Browse through our Journals...
Television and the social idealization of medicine in the U.S.
Daniel J. Bristow, M.D.
Oregon Health and Science University
3181 SW Sam Jackson Park Road
Mail Code 80
Portland, Oregon 97239
Medical drama on television often depicts doctors and modern medicine as infallible and capable of unrealistic feats of curing the sick. The public tends to believe these misrepresentations as medical facts which leads the public to idealize medicine. This paper explores the idealization of medicine as a defense to protect individuals emotionally from considering their own mortality. But having unrealistic faith in medicine can lead to disillusionment in patients when the medical system cannot provide adequate treatment, information, or results. In these circumstances, patients are more likely to discontinue medical care or seek alternatives such as complementary and alternative medicine. It becomes the role of the physician to educate patients where television drama fails. Talking with patients about their expectations regarding their medical care gives physicians a chance to dispel medical myths and provide more accurate health information while assisting patients in making more informed choices in their own health care.
Keywords: television, popular media, health care education
Television for decades has promoted the image of the omnipotent doctor: the grandfatherly family practitioner who always knows best, the gruff rebel who breaks the rules but makes the correct diagnosis, the young surgeon who faces insurmountable challenges but succeeds unscathed. Physicians in television drama dedicate themselves to our immortality. It reassures us to think that there is an all-knowing and caring system of medicine that can give us life when we fear death. But practical reality tells us that medicine is indeed fallible. As many as 98,000 hospitalized people die in the United States every year due to preventable medical errors (1). Although this makes medical errors in hospitals one of the leading causes of death in America, the image of the accurate and dependable physician continues to entertain millions.
This paper explores the human inclination to idealize medicine based on television's portrayal of medical myth as fact. Public idealization of medicine can lead to disillusionment when individuals’ real health outcomes do not match the fictional portrayals on TV. To prevent misconceptions about the realities of medicine, educating the public becomes the physician’s role when television fails.
The promotional power of television
Television permeates the American home more than any other form of broadcast media. Ninety-seven percent of American households have a television (2). With access to so many viewers, television might be America’s main provider of health misinformation.
In a highly publicized study by Diem et al (3), the authors found that the success rate of cardiopulmonary resuscitation (CPR) on television medical drama was drastically inflated compared to real-life statistics. The authors suggest that this overoptimistic portrayal of CPR can lead patients to make poorly informed decisions about their own health care. In a similar study, subjects who cited TV as a source of information predicted a higher survival rate of patients after CPR than those who did not cite TV as a learning source (4). CPR is not the only medical phenomenon misrepresented by television. First aid treatment of seizures (5) and improper screening procedures for breast cancer have been linked to television (6). When the public expects unrealistic medical results in their own lives, the greater the potential for disappointment when these expectations are unfulfilled.
Studies have shown that the public needs more accurate health education. More than 90 million Americans have limited health literacy (7), or difficulty reading, understanding, and using health information in their own medical decisions. Medical television drama is not helping health literacy in America. Television portrayals of doctors and medicine blur the line between medical fiction and reality. The public starts to believe that the miracles seen on television are common. This false belief along with the human tendency to deny one’s own mortality leads the public to idealize medicine for emotional protection.
Idealization (overvaluation) can be described as a defense mechanism that alleviates anxiety when an individual feels vulnerable. When frightened by the illness, terrors, and atrocities of our world, it is comforting to believe that an “all-powerful authority is in charge” (8). Modern medicine symbolizes this authority because of its proximity to the illness that upsets the human drive for immortality. Medical doctors see illness and death daily. They understand it. They have the power to protect us from it. The individual and society empower medicine as an omnipotent savior to mitigate the distress caused by the acknowledgement of human mortality. But this is not always a pathological defense. It is a natural human inclination.
It makes evolutionary sense that a person would value an institution that promotes their immediate survival. In times of physical and emotional strain and vulnerability, it is reasonable to overvalue a life-saving institution as a compensatory way to quell fear and doubt. Idealizing medicine relieves the anxiety caused by threat to one’s survival. It makes us feel safe in a dangerous world.
From idealization to disillusionment
When a patient realizes that medicine cannot uphold their wish for immortality, disillusionment can result; and the greater the illusion, the harder the fall (8). Television drama depicting medicine as infallible creates a powerful illusion to the viewer. When a patient’s health fails in real life, this breaks the illusion that medicine will prevent their mortality. This can emotionally devastate a person and cause them to become disillusioned with modern medicine’s potential to help them.
Signs of disillusionment already exist in traditional medicine, particularly in patients with chronic pain. A recent study by Dewar et al (9) of patients with chronic pain outlines a path of expectation and optimism that their pain will be relieved by medical treatment. But when medicine could not explain or treat their source of pain, many patients became “disenchanted” with their doctors and the medical system and frequently sought alternatives. The more severe, chronic, and disabling the pain, the more likely a patient will turn to other forms of treatment such as complementary and alternative medicine when traditional medicine does not provide satisfactory results (10, 11). As a testament to the power of good doctor-patient communication, the physicians who maintained a supportive and trusting relationship with these disillusioned patients helped them to have more self-reliance and realistic expectations of what medicine can provide (9). Without the guidance of a trustworthy health care practitioner who can speak candidly about realistic expectations, patients can become disillusioned and even stop seeking medical care when they perceive that medicine has not helped them.
When patients have more accurate information, they make more informed decisions. Patients with limited health literacy have shown more uncertainty in their medical decision-making about end-of-life care. Volandes et al (12) studied end-of-life preferences in dementia and found that subjects preferring comfort care with a focus on quality of life versus life-prolonging care increased significantly from 69 percent to 93 percent after viewing an educational video featuring a patient with advanced dementia (a condition which is not medically curable). If video images on a television screen can promote misinformation in medical drama, this study shows that video images also have the power to positively change opinions and decisions and even potentially improve
quality of life.
TV doctors in medical dramas ease our minds and help us avoid considering our own mortality. But this comfort has a price—disillusionment when we realize that we are mortal and medicine cannot ultimately change that. Society cannot rely on television to teach the realities and limitations of medicine through TV medical dramas. Reality makes us consider our own mortality, which is not comforting or entertaining. Real-life physicians must ultimately take the responsibility to educate the public on the abilities and limitations of medicine (4). Physicians should ask specifically about patients’ misconceptions and unrealistic expectations to help them make more informed decisions about their health care. If television drama will not educate the public accurately, then physicians must correct the misinformation face-to-face, one patient at a time.
There are no conflicts of interest to report or sources of outside funding for this research.
1. National Research Council. 2 Errors in Health Care: A Leading Cause of Death and Injury. To Err Is Human: Building a Safer Health System. Washington, DC: The National Academies Press; 2000.
2. Stelter B. Ownership of tv sets falls in U.S. New York Times. May 3, 2011. http://www.nytimes.com/2011/05/03/business/media/03television.html. Accessed September 23, 2011.
3. Diem SJ, Lantos JD, Tulsky JA. Cardiopulmonary resuscitation on television: Miracles and misinformation. N Engl J Med. 1996;334(24):1578-82. [PMID: 8628340]
4. Jones GK, Brewer KL, Garrison HG. Public expectations of survival following cardiopulmonary resuscitation. Acad Emerg Med. 2000;7(1):48-53. [PMID: 10894242]
5. Moeller AD, Moeller JJ, Rahey SR, Sadler RM. Depiction of seizure first aid management in medical television dramas. Can J Neurol Sci. 2011;38(5):723-7. [PMID: 21856575]
6. Nur N. Breast cancer knowledge and screening behaviors of the female teachers. Women & Health. 2010;50(1):37-52. [PMID: 20349394]
7. Paasche-Orlow MK, Parker RM, Gazmararian JA, Nielsen-Bohlman LT, Rudd RR. The prevalence of limited health literacy. J Gen Intern Med. 2005;20(2): 175-84. [PMID: 15836552]
8. McWilliams N. Psychoanalytic diagnosis: Understanding personality structure in the clinical process. New York: The Guilford Press; 1994.
9. Dewar AL, Gregg K, White MI, Lander J. Navigating the health care system: perceptions of patients with chronic pain. Chronic Dis Can. 2009;29(4):162-8. [PMID: 19804680]
10. Cutler RB, Fishbain DA, Cole B, Steele-Rosomoff R, Rosomoff HL. Identifying patients at risk for loss to follow-up after pain center treatment. Pain Med. 2001;2(1):46-51. [PMID: 15102317]
11. Ndao-Brumblay SK, Green CR. Predictors of complementary and alternative medicine use in chronic pain patients. Pain Med. 2010;11(1):16-24. [PMID: 20447293]
12. Volandes AE, Barry MJ, Chang Y, Paasche-Orlow MK. Improving decision making at the end of life with video images. Med Decis Making. 2010;30(1):29-34. [PMID: 19675323]
First Published April 2013
Copyright Priory Lodge Education Limited