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I have a love of bad medical dramas; I always have. Who knows whether I will still enjoy them through medical school and beyond, but for now I find them somewhat relaxing.

Many people have noticed the differences between medical dramas and reality, even in the dramas that say they are trying to be “realistic”. One aspect that is often discussed is the dangers posed from CPR displays on these shows. CPR is frequently shown as a very casual pressing on the chest with bent arms, and if anyone who performed CPR in that way in real life would be 100% unsuccessful. Additionally, the chances of “coming back” and eventually being discharged from the hospital after needing CPR are 23%, whereas in hospital shows it appears that the majority of patients fully recover after CPR. One study shows that 71% of patients in House and Grey’s Anatomy survived CPR and were eventually discharged.

This is one area in which I think that the show Chicago Med actually does well. While it does have some patients physically recovering after being “down” for prolonged periods of time, these patients are then shown as having very limited brain function as a result of the prolonged lack of oxygen. This is far more realistic than the full recovery that is most commonly shown in medical dramas.

One thing that recently concerned me in this show, which is indicative of the way many of these shows work, is the “magic diagnosis”. In this case, it was a woman diagnosed with Alzheimer’s disease who was brought in for unrelated issues and suddenly found to have hydrocephalus. The discovery of this resulted in a simple cure that removed all of the previous dementia symptoms.

Medical dramas function in the opposite way to real life. The old adage “if you hear hoofbeats think horses, not zebras” is supposed to remind doctors and students that the common diagnosis is the most likely. The TV shows tend to show the opposite; it seems that hoofbeats are most frequently zebras and even unicorns!

What effect does this have on those patients and their families watching from home?
Even as someone with a scientific background, I find myself drawn into the show’s reality, hypothesizing: perhaps XYZ-rare-disease is actually the problem when the patient has previously been given an otherwise simple diagnosis. I imagine that doctors frequently get patients coming in saying “I saw on TV that my common chronic disease might actually be this other treatable disease”. I can’t imagine the false hope that might have been felt by families of Alzheimer’s patients just wondering if maybe, just maybe, their relative actually had this curable disease instead.

A similar unrealistic phenomenon of illness exists in House. Ignoring many of the other aspects of the show that were unrealistic and focusing on the medicine, we see a doctor who is supposed to specialize in the sickest, and most undiagnosable patients. In 177 episodes it seems that there were only 14 episodes where the patient died, which is amazing given how sick these patients were to begin with. [As an aside, this website has really cool reviews of every House episode and its medical accuracy].

The question is whether this is important. We are fully aware that these shows are not real, but I think that part of the problem is that aspects of them are real. Hydrocephalus is a real disease that does cause symptoms similar to Alzheimer’s disease. CPR does work occasionally, and, in general, most medical dramas do get many of the symptoms and basic disease treatments correct. The problem with the shows is that, though fiction, they are based on real facts, and it is this that makes them dangerous in terms of how people perceive medicine and develop false hope about certain diseases.

I am not arguing that TV shows have to be 100% realistic, but the dangers of bad and unrealistic medicine on these shows is very well reported (here and here, for instance) and the false hope I have described has been well documented. Maybe medical dramas could be slightly more realistic in the general medicine? I am not suggesting they need fully accurate treatment plans and that the medical professionals cannot keep having affairs with each other and all the patients; however, when it comes to the major stuff, the information the public takes in and apparently “learns” from, maybe they could take advantage of their place in the primetime viewing slots to provide viewers with the knowledge of how to perform real CPR and other such basic medical knowledge.

The question of the false hope is more difficult. One of the reasons people watch these shows is for a feel-good factor. We don’t want to see 99% of the patients not surviving CPR, and we want to see magic cures of seemingly incurable diseases. Is there a way to still provide the viewer with this feel-good factor without creating false hope for those in similar situations? I don’t know. Does anyone have suggestions?