Opinion

opinion | Michelle Mello and David Studdert

When entertainment, reality, and ethics collide at the bedside

Few of us want to go to the hospital as a patient. From the moment we arrive, we are vulnerable. We put our well-being in the hands of people we’ve never met, and trust them with very private information. The stakes are high.

Small wonder that the mystery and drama of what happens inside hospitals has long been a source of fascination — a fact the entertainment industry knows well. From “City Hospital’’ in the early 1950s to “Grey’s Anatomy’’ and “Nurse Jackie’’ today, television and film have explored and exploited this fascination.

Medical reality shows, such as “Boston Med’’ and “NY Med,’’ are latecomers to the genre. Are these dramas, documentaries, or news programs? There’s no easy answer. They are unscripted and involve real patients, but they do not have the feel of a conventional documentary. A scene describing a promising new surgical technique may be followed by one in which a handsome physician flirts with a coworker. One thing is clear about the new shows: They raise some ethical questions.

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One issue is the conditions under which permission to film a patient’s care is obtained. This problem has been spotlighted by recent news reports of a case in which “NY Med’’ filmed and aired a patient’s death without the consent of the patient or his family. Shows focused on emergency department care face special challenges, since the patients involved are often in a critical condition and family members may be absent or distressed. If no one is available to provide permission to film, the filmmakers must make an awkward approach to get retrospective approval later on.

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We think it is possible for patients to give meaningful consent to have their care filmed, but only in some situations and only if stringent standards are met. Patient permission should be obtained twice — before filming begins, and then again after the edited footage that will be aired has been offered for their review.

A second issue is whether filming affects the quality of care patients receive. There is little evidence either way, but it is well known that humans tend to behave differently when they know they are being watched. Trying to look our best in front of a camera is simply human. This could make care better: knowing she is quite literally under the lens, a physician or nurse may take extra care and display her very best bedside manner. On the other hand, playing for the camera could also prompt clinicians to say and do things that do not benefit patients, or even cause harm.

A third issue is how much social value these shows really have. Hospitals that participate are quick to cite public education as their motivation (though some have also openly acknowledged how attractive an opportunity it is to “showcase” their institutions). Medical documentaries can certainly have educational value. For example, portrayals of cardiopulmonary resuscitation and labor and delivery on medical dramas often provide a distorted, overly sunny view. A public more aware of the realities of medical care may make better decisions. And some young viewers may be inspired to strive for careers as nurses, doctors, or paramedics.

The reality of the new shows, however, is that a flair for the dramatic often appears to overshadow educational content. The promotional trailer for “Boston Med,’’ for example, features footage of a physician asking a woman out, a young physician running down the hall with a bouquet of roses, and a shoving incident.

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The social value question is an important one for hospitals. The less the true educational merit, the more likely participation is to be unethical, because even small risks to patient privacy and quality of care may be unjustified.

To guard against this possibility, hospitals should “walk the walk” on their claims about educational value, and demonstrate this is not merely cover for a promotional opportunity. They should thoroughly investigate the filmmakers, their past work, and the way in which the show will be packaged and marketed. Even then, it won’t be clear what the finished product will look like. Hospitals should monitor what goes to air and make their permission to continue to film revocable or modifiable.

The line between documentary films and news on the one hand, and entertainment on the other, seems to blur further with each passing year. Hospitals will need to work hard to stay on the right side of it.

Michelle Mello is a professor at Stanford Law School and a professor of health research and policy at Stanford University School of Medicine. David Studdert is a professor at Stanford Law School and a professor of medicine Stanford University School of Medicine.