That’s Not How Dr. House Did It! TV Misleads Your Clients

TV medical dramas are entertaining, but they may be tripping up your clients in an important way. How?

The depictions of life-saving techniques and their outcomes are unrealistic, inaccurate, and misleading. And when viewed enough times in our popular culture, these shows actually influence our perceptions.

Inaccuracy of TV Medical Dramas
OK, I admit to getting hooked on Grey’s Anatomy for a while when my daughter was catching up on prior seasons. And I’ve always liked House. But that doesn’t mean we can’t look critically at what these shows do – and don’t do.

Recently, researchers at USC Davis School of Gerontology found that on popular medical dramas like House and Grey’s Anatomy, patients survive CPR at nearly twice the actual rate of real patients. And that’s just looking at their resuscitation immediately after the CPR. Even more unrealistic: these shows depict patients as being four times more likely to live long enough to go home from the hospital. In reality, most patients die, according to Making Your Wishes Known, a website created by physicians to help people learn about advance care planning and create advance directives.

In reality, most folks receiving CPR are over 65, and many have underlying advanced illnesses, which make their chances of surviving CPR much lower. In addition, many patients who do survive CPR have resultant brain damage (from the lack of oxygen) that can severely compromise their ability to function. Meanwhile, the TV medical dramas depict most patients receiving CPR as adults 18 – 65 years old, and rarely depict anyone with brain damage.

Sadly, the realism of CPR on TV has barely improved in the last two decades. Compared to a 1996 study on the same subject, this study only found a slightly lower survival rate (from 75% down to 70%).

TV Influence on Viewers
Here’s another miscue: TV dramas hardly ever give a realistic portrayal of what the act of CPR is like for the patient. CPR is a procedure that de facto involves physical trauma to a patient’s body.

In a recent article, “The CPR We Don’t See on TV,” medical resident Dhruv Khullar writes about the first time he saw a patient after CPR was administered. “I wasn’t prepared for the scene before me: a frail woman in her mid-80s, barely conscious, vomiting, with broken ribs and a bruised lung. Her stomach was bloated and her chest was bleeding. She looked more like a survivor of CPR than of cardiac arrest…” Khullar ends his account this way: “When she died a few days later, I couldn’t help wondering if she really knew what she was getting herself into.”

And she may not have known. The USC Davis study found that 42% of older adults actually are basing their knowledge of CPR on what they see in the media. And that perception is in fact skewed.

A 2006 study from the Journal of the American Osteopathic Association looking at elderly patients’ perceptions of CPR found that 81% of study participants believed they had a 50% chance or better of surviving CPR and making it out of the hospital. Further, 23% of those participants believed – highly erroneously – that their chance of surviving and going home was 90% or better.

Client Education
The question of whether one wants CPR administered is principally relevant for your older clients and those with underlying terminal or advanced illnesses. And for these folks, it is highly relevant. Clients have a right to a realistic understanding, as Khullar put it, of what they’re getting into.

So what can you do? When these clients are completing their advance directive initially (and when they review it subsequently) and consider whether or not to receive resuscitation, you can:

• Counsel them to talk with their physician to be more informed about their medical status and the plusses and minuses of medical treatments/interventions for them.

• Suggest that they specifically talk with the doctor about CPR, which, by its life-saving nature is performed more “instantly” than other procedures and must always be “opted out of” rather than “opted in to.”

• For clients with terminal or advanced, chronic illness, counsel them to also ask their doctor whether the POLST form is available in their state. For these clients only, POLST turns a client’s advance directives wishes into “actionable” physician’s orders, on their medical chart, that can travel with them between health care providers.

• Tell them to ask the doctor if he/she recommends any educational videos about CPR and about advance care planning in general. Some hospitals and health systems are starting to contract with entities like ACP Decisions and other non-profits, which produce patient education videos designed to help patients make their own, more informed, care decisions. Though more research is still encouraged, academic medical research studies have found that on the whole, patients who watch these videos make different decisions about CPR than those getting their information in other ways. (These videos, which are not inexpensive to produce, are generally proprietary, which is why I can’t link you to one here.)

And now that Medicare will likely soon reimburse doctors to have advance care planning discussions with their patients, you are actually doing the docs a favor by getting the ball rolling. You might even choose to use it as a marketing opportunity with area physicians.
Randi J. Siegel, MBA, is the President of DocuBank (docubank.com), which ensures that the emergency information and healthcare directives of its 200,000+ enrollees are available 24/7/365 through the largest advance directives registry in the U.S., as well as access to an online safe for storage of digital assets and other vital documents. Working with estate planning professionals since 1997, Randi frequently speaks at national estate planning conferences and has appeared on radio and television as an authority on registries. A member of the Philadelphia Estate Planning Council, the International Society of Advance Care Planning and the Coalition to Transform Advanced Care, Randi is active in health education and public engagement related to advance care planning/advance directives. She serves as Pennsylvania liaison to the National Healthcare Decisions Day initiative and as a board member of the Center for Advocacy for the Rights and Interests of the Elderly. Randi is an ongoing contributor to the Academy blog.

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