The medical sins of Grey's Anatomy.

Health and medicine explained.
Sept. 26 2005 2:09 PM

Paging Dr. Welby

The medical sins of Grey's Anatomy.

"This patient has an acute case of incredulitis. Perhaps if I kiss her..."
"This patient has an acute case of incredulitis. Perhaps if I kiss her..."

On the season's first episode of Grey's Anatomy, surgical intern Meredith Grey was drafted to help a pediatric surgeon, who happens to be her boyfriend's wife, operate on a pregnant woman, who happens to have lost her husband to an affair. Genius. As doctors, though, we haven't been dreading the show's reappearance because of its silly plot twists. We have a professional beef with Grey's Anatomy: Along with House, the other hospital show on the air at the moment, it is medically far-fetched and misleading. Most of all, we dislike the show because it loses sight of the point of any medical enterprise—the patients.

It hasn't always been so. The TV medical dramas of the 1960s brought viewers to patients' bedsides and kept them there. Shows like Ben Casey and Marcus Welby, M.D., were structured around patients in part because doctors had a surprising degree of control over their TV image. However self-servingly, they nudged producers to paint a clearer, better picture of medicine than today's shows.

The American Medical Association started campaigning in the early 20th century to redefine doctors as scientists and healers, rather than quacks and leech-bearing butchers. When the first medical dramas hit the airwaves in 1951 with the debut of City Hospital, the AMA demanded from television producers the right to revise scripts in the name of medical accuracy. The association struck deals with NBC and ABC that gave it veto rights in exchange for an AMA seal of approval to be aired at the end of each vetted show. Often the AMA wasted its time carping about decorum. On Ben Casey, male doctors were not allowed to be seen sitting on female patients' beds, driving fancy cars, or discussing dying patients casually over coffee. Nor, usually, were they allowed to make mistakes. AMA representatives were hawks for medical accuracy, ensuring that surgeons held scalpels properly. They were also careful to protect their own interests, editing out story lines that focused on medical malpractice, according to Dr. Joseph Turow, professor at the University of Pennsylvania's Annenberg School of Communication and author of Playing Doctor: Television, Storytelling, and Medical Power.

The AMA also pushed to keep the focus away from physicians' personal lives. Throughout the '50s and '60s, shows like Ben Casey; Dr. Kildare; and Marcus Welby, M.D. instead spotlighted patient dilemmas that stood in for larger societal problems. On one episode in which Dr. Casey took care of a young girl beaten by her father, his show explored the ramifications of child abuse. In another, Dr. Kildare became responsible for a mentally disabled man who was the brother of a patient who had died. Patients' struggles drove the story lines. They were the complex characters while the physicians were typecast as one-dimensional superheroes, always available, ever altruistic and humble, without any problems of their own.

The AMA's reign began to crumble in the mid-'60s with the rise of a new show, The Nurses. Its producer, Herbert Brodkin, refused to hire AMA vetters, instead employing a nurse to ensure medical accuracy. The Nurses flopped. But it put an end to the AMA's hegemony. Then, in the 1970s, the new hit series M*A*S*H further altered the formula by treating doctors with utter irreverence. Set on the front lines of the Korean War, the show critiqued authority in general along with the U.S. military presence in Vietnam. Drs. "Hawkeye" Pierce and "Trapper John" McIntyre (played by Alan Alda and Wayne Rogers) were as dedicated to chasing nurses and drinking homemade hooch as they were to performing surgeries.

Over the next few decades, medical dramas continued to write scripts around physicians. Advertisers ate up shows that encouraged young professionals to watch characters they could identify with. St. Elsewhere and ER get credit for portraying decaying urban hospitals and taking on controversial story lines—St. Elsewhere was the first prime-time drama to feature an AIDS patient; ER was the first to show a lesbian doctor. But the shows filtered every experience through the eyes of a doctor or nurse. Unlike their godlike predecessors, the physicians on these series were pathetically human, battling drug addictions, health problems, and bad relationships.

Grey's Anatomy is an extreme of this genre. In last season's premiere, blond and attractive Meredith Grey oversleeps on the first day of her surgical residency after a one-night stand with a stranger—who later turns out to be her boss. As the show unfolds throughout the season, the two struggle to stay apart, soap-opera style. Meanwhile, Grey and her fellow interns suffer through the humiliations of residency, from an abusive chief nicknamed "the Nazi" to a hospital-wide syphilis epidemic started by a surgical intern.

Many moments would make the old-time AMA vetters cringe. Instead of asexual father figures, the doctors on cast are hyper-hormonal. Attendings sleep with residents. Interns bed nurses. Even patients are fair game. On one episode, Grey kisses an injured biker brought in to the hospital after an accident involving spokes sticking out of his abdomen. Normally, any of these infractions would be grounds for dismissal. At Grey's hospital, they're all in a day's work.

These breaches, however, are minor. What matters are the glaring inaccuracies in complicated and delicate areas of medicine. In one egregious episode, the character played by Sandra Oh, Cristina Yang, asks a woman to donate her husband's organs after he dies unexpectedly. Yang botches the job, dispassionately asking for the husband's eyes and skin as if they were no more than items on a grocery list. Then she runs out of the room as the wife begins to cry.

The scene is rife with errors that could damage public perception of organ donation, starting with the premise: Yang is angling for the husband's organs because another patient (who also happens to be a close friend of the chief of surgery) is dying from liver failure and will be saved if the wife agrees. In real life, hospitals go to great lengths to prevent exactly these types of conflicts of interest, barring doctors from approaching patients directly and designating statewide organizations instead of individual hospitals to distribute organs. Maybe we're just two overeducated doctors who take television too seriously, but we worry that this plot line could have done real harm by discouraging people from donating.

In another episode, two of the characters experiment on a patient, performing an illegal autopsy against a family's wishes. On the show, the characters are forgiven, instead of arrested, because they discover the patient had a rare genetic disease (which Oh blithely mispronounces). But as doctors, we could not forgive the producers for their superficial all's-well ending. Since the Tuskegee tragedy, doctors have instilled institutional checks to ensure that clinical research is ethical. Still, many patients avoid doctors because they are afraid of being experimented on. The autopsy on Grey's Anatomy's casually corroborated their worst fears.

Watching these episodes makes us long, in spite of ourselves, for the days when the AMA had television producers on a tight leash. Don't get us wrong: We don't miss Dr. Welby's starched white coat. But we are afraid that TV's worst inaccuracies may compromise what trust remains between doctors and patients.

A few months ago, one of our patients left the hospital emergency room before getting treated because he did not want to miss a Grey's Anatomy episode. As he signed out against his doctors' advice, he reminded us that medical shows are sometimes better than patient realities. Maybe so. But the patients are what real doctoring is all about.

Ingrid Katz and Alexi Wright are medical residents at Brigham and Women's Hospital in Boston and clinical fellows in medicine at Harvard Medical School.