I DON’T NEED A MEDICAL DEGREE, I WATCH TV
A Thesis
Presented to
The Graduate Faculty of The University of Akron
In Partial Fulfillment
of the Requirements for the Degree
Master of Arts
Elizabeth Shiller
August 2018
I DON’T NEED A MEDICAL DEGREE, I WATCH TV
Elizabeth Shiller
Thesis
Approved: Accepted:
Advisor Interim Dean, College of Arts and Sciences Dr. Dudley Turner Dr. Linda Subich
Committee Member Dean of the Graduate School Dr. Val Pipps Dr. Chand Midha
Committee Member Date Mr. Gabriel Giralt
Director, School of Communication Dr. Heather Walter
ii
ACKNOWLEDGEMENTS
I would like to thank my advisor, Dr. Dudley Turner, for giving me the guidance and encouragement to see my research as more than just a “graduation requirement.” His passion for teaching has given me a new perspective on education and has inspired me to continue on in my education past the master’s degree level.
I would also like to thank my committee members. To Dr. Pipps, thank you for being the friendly face greeting me when I first walked into Kolbe Hall. To Mr. Giralt, thank you for challenging me to open up my way of thinking to consider all different aspects of my focus. I would not be here, completing a thesis without the help and encouragement I received from my committee.
Finally, I would like to thank my parents, whom without which, I would’ve quit long before I got to this point. You always believed in me and kept me grounded while I achieved my goals. I appreciate every opportunity you gave me and I will always remember to read the question, answer the question, and check my answer.
iii
ABSTRACT
TV has become a part of our daily lives. Studies have linked TV viewing with skewed versions of reality. People who view a lot of television tend to believe what they see and take the content for fact. This study used this idea to explore the effects viewing fictional medical shows have on doctor-patient communication. This study also looked at whether these same shows teach viewers enough about medicine to be considered entertainment-education. Participants from the Northeast Ohio region were given a survey to measure their TV viewing habits along with their opinions about their doctors.
Results suggested that viewers do not believe the shows are meant to be educational, although they do feel like they can perform basic medical procedures. Viewing these shows also had little effect on doctor-patient communication, but the participants did believe that the doctor knows best.
Keywords: Cultivation Theory, Entertainment-Education, doctor-patient communication, television, medical show
iv TABLE OF CONTENTS
LIST OF TABLES vii
CHAPTER
I. INTRODUCTION 1
II. LITERATURE REVIEW 4
a. Entertainment- Education 4
b. Cultivation Theory 6
c. Mean World Syndrome 8
d. Medicine on TV 9
e. Doctor-Patient Communication 12
f. Patient Expectations 13
g. The Gap 15
III. METHODOLOGY 18
a. Instruments 18
b. Procedures 19
IV. RESULTS 21
a. Research Question 1 22
b. Research Question 2 23
c. Hypothesis 24
V. DISCUSSION 26
a. Limitations 29
b. Further Research 30
c. Conclusion 31 v REFERENCES 33
APPENDICES 38
APPENDIX A: IRB Approval Form 39
APPENDIX B: Questionnaire 41
APPENDIX C: Informed Consent Form 45
vi LIST OF TABLES
Table Page
1: Viewing Medical Shows and TV Medicine 23
2: Viewing Medical Shows and Medical Procedures 24
3: Viewing Medical Shows and Doctor-Patient Communication 25
7 CHAPTER 1
INTRODUCTION
Imagine that you are sitting in a crowded room when suddenly you feel this intense pain in your chest. You begin to panic and clasp your chest. You know that you are healthy because you take care of yourself, so why is this happening to you? It’s getting harder to breathe. You start gasping and fall to the ground. Everyone immediately starts to panic. The woman sitting next to you starts crying and shouts
“Somebody call 911! Somebody call a doctor!”
Out of the corner of your eye you see a man rushing over to you.
“I’m a doctor, let me help,” he says calmly.
In the midst of the panic, you recognize that you are probably having a heart attack because one of the patients on the Scrubs episode you watched last night, had a heart attack with the same symptoms. You also remember that the patient didn’t make it.
Do you push the doctor away because you are certain that his actions are futile, or do you let the guy with the medical degree help you?
Attaining an advanced degree of any kind is a lengthy process. It requires education and experience. Becoming a medical physician usually means having to endure eight years of schooling, three to seven years of residency training and passing state exams. As long as they are practicing, physicians must keep their licenses and certifications up to date. (Lindberg, 2012; Medical Education, 2017). If they are
1 specialists, then that would mean more schooling, training and exams on top of what they’ve already accomplished.
There are many methods used in education like lectures, e-learning, experiential learning, and narratives. Narratives tend to utilize stories that blend fact with fiction to translate the lesson. But this method isn’t just used in the classroom, it is applied outside the classroom as well.
Television and radio shows use a technique known as entertainment-education
(EE). This is when the show intentionally targets the audience with an entertaining story that has a deeper educational meaning. EE can expand to all genres, topics and media.
This technique teaches lessons by having the characters in the stories learn the lessons
(Singhal & Rogers, 2004).
Sesame Street and 16 and Pregnant are examples of EE. Sesame Street is a fictional show designed to help children learn preschool concepts like sharing, counting and the alphabet (Jin, 2006). 16 and Pregnant is a reality TV show that looks at teen pregnancy and what it is like to be in that situation. The show, though deemed controversial, has led to a spike in Google searches about birth control, abortion and condom usage (Kearney & Levine, 2014).
People can become educated by watching these shows for their entertainment value. Singhal, Cody, Rogers, and Sabido, (2004) stated that there is already substantial evidence that says that EE has been effective in helping people lead healthy lives. But has it improved communication with health care providers?
2 Since EE programs base their educational content on accurate information, viewers are inclined to believe what they watch. If EE is found in both fictional and nonfictional programs, how would a viewer know when the information in the episode was real or an exaggeration. This poses the question: should you believe everything you see on TV?
This study explored whether or not viewing medical shows affected peoples’ expectations of their physicians. These medical shows were fictional, but the medicine was based on reality. These shows even employed medical consultants to ensure the medicine was as accurate as possible. Grey’s Anatomy had a medical producer, Linda
Klein, who brought in real surgeons to help stage and act in surgery scenes. She also had the cast train with real doctors and had them watch videos of procedures to make sure they were prepared (Burns, 2017). Because of this, would a person viewing these shows, perceive them more as EE rather than as fiction, substituting what they learned on television for real knowledge?
Mark Twain, in the late 1800s, once said “Be careful about reading health books.
You may die of a misprint” (Taylor & Forhan, 2013, para.8). This quote is as relevant today as it was back then.
3 CHAPTER 2
LITERATURE REVIEW
Entertainment-education
Singhal and Rogers (1999) have defined entertainment education as purposefully embedding educational messages into entertaining media in order to increase audience knowledge about an issue or to persuade a change in attitude or behavior. These programs can be found in a wide range of media genres and formats. They are useful for promoting public health because they engage viewers in ways that news and public affairs programs can’t, delivering messages about educational issues, and persuading against destructive habits.
As an example of EE showing the destructiveness of unhealthy habits, the reality show My Strange Addiction takes someone with a highly destructive habit, such as tanning every day or eating Brillo pads, and gets them the help they need, all while showing the audience how harmful the habit is (My Strange Addiction). My Strange
Addiction, along with Sesame Street and 16 and Pregnant are examples of whole programs that entertain while educating. There are individual episodes in sitcoms and TV shows that act as EE. For example, Glee and The Fosters addressed the topic of mass shootings after the Sandy Hook, Connecticut shooting and the Orlando nightclub shooting. Although both shootings in the purely fictional TV shows took place in a school setting, they were relevant and educated viewers on the topic.
4 EE is useful in that it engages the audience. The characters in the story either directly relate to the audience or indirectly make the audience reflect on their own lives
(Quintero Johnson, 2011). People have a tendency to learn through experience, whether direct or indirect. Often this learning occurs when observing someone else’s experiences
(Stinson & Heischmidt, 2012).
EE can function as a kind of informal instruction. This informal learning is unplanned and in most cases vicarious. In fields such as medicine, experiential learning, or learning by doing and practicing, is essential. EE isn’t going to be effective in this instance, and some of the diagnostic medical situations that appear in primetime medical television shows are incomplete, incorrect or completely unrealistic (Jubas & Knutson,
2013).
The EE technique gives viewers the opportunity to learn while immersing themselves in the story. Bandura (2001) states that EE programs are designed for people to learn, but learning can be unintentional by observing fictional television characters’ behaviors. The behaviors learned here are cultivated through observation and reinforced through mimicry.
The author has observed that EE can be very trivial, as in learning terminology or a random fact. For example, The Big Bang Theory states that Fig Newtons were named after a town in Massachusetts, not after Sir Isaac Newton (Cendrowski, 2009). That being said, The Big Bang Theory is not an EE program. Fictional television shows can be educational at times, even if they aren’t considered EE programs.
5 EE has proven to be effective. As mentioned earlier, 16 and Pregnant viewing led to a spike in Google searches about birth control, abortion and condom usage (Kearney &
Levine, 2014). On Friends, there was an episode where the main topic involved condom failure that leads to pregnancy. After this episode aired, about 38 percent of teenage viewers stated that they learned something new about condoms. Similarly, while watching ER, about 30 percent of viewers said that the information presented on the show helped them make choices when it came to their own health and about 20 percent of viewers said that they go to additional sources to find out more about what they saw on the show (Entertainment Education, 2004).
Cultivation Theory
Cultivation Theory looks at what happens with long-term exposure to television.
Long-term television viewing habits encourage viewers to hold reality to certain standards (Perry, 2006). Cultivation becomes a problem when occasional viewing turns into heavy viewing. Heavy viewing has been defined as 35+ hours of television a week or
4+ hours a day. (Burzyńska, Binkowska-Bury, & Januszewicz, 2015; Gerbner & Gross,
1976; Stinson & Heischmidt, 2012).
Cohen & Weimann (2000) deduced that the more time a person spends 'living' inside the television world, the more likely that person is to believe the social reality portrayed on the screen. Over time, a long-term viewer’s perception of reality becomes skewed to the point that everyday life is as they see on TV (Gerbner & Gross, 1976;
Gerbner, Gross, Morgan, Signorielli, & Shanahan, 2002). Cultivated viewers see the real world as a replica of the TV world, even if these perceptions are inaccurate (Perry, 2006).
6 Television programs that tend to cultivate viewers are not designed to be taken as fact; they are fiction. Fictional programs, however, are often rooted in real events. The news is looked at as a program that can cultivate viewers due to the frequent and intense reporting of tragedies around the world.
Cultivation does not focus on one genre, show or instance. It focuses on behavioral patterns (Chory-Assad & Tamborini, 2003; Gerbner & Gross, 1976; Gerbner et al., 2002). One ad persuading a consumer to change products does not mean that the consumer has been cultivated. Neither is a child who is afraid of dogs after a singular viewing of Stephan King’s Cujo (Shanahan & Morgan, 1999). Watching the same show every day is a pattern and these patterns are what cultivate viewers and skew their realities. Cultivation requires that the message be received multiple times. Gerbner’s
(1976) idea was that cultivation was cumulative, and Cohen and Weimann’s study in
2000 agreed with that.
Cultivation affects people differently. Those who are inexperienced with the program’s context may view the material to be accurate (Quick, 2009). Cohen and
Weimann found that teenagers were more affected by television than young children.
They also noticed that those who were religious were less “at risk” of cultivation, but failed to find a formula for “high-risk” individuals. Gerbner et, al. (1986) also found that personal interactions while watching television affected the cultivation process.
Adolescents whose parents watch their show with them were less cultivated.
Not only do these patterns lead to learned behaviors, but also to how people form relationships. Negative relationships become apparent when the consumption of television and the beliefs of large groups of people coincide (Shanahan & Morgan, 1999). 7 Viewers don’t just turn the TV on and watch it blindly. They have a specific show or genre that they prefer to watch. For example, crime dramas affect the perception of the frequency of crime, and coming of age shows, in a college setting, affect perceptions about what college is really like. Genres differ in content and social realities, so while the news focuses on public life, sitcoms and dramas focus more on private, personal lives.
Action and crime dramas stress the event, soap operas focus on character interactions, and game shows highlight different skillsets (Cohen & Weimann, 2000).
Mean World Syndrome
Crime dramas such as CSI, Law and Order, and Hawaii Five-O depict a serious crime every episode. Homicide and attempted homicide make up the most crime on television, followed by assault (Brown, 2001). According to a report by the Annenberg
Public Policy Center, the number of violent sequences per TV hour actually fell from a high of 6.5 in 1972 to 1.4 in 1996, and then increased to 3.7 in 2010 (Romer & Jamieson,
2013). Another report from 2013 suggested that gun violence has tripled in movies since the PG-13 rating was established in 1985 and is actually surpassing the amount in R rated films (Bushma, Jamieson, Weitz & Romer, 2013).
These statistics seem to correlate with people’s fear of violence, but they do not support the idea that people think there is actually more crime in their neighborhood.
There is no evidence that the amount of crime shown on television corresponds to real life crime statistics. The Bureau of Justice Statistics for 2014 recorded a steady decrease in violent and property crime from 2010- 2014 which is opposite to the Romer and
Jamieson study above. Sexual offenses rose then dipped again in the same time frame
(Motivans, 2017). 8 This plays into Gerbner’s idea of the “mean world syndrome.” Mean World
Syndrome is the idea that the world is an awful violent place because that is all the news and mass media talk about. Gerbner thought that people who watch television heavily tend to be more fearful of the world. He spoke a lot about violence in action films and in dramas versus violence on the news. Violence is often glamorized and in the end, there is a happy ending.
“Humor makes the pill easier to swallow. Humor is an excellent communication device because the pill is the pill of power: who can get away with what against whom”
(Earp, "The Mean World Syndrome Media Violence & the Cultivation of Fear Featuring
George Gerbner & Michael Morgan"). Here Gerbner talks about how there is a great deal of humor in violent action scenes as well, playing down the seriousness of the action. He essentially brings up the idea that the violence itself isn’t what skews people’s realities, but the meaning or intent behind the violence.
Television shows exaggerate what is really going on in the world. They play up the drama to make the world seen more awful than it is and that everyone living in it is out to get you.
This study focused on fictional medical television dramas. Because crime dramas are strongly cultivated, could the same thing happen with medical dramas? With cultivation, long-term exposure to medical shows can skew perceptions of doctors and hospital life. These shows almost glamorize the medical profession adding to the misperception of the field.
Medicine on TV
9 Medical shows in the 1950s and 60s featured one doctor who could cure everything. In the 1970s and 1980s, the singular doctor turned into a team and the show explored conflicts among them and took on more controversial issues. It wasn’t until the
1990s that the doctors on TV made mistakes or that patients died because of their mistakes. The patients’ roles grew as well; they are now allowed to think for themselves and respond to decisions made by their doctors (Hetsroni, 2009).
Chory-Assad and Tamborini (2003) add that in the 1960s the perceptions of doctors portrayed on TV were mostly positive but in the ‘90s they were less favorable.
They concluded that contemporary fictional doctors were “mean, unethical, incompetent, insubordinate, and sometimes even criminal” versus their nonfiction counterparts. Scrubs,
House M.D. and Grey’s Anatomy are all medical dramas that include both positive and negative portrayals.
The demographics of TV doctors are completely true to life, with 95 percent of television doctors portrayed as male and more than 50% being Caucasian. Women doctors on TV are proportional to physicians in real life; however, minority TV doctors are overrepresented (Jain & Slater, 2013). These demographics could be used to lessen negative stereotypes or to provide positive role models for young children. It gives society the idea that the world is more integrated than it really is.
Patient portrayals are not entirely accurate. One fourth of patients in real life hospitals are infants and expectant mothers, whereas in TV hospitals, these patients are rarely seen. Men make up 70% of TV patients and the elderly are very underrepresented.
Caucasians are overrepresented, so a patient on TV is more likely to be a middle-aged white male (Hetsroni, 2009). 10 The accuracy of TV medicine is debatable. Hetsroni (2009) looked at diagnosis distribution and mortality rate between TV and real life hospitals. He discovered that the distribution rate has some inconsistencies. In real life, mothers about to deliver their baby as well as infant diseases make up the majority of reasons for being in the hospital.
Injuries, poisonings, alcoholism and affective disorders are seen more often on TV than in real life. Patients die on TV for these afflictions more than they would in real life. In reality, these ailments make up about 5% of deaths, while diseases such as cancer and heart disease are responsible for the deaths of almost 50% of real world patients. These statistics lead patients to be more concerned with minor conditions than life-threatening diseases. These shows are seemingly portraying hospitals as places of trauma and sadness with doctors who can’t save them.
Most medical dramas do utilize medical advisors to help with medical decisions in the show's script, but program creators often disregard those suggestions and air unrealistic medical portrayals (Turow, 2010). They do this to bump up ratings for the program and increase the drama.
It is impossible to cram every step of a medical procedure into a 22 minute or 42 minute episode, but it is important that the basic medicine is accurate.
Diem, Lantos, & Tulsky (1996) decided to look into cardiopulmonary resuscitation, CPR, survival rates on TV versus real life. They saw that CPR is performed both correctly and incorrectly on TV. They took the survival rate from when CPR was first administered and found that on TV 75% of patients survive, whereas that number drops to 40% in real life patients. 11 On a lighter note, Record (2011) saw that medical dramas have an elevated rate of what are called medical miracles. These miracles include awaking from a coma, surviving a risky surgery or surviving an instance where the patient should have died. She saw that these shows made it seem like miracles happen all the time, when in reality, there are only about four miracles a year.
Repeated exposure to these portrayals of the medical field can affect not only a patient’s perception of the medical field as a whole, but also how they see their doctor or practitioner.
Doctor-Patient Communication
Viewers who watch medical shows where doctors are almost always correct in their diagnoses, could assume that real life doctors were correct just as often. These assumptions can create some confusion or problems in the real world. One way to tackle these issues is through doctor-patient communication.
Doctor-patient communication is important for an effective visit. This includes being able to ask questions and answer questions, and listen to the patient. The relationship between the patient and doctor rely on respect, confidence, and trust.
Effective communication during the examination leads to positive outcomes. Patients who experience positive outcomes are more likely to adhere to prescribed treatment, seek healthcare and have less stress among other benefits. Not only that, but effective communication allows doctors to correctly diagnose their patients. Doctor-patient communication has not been directly linked to patient health care. Doctors think their communication is adequate; however, only about 20% of patients are satisfied when
12 communicating with their doctors (Ahmed & Bates, 2016; Blanquicett, Amsbary, Mills &
Powell, 2007; Ha & Longnecker, 2010; Schneider & Tucker, 1992).
Doctor-patient communication relies heavily on exchanging information in a competent manner. According to a study by Cegala et. al. (2004), doctors are confident that they are competent in gathering information while emphasizing a patient’s competence in providing the information.
There are other factors that go into effective doctor-patient communication. Social skills, interpersonal communication skills, patient willingness, and preconceived expectations are all needed to make a regular examination successful. Because of medical shows, patients have developed expectations of what communication in the examination room and the relationship between themselves and the doctor should be like (Blanquicett et. al., 2007; Jain & Slater, 2013).
Patient Expectations
Patients have preconceived expectations of doctors and their roles. Up until the
1970s, doctors were seen as healers and absolute heroes providing a service to anyone who needs it (Turow, 1996, as cited in Stinson & Heischmidt, 2012). After the ‘70s, these
TV doctors weren’t portrayed as patient-oriented and, therefore, attitudes toward real life physicians changed. Now medical shows portray doctors making mistakes, in and out of the examining room, or being uncertain when they treat patients.
Quick (2009) hypothesized that through cultivation, patients would have a specific perspective of doctors. For example, in Grey’s Anatomy, the doctors are seen as courageous. Quick stated that heavy viewers of Grey’s Anatomy found medical
13 professionals to be extremely credible, and, according to the show, ethnically diverse, which, when compared to other medical shows and real life institutions, gives false illusions. Although the ratio of women doctors to male doctors is proportional to their real life models, women doctors are often portrayed as being there more for romantic purposes than medical. Jain and Slater (2013) also noted that these shows portray minorities as having a more equal role in medicine than they do in real life (Jain & Slater,
2013).
In Grey’s Anatomy, actors in Hollywood portray the doctors, so the expectation right away is that doctors are attractive. Hollywood likes to portray itself as being diverse. All of these doctors are intertwined as they work and learn in the teaching hospital (Jubas & Knutson, 2013).
Jain and Slater (2013) did note that TV doctors used other focused behaviors such as active listening, immediacy, and cultural respect as opposed to real doctors. However, they believe there may be some further research needed to actually determine whether or not fictional doctors engage in these behaviors more than real physicians.
When a patient’s expectations are met, they are satisfied with their examination.
Patients who are satisfied are more likely to follow the treatment plans laid out by their doctor (Quick, 2009). When expectations are not met, satisfaction is not there. When patients aren’t satisfied, or are caught off guard, they begin to become difficult and communication breaks down. Interestingly, doctors are not shy about discussing their views on difficult patients or the fact that they tend to develop attitudes toward patients whether positive or not (Cegala et. al., 2004).
14 Quick (2009) also brought an interesting finding to cultivation theory: Heavy viewers of fictional medical dramas could become more cultivated than heavy viewers of shows where medical information is shown sporadically.
The Gap
The narrative in the television shows that are used in this study are purely fictional, and with that, it can be assumed that one can’t watch the entire series and then perform open heart surgery. But could the viewer be able to perform simple tasks like recognize a heart attack or check for a pulse?
Some medical students found that viewing Grey’s Anatomy was a decent introduction to their new career path and, whether good or bad, had a generally realistic impression. These students also said that watching the show helped them with their studies because it reinforced the material they were learning (Jubas & Knutson, 2013).
Comelles and Brigidi (2014) argued that medical shows aid in the development of personal experiences and shared feelings related to specific diseases, and to general knowledge of said diseases. They also believe that the narratives within the shows not only identify with viewers but help them find information. The same is true for some doctors as well, like the example used above where House M.D. helped diagnose a man with an unusual coronary heart disease. The doctor on that case compared his patient’s symptoms with that of one of Dr. House’s and ran the same tests and found that the patient’s high levels of cobalt and chromium were what was causing his heart failure
(Burzyńska, Binkowska-Bury, & Januszewicz, 2015).
15 There is a fine line between entertainment-education and cultivation. EE is used to teach life lessons through media programming, while cultivation is what happens when a fictional program is viewed excessively and is thought of to be an exact replica of real life. However, despite the negative “mean world” impact cultivation has on people, it can be argued that these programs are more true to life than we thought. With this in mind, could shows like Grey’s Anatomy and House M.D. among the countless other medical shows be used as a way to get answers as to what might be troubling ailing viewers? One researcher argued that students who watched weekly episodes of ER over a 4-year period could compare to a student who spent their time in a typical emergency room (O’Connor,
1998). This study aims to see if this could be true. Could someone who frequently watches medical shows compare their knowledge to those who attend medical school?
Even with the fact that fiction shows only attempt to portray reality and are most often exaggerated, along with the medicine in medical shows being less than accurate, could these programs be considered as entertainment education?
Keeping everything in mind, this study answered the following questions.
RQ1: Do those who watch more medical shows believe they can learn more than
do those who view less?
If people learn from viewing these types of shows, then they could be considered a form of entertainment-education. The following research question delves further into seeing whether or not these shows can be used for EE.
RQ2: Do those who watched more medical shows believe they can perform more
medical procedures than do those who view less?
16 On top of the idea that medical TV show viewing could potentially be thought of as EE, it was important to consider if this EE has an effect on doctor-patient communication. This factor led to a prediction that this study tested.
H1: Viewing medical shows impacts on doctor-patient communication.
The hypothesis predicted that medical shows could have an impact on doctor- patient communication. The medical shows patients watch could lead them to believe in their doctor, or they could lead patients to second guess everything the doctor does.
Patients who don’t completely trust their doctors could put up walls when communicating with the doctors. Heavy viewers could have more of an opinion on how the doctor treats them or how the examination goes. They could feel like the doctor isn’t doing all he or she can to treat them. Seeing how TV doctors treat their patients could have an impact on how the real life patient feels he or she should be treated. Could viewing medical shows heavily create communication barriers? This effect could be either positive or negative.
17 CHAPTER 3
METHODOLOGY
This study investigated the relationship between television viewing and an individual’s perception of reality. Cultivation theory suggested that extended television viewing clouds a person’s judgment on what is happening in the world, whereas, education-entertainment is a program that is designed to educate while it entertained.
This study looked specifically at the viewing of fictional medical shows, such as Grey’s
Anatomy, House M.D., Scrubs, etc., that have a heavy emphasis on medicine and doctor- patient communication.
Although demographic information had been recorded, the participant’s anonymity was kept confidential. Approval from the researcher’s academic institution,
The University of Akron’s Institutional Review Board, has been received (See Appendix
A).
Instruments
A questionnaire was developed online at The University of Akron’s
Qualtric’s website. This questionnaire has been modeled after one that Gerbner used in
1976 and one that Quick used in 2009. The Medical Drama Credibility scale is also being used to measure how credible participants found medical dramas (Record, 2011). It measures several aspects of the viewing habits of the participants and their perception of their own medical knowledge. This questionnaire consists of 5-point Likert Scale questions (5: strongly agree to 1: strongly disagree) and multiple choice questions 18 including some demographic questions. This questionnaire asks simple medical questions to determine if these shows have qualities similar to that of EE. Some examples from the questionnaire are “I believe that medicine performed on TV is correct” or “I believe that medical shows are meant to teach people about medicine.” It also asks questions related to doctor-patient communication, such as “I believe my doctor listens to me when I tell him/her my symptoms” or “I believe my doctor treats me without knowing all of my symptoms.” Another set of questions involved the ability to perform medical procedures.
Some examples are “I can perform CPR” and “I can identify symptoms of a heart attack.”
The procedures used in this questionnaire are commonly found in medical shows and are fully performed within the show. These procedures are also performed with little to no medical equipment. The full questionnaire can be found in Appendix B.
Procedures
Due to a lack of accessibility to a large audience, a snowball sample has been used. By using a snowball sample, the study reached out to individuals who might not view medical shows. This helps to see if there is a difference in doctor-patient communication between viewers and nonviewers.
The researcher reached out to classmates, professors, family, friends, club members and so on, relying on these participants to pass the survey along to people they know. Participants received an email stating a brief explanation of the purpose of the study and its time requirements, as well as a link to the Qualtric’s survey. All participants received a copy of the informed consent to participate in the study (See Appendix C).
Participant confidentiality is ensured by not asking for personal information that would identify the respondent. 19 A quantitative method was used to assess the relationships between television consumption and an individual’s perception of reality. This study used SPSS to look at the means, frequencies, and ratios of the data set. Correlation tests were used to find a relationship between medical show viewing and participants’ opinions on if they could learn from these shows, if participants have a good understanding of basic medical procedures based on their medical show viewing habits, and if there is a relationship between medical show viewing and participants’ opinions on their communication with their doctor. The next chapter will discuss the results of the questionnaire.
20 CHAPTER 4
RESULTS
In total, 111 participants responded to this survey, 40.6% male, 57.3% female and
2.1% preferring not to answer. The ages varied with 24.7% 18-25, 24.7% 55+, 19.6% 26-
35, 10.3% 36-45, and 20.6% 46-55. Ethnicities, however, were not as diverse with 85.6% of the participants identifying as white.
Outside of basic demographic questions, the survey asked participants if they or a family member have experience working in the medical field, 9.3% said that they, themselves have experience, 42.3% said a family member has experience and 48.5% said neither they nor a family member have experience in the medical field. The survey also asked if the participants were currently being treated for a medical condition, 44.3% said yes and 55.7% said no.
Viewing TV shows online through networks such as Netflix, Hulu or Amazon were a popular choice at 38.1%, while 23.7% enjoy viewing episodes when they air on cable, and 8.2% prefer recording the show or watching it later, on demand. Some participants, 26.8%, enjoy viewing TV shows through all three options. The average amount of time spent watching TV was 2 hours a day with 72.1% saying they viewed multiple episodes of a show at a time. As for medical shows, 32.4% say they view them a couple times a month whereas, 21.6% view a couple episodes a week and 6.3% view multiple episodes a day. About a third of the sample say they don’t view any at all
(27.9%).
21 Overall, the responses to questions involving medical opinions and knowledge were positive. Participants agreed that doctors do everything they can to help participants, including prescribing the correct medication, listening to symptoms and addressing concerns. Participants visit the doctor regularly and feel satisfied when they leave their appointment. Participants also felt confident in their ability to dress wounds, perform
CPR and identify symptoms of a heart attack.
Participants disagreed that going to the doctor was a waste of time, the medicine on TV is correct and is based on real life, these shows are meant to teach medicine and that participants felt they can draw blood. Participants also did not wish that their doctors acted like the ones they see on TV. Participants also felt neutral about how they feel about statements such as doctors never make mistakes, doctors treat participants without knowing the symptoms, feeling that they can diagnose themselves or that they know what’s best for their condition and that they look up topics after viewing a medical show episode.
RQ1: Do those who watch more medical shows believe they can learn more than do those who view less?
The first question this study asked was if participants learned something from viewing medical shows. A series of Pearson Correlation tests were used to measure the relationship between viewing medical shows and feeling like these shows are meant to be educational. The number of medical shows viewed was tested to see if there was any correlation with TV medicine. The questions include believing medical shows are meant to teach (r=.47 p<.05), the medicine on the shows is accurate (r=.413 p<.05) and true to life (r= .455 p<.05), and whether they look up topics after viewing a medical show 22 (r=.225 p<.05). The tests showed significance (see table 2). The tests showed positive correlations between medical show viewing and the perception of being able to learn from these shows.
Table 1: Viewing Medical Shows and TV Medicine
Medical Medicine on Medical I look up shows teach TV is shows are topics after How medicine accurate based on viewing an often do real life episode you Pearson .470* .413* .455* .225* view Correlations medical Sig. (2-tailed) .000 .000 .000 .026 shows Sum of Squares 51.71 43.11 50.00 27.71 N 98 98 98 98 *p<.05
RQ2: Do those who watch more medical shows believe they can perform more medical procedures than do those who view less?
The second question expanded upon the first question asking if participants felt like they have a good understanding of basic medical procedures based on their medical show viewing. A series of Pearson Correlation tests were used analyze the data. The number of medical shows viewed was tested to see if there was any correlation with the questions involving the viewers’ perception of their ability to dress a wound, draw blood, perform CPR and identify heart attack symptoms (see table 2).
23 These results showed that there is a significant positive correlation between the number of medical shows viewed and the participants’ perception of their ability to draw blood (r=.256 p<.05) and perform CPR (r= .295 p<.05). There was no significance between the number of medical shows viewed and the viewer’s perception of their ability to dress a wound (r= .191 p>.05) or identify symptoms of a heart attack (r= .159 p>.05).
Table 2: Viewing Medical Shows and Medical Procedures
Dress a Draw blood Perform Signs of a wound CPR heart attack How often Pearson .159 .256* .295* .191 do you Correlations view Sig. (2-tailed) .118 .011 .003 .059 medical Sum of 18.14 33.16 39.10 20.42 shows Squares N 98 98 98 98 *p<.05
H1: Viewing medical shows impacts doctor-patient communication.
The hypothesis predicts that medical show viewing has an impact on doctor- patient communication. A series of Pearson Correlation tests were used to measure the relationship between viewing medical shows and doctor-patient communication. The particular items are questions dealing with believing doctors listen and address primary concerns and symptoms, whether doctors prescribe correct medication and the ability to diagnose oneself (see Table 3).
24 Overall, the hypothesis was not supported. These results show a significant negative correlation between the number of medical shows viewed and the belief that doctors treat participants without knowing their symptoms (r= -.284 p<.05) and the belief that the participants know what’s best for their condition (r= -.208 p<.05). There is a significant positive correlation between the number of medical shows viewed and wishing that real-life doctors acted more like the ones on TV (r= .202 p<.05).
Table 3: Viewing Medical Shows and Doctor-Patient Communication
Treatment I know what’s I wish my without best for my doctor acted How often do knowing condition like a TV you view symptoms doctor medical Pearson -.284* -.208* .202* shows Correlations Sig. (2-tailed) .005 ..040 .046 Sum of -27.14 -21.28 21.429 Squares N 98 98 98 *p<.05
There were no significant relationships between the hours viewing medical shows and questionnaire items about the beliefs that doctors are correct all of the time, that doctors listen and address primary concerns and symptoms, that doctors prescribe correct medication, nor with feeling satisfied when leaving an appointment, or believing one can diagnose oneself.
25 CHAPTER 5
DISCUSSION
Often time fictional TV shows are thought of as true to life, and some people find themselves believing the content of the show they are viewing is factual. These people have been cultivated by what they watch on TV. Cultivation is usually negative due to the fact that these shows are fiction and are loosely based on true events. Medical shows, however, come into a grey area, because they focus on a subject that so many people are familiar with: medicine. Medical shows tend to have correct content but due to time constraints and dramatic intent, they don’t completely show the process on TV.
Although medical TV shows are fictional, they need to get the medicine right in order to be believable. Because of this, these shows are often considered factual without question. That is not true in every case. Fictional medical shows try to get everything right, but they are meant for entertainment, not education.
Medical students have indicated that viewing these shows aided in their education, but they were already studying that subject and didn’t think the shows could be used instead of formal education. Medical shows reinforced the material they were already learning (Jubas & Knutson, 2013). O’Connor (1998) argued that these shows could be considered education and that weekly viewing equates to time spent in an emergency room.
The research here provided a greater understanding of cultivation theory when related to medical TV shows and how this affects doctor-patient communication. The 26 study factored in the number of medical shows a participant watched and their opinions on entertainment-education, basic medical procedures and their personal doctor-patient communication. These factors were then analyzed in relation to the number of medical shows the participants viewed.
This study found that Grey’ s Anatomy, E.R. and House M.D. were the most popular TV shows of the sample, each having at least 30 participants indicate that they watch them. Other shows like Scrubs, MASH, and The Good Doctor were also viewed heavily by participants. There were more than 40 medical shows mentioned in the responses to the questionnaire with the majority having been viewed by fewer than 5 participants.
The study also found that the more medical television a person watches on an average day, the more they were likely to think they learned from medical shows. This first research question was asked to determine if viewers felt like these shows are educational- entertainment. The tests indicate that those who view medical shows do believe they can learn from viewing these shows. Furthermore, the tests show that medical show viewers feel more compelled to research the medical topic after they view an episode. Viewers also feel that the medicine performed on TV is accurate and that the cases are true to life.
Participants know that these shows are fictional and are loosely based on real life, yet they believe that the content of the show is true to real life as indicated by the results.
These participants truly felt like the content presented on the screen was accurate enough to be considered entertainment-education.
27 The second research question asked if participants who viewed more medical shows had a better understanding of how to perform medical procedures than those who viewed less.
The results were split. The tests indicate that the more medical TV shows a person watches, the more confident he or she feels in his or her ability to draw blood and perform CPR. Participants didn’t feel confident in their abilities to dress a wound or identify signs of a heart attack. This is interesting considering that with the first research question, participants who viewed more medical shows indicated they learned more than those who viewed less.
Drawing blood and CPR are usually considered more invasive when compared to knowing heart attack symptoms or dressing a wound. It could be inferred that participants weren’t sure what was meant by dressing a wound or that the medical shows they viewed didn’t cover dressing wounds as much as they did drawing blood. A lot of medical shows, specifically House M.D., dealt more with diseases and disorders than they did physical injuries.
The participants also believed that the content in these shows were accurate and that they could to learn from it. If this were so, then the participants could feel confident in their abilities to perform basic medical procedures. The even split among the responses suggests that the participants indicate that they believe they can learn certain medical procedures from watching these shows. Even these responses could be an indication of their personal experience with these procedures, for example, someone with health problems would probably get blood drawn regularly thus that individual might be able to replicate the procedure.
28 The hypothesis predicted that the number of medical shows viewed impacts doctor-patient communication. The hypothesis is unsupported because less than half of the tests produced a significant result. Although the tests did not provide enough evidence to support the hypothesis, the tests that were significant found that participants who viewed more medical shows believe their doctor takes all of their symptoms into consideration before prescribing treatment and that they rely on doctors to know what’s best for their condition. They did, however, wish that their doctors acted more like the ones on TV. The tests that were not significant involved the doctor listening to participant’s symptoms, prescribing correct medication, and addressing participant’s concerns. The tests involving the participants feeling satisfied when leaving the appointment and believing that they can diagnose themselves were also not significant.
This is interesting because the first research question showed that those who viewed medical shows more than others feel like they are more knowledgeable when it comes to medicine, yet they don’t feel like they can diagnose themselves or that they know what’s best for their condition. They felt like these shows are educational enough to learn some basic procedures but not educational enough for them to help themselves.
While heavy viewing leads to participants believing they know more about medicine, they don’t feel like they learned enough to perform procedures or diagnoses.
Limitations
Despite these interesting findings, this study had limitations. The significance of the results was limited by the sample size and lack of diversity. The sample size for this study consisted of 111 participants. The snowball sampling is limited as there is no control over who is sent the survey and how many people receive it. This method also
29 does not guarantee that those who receive the survey will take it or pass it on. This small sample size made it impossible to make any generalizations to a larger population.
Another limitation is that the questionnaire wasn’t specific enough. Questions pertaining to drawing blood or dressing a wound were not precise. Another limitation was that the participant’s perception of their medical knowledge and abilities to perform procedures could be different from their actual level of knowledge and abilities.
About a third of the sample stated that they don’t view medical shows at all and only 6.3% view medical shows daily. This is a significant limitation as the study is based on heavy viewing of medical shows.
Further Research
Due to the limitations of this study, the results could not generalize across a large population. That being said, this study could be reworked with a larger, more diverse sample size to produce more accurate results. A larger sample size would also improve the likelihood that more participants view medical shows daily. The questionnaire could also reword some of the questions to be more precise. This study also focused heavily on the participants’ perception of their knowledge and medical abilities, so another study could use a physical experiment to fully gauge their abilities. More testing could be done with the covariates that weren’t used in this current study to see if those have any effect on the results as well. These covariates include whether or not the participants had medical experience, if they believed going to the doctor was a waste of time or how they view the medical shows. The study could also utilize factors such as age, ethnicity, education level or gender when analyzing the results.
30 Based on the results found in this study, additional questions were brought up.
Since participants felt like they learned from watching medical shows, do some medical shows educate viewers more than others? Is there a reason why people are drawn to a certain show over another? Why do participants feel like they can draw blood, but not identify symptoms of a heart attack? Drawing blood seems to be the more advanced skill out of the ones in this study, so why did participants feel confident in their ability to perform these procedures over the others?
Further research would consider how often the participants visit the doctor and what they are visiting the doctor for. The research would also consider those who work in the medical field, such as doctors or nurses. They could provide insight into how participants communicate with them and how they communicate with their participants.
Another study could distribute the survey or have participants visit a doctor immediately after a marathon viewing to test the immediacy of the effects of medical show viewing on doctor-patient communication.
In looking back at the study that acted as a catalyst for this research, maybe
O’Connor’s 1998 study could be retested now that it is 20 years older. It could also be tested with a more modern medical show to see if the results are similar.
Conclusion
Overall, this study provided a glimpse into how much viewing fictional medical
TV shows affects how patients communicate with their doctors. The data was inconclusive in proving whether or not medical show viewing affects doctor-patient communication, but there was some data to suggest that viewers believe in their doctor and what he/she says. This study found that people who view medical shows do believe
31 that the shows are meant to educate and they feel like they get a good understanding of basic medical procedures based on what they watch.
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37 APPENDICES
38 APPENDIX A IRB APPROVAL
39 40 APPENDIX B QUESTIONNAIRE
Section 1: Select the number below that best represents how you feel about your doctor or medicine for each statement. 1 is strongly agree, 5 is strongly disagree. (20 questions)
Strongly Agree Agree Undecided Disagree Strongly Disagree 1 2 3 4 5 My doctor listens to me when I tell him/her my symptoms. My doctor prescribes the correct medication to me all the time. My doctor addresses my primary concerns. I feel satisfied when leaving my doctor’s office. I believe that doctors do everything they can to help their patients. Doctors never make mistakes. My doctor treats me without knowing all of my symptoms. I believe that going to the doctor is a waste of time. I believe that I can diagnose myself. I believe that I know what’s best for my condition. I know how to draw blood. I can identify the signs of a heart attack. I know how to give CPR. I know how to dress a wound. I believe that medical shows are meant to teach people about medicine. Medicine performed on TV is correct. Medical shows are true to life. I visit the doctor on a regular basis. After watching a TV show, I like to look up the topic of the episode to learn more. I wish my doctor acted more like the ones I see on TV.
41 Section 2: Multiple choice Questions about TV viewing habits. (7 questions) Respond with the answer that best describes you.
How much television (in hours) do you watch on an average day, including Saturday and Sunday? o 0-1 o 1-2 o 2-3 o 3-4 o 4-5 o 5+ hours
Do you ever watch more than one episode of a TV show in one day? o Yes o No
During an average week, including Saturday and Sunday, how many episodes of a TV show do you watch? o 0-1 o 1-2 o 2-3 o 3-4 o 4-5 o 5+ episodes
How do you prefer to watch TV? (Pick one) o Cable o On Demand or recording o Online (iTunes, Netflix, Hulu) o All of the above o Other (Please specify) 42 How do you prefer to watch TV? o Alone o With a few friends o With a group
A medical drama is defined as a television series taking place in a medical environment where the show tells the story of fictional character that practices medicine. Medical shows are the focus of this study, so which medical dramas have you seen? o
How often do you view medical dramas? o Multiple episodes a day o One episode a day o A couple episodes a week o A couple episodes a month o I don’t watch medical dramas
Section 3: Demographic Questions (8 questions)
Fill in the bubble with the answer that best describes you.
I or a family member work in a medical field? (example: nurse, doctor, surgeon, etc…) o Yes, myself o Yes, a family member o No
I am being treated for a medical condition? o Yes o No
Please indicate your gender. o Male o Female o I prefer not to respond
Please indicate your age.
43 o 18- 25 o 26- 35 o 36- 45 o 46-55 o 56-65 o 66+
What is the highest level of education you have completed? o Some high school o High school graduate o Some college o 2 year degree o 4 year degree o Professional degree o Doctorate
What is your ethnicity? o African American/Black o Asian o Caucasian/ White o Hispanic/ Latino o Native Hawaiian or Other Pacific Islander o other o I prefer not to answer
How would you describe your political views? o Very Conservative o Somewhat Conservative o Indifferent o Somewhat Liberal o Very Liberal
Are you Religious? o Yes o No
44 APPENDIX C INFORMED CONSENT
You are invited to take part in a research project being conducted by Elizabeth Shiller, a graduate student in the Department of Communication at The University of Akron. The purpose of this study is to advance the academic knowledge in the field of communication about the relationship between television viewing and doctor-patient communication. Your participation will require approximately 10-15 minutes and is completed online. Participants in this study must be over the age of 18. There are no known risks or discomforts associated with this survey. You will receive no direct benefit from your participation in this study, however your participation may help us better understand how television influences our communication with doctors. Taking part in this study is completely voluntary. If you choose to participate in the study, you can withdraw at any time. No identifying information will be collected, and your anonymity is further protected by not asking you to sign and return an informed consent form. If you have any questions about this study, you may e-mail Elizabeth Shiller at [email protected] or Dr. Dudley Turner at [email protected]. This project has been reviewed and approved by The University of Akron Institutional Review Board. If you have any questions about your rights as a research participant, you may call the IRB at (330) 972-7666. Please feel free to print a copy of this consent page to keep for your records. By clicking the arrow button below and continuing the survey, you are indicating that you are 18 years of age or older, and that you agree to participate in this survey.
45