Both Dr Murray and Scott Krugman, MD, vice chair of pediatrics at the Herman & Walter Samuelson Children’s Hospital at Sinai in Baltimore, Maryland, described the most difficult and concerning misunderstandings as those arising from sexual assault or abuse cases. “We know that in the overwhelming majority of cases of child sex abuse, children will have a normal physical exam, so we have the conversation that ‘It’s not like what we see on the crime shows where they say the doctor took a look and this or that must have happened,’ ” Dr Murray said.
Just as heartbreaking are the parents who fear their daughter has been abused because they don’t understand how hymens work. “Once we talk about anatomy and that no girl would ever get their period if there wasn’t always a hole, parents are reassured, but it’s sad that they went through an emotional rollercoaster because of myths and so many people’s concerns about speaking honestly about our bodies,” she told Medical Bag.
Dr Krugman, too, finds himself frequently telling parents, “It’s not like CSI.” Television portrays sexual assault cases as fast-paced investigations that are solved quickly with apparently easily accessible DNA. “The reality, especially for child sexual abuse in prepubertal girls, is that there is rarely evidence on the child’s body unless they are evaluated within 24 hours of the abuse,” Dr Krugman told Medical Bag. “Most evidence comes from clothes and sheets, and it takes months to years to get a result. Because of the infrequent evidence hits, plus 95% chance of a normal exam, in the vast majority of cases we rely on the child’s disclosure.” (And unfortunately, in real life, many children aren’t believed by the person to whom they initially disclose the abuse, sometimes even including clinicians.)
Proactively Addressing Misconceptions
So what’s the solution? Television producers and writers aren’t likely to change their storylines and practices any time soon — they’re in the business of turning up the drama. That leaves it to clinicians to be proactive about identifying and correcting misconceptions developed from television shows. The best step physicians can take is simply to ask patients about any health beliefs they have based on television, religion, or cultural beliefs. “Once you know where they are coming from you can better address the issue,” Dr Krugman said.
In some areas, such as palliative care, this kind of proactive discussion may be particularly beneficial to patients. “As a palliative care physician, families deal with the unrealities of life extension,” tweeted Paul Rousseau, MD, from Wake Forest School of Medicine in Winston-Salem, North Carolina. “Granted, we can prolong ‘life’ in the [intensive care unit], if you want to call that life, but families deal with an inability to understand why their loved one can’t recuperate and live longer like on TV.”
Rebecca Melvin, EMT-P, a trauma education coordinator for TraumaOne Flight Services at the University of Florida Health Jacksonville, agreed. “TV portrays dying in either a rather dramatic manner or quietly falling asleep. This creates confusion when a family is confronted with a loved one who is going through the dying process and doesn’t fit the ‘TV’ narrative.”
Even “reality” shows can warp how people think about a disease or recovery process and require proactive reeducation. “The Biggest Loser grotesquely embodied everything wrong with modern-day diet culture, and then served it up to tens of millions of viewers worldwide, and in so doing, perpetuated incredibly negative stereotypes about people with obesity,” Yoni Freedhoff, MD, an obesity physician and associate professor of family medicine at the University of Ottawa, told Medical Bag. “It taught the world that scales measure more than just gravity, that they measure health, happiness, success, effort, and self-worth. It taught people to believe that intense, vomit-inducing exercise was the key ingredient to weight management, and it taught people that those who ‘fail’ do so because they just didn’t want it badly enough.”
As founder and medical director of the nonsurgical Bariatric Medical Institute, Dr Freedhoff spends a lot of time in his office and online6 correcting misconceptions of people who embark on behavioral intervention programs for weight loss, including how long the process can take and what realistic goals are.
“It also led viewers to believe that incredibly rapid and extreme weight loss was safe and achievable, which, in turn, set them up for disappointment, despite at times incredible improvements to their health and quality of life, but with subtotal weight loss,” he said. “Intellectually, it’s not difficult for patients to embrace the notion that their best weight, the term we coined and use, is whatever weight they reach when they’re living the healthiest life that they actually enjoy. Emotionally, however, it’s at times difficult for them to let go of Biggest Loser-style expectations.”
Clinicians have enough on their plates without correcting misconceptions about television, yet not considering this misbeliefs and proactively addressing them can lead to more pain down the line. “I think you just have to describe the reality and ask if they have any questions or misconceptions,” Dr Krugman said.
- Portnova J, Irvine K, Yi JY, Enguidanos S. It isn’t like this on TV: Revisiting CPR survival rates depicted on popular TV shows. Resuscitation. 2015;96:148-150.
- American Heart Association. CPR & First Aid. Emergency Cardiovascular Care. Accessed April 1, 2019.
- Diem SJ, Lantos JD, Tulsky JA. Cardiopulmonary resuscitation on television — miracles and misinformation. N Engl J Med. 1996;334:1578-1582.
- Serrone RO, Weinberg JA, Goslar PW, et al. Grey’s Anatomy effect: television portrayal of patients with trauma may cultivate unrealistic patient and family expectations after injury. Trauma Surg Acute Care Open. 2018;3(1):e000137.
- Chung JE. Medical dramas and viewer perception of health: testing cultivation effects. Hum Comm Res. 2014;40(3):333-349.
- Freedhoff Y. I’m an obesity doctor. I’ve seen long-term weight loss work. Here’s how. Vox. https://www.vox.com/2016/5/10/11649210/biggest-loser-weight-loss. May 10, 2016. Accessed April 1, 2019.
This article originally appeared on Medical Bag