Mortality as depicted in medical TV shows compared with reality

Medical television (TV) dramas, a subgenre of television that has grown in popularity over the last few decades, fictionally depict a multitude of real-life medical care scenarios. The longest running medical TV drama, Grey’s Anatomy , at its peak amassed over 19 million viewers in a single season premier whereas its lowest seasonal premier viewership was still over 9 million viewers [ , ]. Despite the popularity and potential of these shows to increase viewer knowledge of medical topics with sufficient viewing, one area of interest that is being studied is the accuracy of the scenarios when compared to reality and subsequent detrimental effects on viewer perceptions of real-life medical care [ ].

This influence, termed the “ Grey’s Anatomy effect,” is the idea that the disconnect between how medical dramas depict medical scenarios versus real life scenarios can lead viewers to form false perceptions about medical care; perhaps even compromising viewers’ trust in real-life medical providers [ ]. Some studies assessing medical TV drama depictions of medical care have demonstrated inaccuracies in topics such as rates of medical error, CPR survival rates, management of acute pain, and depictions of major disasters in the ED. [ ] Faulty perceptions about real medical care that is based on what a patient sees on television poses a unique barrier to health literacy which has the potential to worsen patient outcomes [ ].

To our knowledge, there have been no published studies examining the depiction of mortality in medical TV dramas when compared to reality. As such, the objective of this study is to determine how mortality was depicted in eight popular medical TV dramas that aired between 1994 to the present day and to compare this data to real-world mortality data published by the Centers for Disease Control (CDC).

We conducted a prospective, observational study in 2021 of eight popular medical TV dramas ( Table 1 ). All eight dramas were specifically selected as they are widely popular, depict various medical settings, and span across a few decades [ , , ]. Two researchers (KK and JC) independently viewed and analyzed the first three, middle three, and last three episodes of the first season for each of the eight medical TV dramas. A standardized data collection method was developed by the authors and included patient demographics (age, gender, and race) and medical setting for each patient depicted during the episodes. For patients whose death was shown on-camera during the episode, we abstracted category of death (natural, accident, homicide, suicide, and other) and specific cause of death ( Table 2 ). Total percent mortality for all included episodes was determined, then specific percent mortality calculated for categories of age, sex, gender, medical setting, and category of death. Mortality depicted in our sample of medical TV dramas was compared to data abstracted from the CDC WONDER database, a large freely available collection of public health data, including causes of death from 1999 to 2020 [ ].

Table 1

Medical TV dramas included in the analysis.

Show (Years Aired)	Seasonal Viewership Range in the US (millions)	Medical Setting	Description of Show
ER (1994–2009)	8.7–35.7	ED	The lives and interpersonal relationships of a Chicago-based ER team are depicted as they care for a multitude of critically ill patients
House MD (2004–2012)	8.7–19.4	Inpatient	Focused on the genius diagnostician and chronic Vicodin addict Dr. Gregory House and his team as they twist rules at a fictional hospital to find solutions for a variety of unique medical cases
Grey’s Anatomy (2005 -)	8.16–19.44	Inpatient	The longest running, and one of the most popular, medical TV dramas which shows Dr. Meredith Grey, daughter of a famous physician, and a team of young surgical interns as they care for patients at a Seattle-based hospital
The Night Shift (2014–2017)	3.97–8.50	ED	A group of physicians, led by army Veteran Dr. T.C. Callahan, run the night shift at a hospital plagued with bureaucratic limitations
Code Black (2015–2018)	6.93–10.17	ED	A show that follows the care provided and complications that are endured by staff at the nation’s biggest ER
Chicago Med (2015 -)	9.83–11.22	ED	Focuses on the staff in a fictional Chicago hospital in the context of a variety of emergency care situations
The Good Doctor (2017 -)	8.16–15.61	Inpatient, Surgery	A young, autistic doctor with savant syndrome provides extraordinary and sometimes unconventional care for patients all while challenging skepticism from those who believe he should not be a surgeon
The Resident (2018 -)	5.64–7.63	ED, Inpatient	A show that focuses on both the medical and bureaucratic aspects of healthcare through many specialties as illustrated in an Atlanta hospital

Table 2

Categories of death.

Mortality type	Description
Natural	This includes all causes of death that are caused by things that qualify as a medical illness or a disease. This encompasses causes of death including, but not limited to, processes like stroke, heart attack, infection, cancer, etc.
Accident	This encompasses all causes of death that are unintentional, and no fatality was observed due to some intent to harm. This includes processes such as inadvertent poisoning, motor vehicle accident, falls, drowning, medical error, etc.
Homicide	This includes all deaths that are sustained from intent to harm from outside parties. Characters that were killed by an unknown third party where it is known that there was intent to harm are counted as homicide. Examples of homicide are murder, self-defense resulting in death of aggressor, gross negligence resulting in death, etc.
Suicide	This includes all deaths that are caused by intentional self-harm with the objective of killing oneself. Patients that commit suicide are intending to end their own life in the absence of injury caused from another person.
Undetermined / Other	This includes all the causes of death that are not included above. This is reserved for those methods of death that are unique, fulfill multiple of the above criteria, or do not fit into any category.

In our sample of medical TV dramas, a total of 380 patients were depicted, with 47 of those having died on-camera (12.4% overall patient mortality). Commonly depicted demographic categories were adult (56.3%), male (62.3%), white (78.9%), and depicted in an ED (75.5%) ( Table 3 ). Of the 47 depicted deaths in our sample, the most common categories of death were natural (46.8%) and accident (36.1%), and the most common specific causes of death were motor vehicle crash (32%), infection/sepsis (17%), and cardiac death (15%) ( Table 4 ). The highest percent mortality based on demographic categories, as seen in Table 5 , was seen in young adults (17.1%), elderly (15.9%), males (14.2%), and Latinx (21.4%) depicted in an operating room (25%). The most represented character demographics were adult, white, male, and depicted in an ED. Similarly, the most common demographics of patients who died were adult, white, male, and depicted in an ED.

Table 3

Patient demographics depicted in the medical TV dramas analyzed.

Demographic	Total n, (%)
Age
Infant	10 (2.6%)
Child	30 (7.9%)
Adolescent	28 (7.4%)
Young Adult	35 (9.2%)
Adult	214 (56.3%)
Elderly	63 (16.6%)
	380 Patients Depicted

Gender
Male	237 (62.3%)
Female	143 (37.6%)

Race
Asian	15 (3.9%)
African American	51 (13.5%)
Latinx	14 (3.7%)
White	300 (78.9%)

Area of Medical Care
Outpatient / Clinic	14 (3.6%)
Inpatient	55 (14.5%)
ED / Acute Care	287 (75.5%)
Operating Room	4 (1.0%)
Prehospital	20 (5.2%)
Total	380 Patients