included Bien que ces formulaires in the document page count, aient inclus dans la pagination, their removal does not represent il n'y aura aucun contenu manquant. any loss of content from the thesis. Canada Acknowledgements This thesis would not have been possible without the attentive review and guidance of Dr. Carolyn Ells of the Biomedical Ethics Unit. Table of Contents Abstract 1 Introduction , 3 Chapter 1: Storytelling in Medicine 9 Chapter 2: The Effect of TV Medical Dramas on Audiences' Understanding of Medicine and Health Behaviour 15 Chapter 3: What Audiences May Be Learning About Physicians' Character from TV Medical Dramas , 36 Chapter 4: Medical Professionalism and the Fictional TV Medical Dramas 55 Chapter 5: What Dr. Gregory House is Teaching Audiences About Medical Professionalism 76 Conclusion 107 Bibliography 113 Abstract This thesis is an exploration and analysis of what audiences may be learning about medical professionalism from the fictional television (TV) medical drama House MD. Fictional TV medical dramas are an important form of medical narrative in that they are usually created by writers with no medical training. As such, they carry a higher risk of portraying the practice of medicine inaccurately. A review of the scholarly literature reveals that there is a precedent for fictional TV medical dramas to affect viewers' perception of the practice of medicine and health behaviours, and viewers' understanding of medical ethics issues. It also reveals strong empirical evidence that TV medical dramas can affect audience's perceptions of physicians' character. A thorough review of the first two seasons of House MD reveals 20 lessons on professionalism (i.e. lessons on interactions with colleagues and patients, medical ethics, and professional competence) that the title character, Gregory House, is imparting to viewers. All 20 lessons are in direct conflict with established charters on professionalism. Arguments are made for the programme's potential to negatively affect patient access to care, physician- patient relations, interactions between healthcare professionals, and applications to medical school. Ce memoire est une exploration et une analyse de ce dont les spectateurs du drame medicaux fictifs de television (TV) House MD pourraient retenir sur le professionnalisme medicale. Les drames medicaux fictifs de TV sont une forme importante de recit medical parce qu'ils sont habituellement crees par des auteurs sans formation medicale, et, en tant que tels, portent un plus gros risque de mal representer la pratique de la medecine. Une exploration de la litterature academique indique qu'il y a un precedent pour que les drames medicaux fictifs de TV affectent la perception des visionneuses de la pratique de medecine, du comportement de medecins, et de I'ethique medicale. II indique egalement un forte evidence empirique que les drames medicaux de TV peuvent affecter les [l] perceptions du caractere des medecins. Un examen complet des deux premieres saisons de House MD indique 20 lecons sur la professionnalisme (c.-a-d. lecons sur des interactions avec des collegues et des patients, ethique medicale, et competence professionnelle) que le caractere de titre, Gregory House, donne aux spectateurs. Chacune des 20 lecons est en conflit direct avec les chartes etablies sur la professionnalisme medical. Des arguments sontfaits pour que le potentiel du programme affecte negativement I'acces des patients au soin, les relations de medecin-patient, les interactions entre les professionnels de soins de sante, et les applications a I'ecole medicale. [2] Introduction This thesis is an exploration and analysis of what audiences may be learning about medical professionalism from House MD, a fictional television (TV) medical drama currently in its fourth season of broadcasting. House MD is an unprecedented "doctor show" in that it idolizes a physician who exhibits profoundly unprofessional and at times morally and legally reprehensible behaviour. The program was created by a writer with no medical training, and, I postulate, has the potential to seriously harm physician-patient relationships for millions of viewers. The first step in analyzing House MD is to. establish that it is a form of narrative medicine and that, according to the scholarly literature, narrative medicine is a powerful means of communicating messages about the practice of medicine. This is achieved in Chapter 1 of the thesis. Chapter 1 discusses the concept of narrative medicine (defined as the sum of the ways in which patients and physicians use stories to communicate what information is of clinical importance to them and why; Charon, 2004) and firmly establishes House MD as a part of a little-explored genre of medical narrative: fictional stories about physicians written by non-doctors. Chapter 1 reviews the scholarly literature on medical narrative, which states that medical stories can be communicated through a variety of media (oral storytelling, written case histories, works of fiction, TV and radio programs, etc.) and used to many possible ends. These include: to help physicians communicate information to one another about patients; to help patients communicate information to physicians; to help audiences empathize with patients' and physicians' experiences; and, by contextualizing and validating behaviour, to communicate how medicine should be practiced, including what attitudes and actions make doctors respected, popular, desirable, and rich (Charon, 2006; Charon, 2004; Greenhalgh and Hurwitz, 1999). Medical narrative can help both patients and physicians process their experiences (Charon, 2006; Frank, 2002; Gawande, 2002). It also serves to explain concepts of medical ethics (Chambers, 1999; Charon and Montello, 2002). [3] The next step in analyzing the impact that House MD may be having on the public's perception of the practice of medicine is to establish that audiences learn about medicine from TV (Atkin and Wallack, 1990; Nariman, 1993); in particular, that they learn from fictional TV medical dramas, which is the genre of programming to which House MD belongs. This is accomplished in Chapter 2. Not only does Chapter 2 review the scholarly literature supporting an effect of fictional TV medical dramas on viewer's perceptions of health and health behaviours (e.g. Atkin and Wallack, 1990; Nariman, 1993; Brodie et al, 2001), it also reviews the empirical evidence for such an effect. As we shall see, there is good empirical support for the theory that audiences draw conclusions from fictional TV medical dramas about the appropriate use and potential for success of medical interventions such as cardiopulmonary resuscitation (e.g., Diem ef al, 1995; Gordon et al, 1998). Research also supports the theory that audiences change their health behaviours based on this learning (Howe et al, 2002; Richardson et al, 2002). Lastly, there is evidence that audiences are aware of this learning: in surveys, respondents have often stated that they often learn more about medicine from TV than from healthcare professionals (Healthcare PR, 1998; Hemphill etal, 2007; Kaiser Family Foundation, 2002). Ethical issues have been shown to appear regularly in the storylines of fictional TV medical dramas (Turow and Gans, 2002), and there is a strong base in the scholarly literature (but none in scientific research) that audiences learn from the content and presentation of these issues (Annas, 1995; Elliott and Kahn, 1994). All of
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