Depictions of bioethical issues and professionalism portrayed in two popular medical dramas—"Grey's Anatomy" and "House, M.D."—suggest that the shows are "rife" with ethical dilemmas and actions that often run afoul of professional codes of conduct, according to a review in the Journal of Medical Ethics

The authors admit that their findings would end up stating the obvious. But they nonetheless wanted to provide data that would explain how these depictions influence the perceptions of viewers, both health professionals and the general public.

They also hope the research will inform discussions about whether medical dramas should be shown in a classroom to spur conversations about ethics and professionalism among medical and nursing students.

An earlier analysis found that more than 80 percent of medical and nursing students watch television medical dramas. That study also concluded that the programs may prompt students to think and talk about bioethical issues.

In analyzing the second seasons of "Grey's Anatomy" and "House," researchers counted 179 depictions of bioethical issues, under 11 different topics, ranging from informed consent to organ-transplant eligibility to human experimentation.

"Grey's Anatomy," now in its sixth season on ABC, is one of the most watched prime-time television series in the country and chronicles the lives of five surgical interns and their attending and resident physicians. "House," which airs on Fox and is also in its sixth season, follows the medical maverick Dr. Gregory House and his trainees, as they diagnose and treat only the most difficult cases.

Informed consent was the most frequently observed bioethical issue. Of 49 total incidents, 43 percent involved "exemplary" consent discussions, while the remaining instances were "inadequate." In general, exemplary depictions portrayed "compassionate, knowledgeable physicians participating in a balanced discussion with a patient about possible treatment options."

Conversely, inadequate depictions were "marked by hurried and one-sided discussions, refusal by physicians to answer questions" and "even an entire lack of informed consent for risky procedures," the authors state.

They also tallied 22 incidents of "ethically questionable departures from standard practice," most of them depicting doctors endangering patients unnecessarily in their pursuit of a favorable outcome. "In almost all of these incidents (18 out of 22), the implicated physician is not penalized," the authors note.

Matthew Czarny, the study's lead author, recalled an episode of "Grey's Anatomy" in which an intern forged an attending physician's signature. "When this is discovered, the attending seems somewhat grateful that that was pursued," Czarny said. And he cited another egregious example from the show, in which an intern administers medical care while intoxicated.

The study also examined 400 incidents of professionalism, which included interactions among professional colleagues, as well as those with patients. The authors limited their count to incidents they defined as either "exemplary" or "egregious."

"Incidents related to respect were the most frequently observed across both series, and depictions were largely negative," the authors concluded. The next most commonly observed departure from professionalism was sexual misconduct, with 58 incidents notched by the second season of "Grey's Anatomy" and 11 in "House."

Out of 178 interactions between professionals, across all issues, the authors deemed just nine exemplary in nature.

Citation: Matthew J Czarny, Ruth R Faden, Jeremy Sugarman, 'Bioethics and professionalism in popular television medical dramas',  J Med Ethics 2010;36:203-206 doi:10.1136/jme.2009.033621