by Craig Klugman, Ph.D.

Imagine if 5 million people learned about your hospital in a week. Would you want your hospital to be featured in a television reality show? Described as “unscripted authentic medical dramas,” such shows follow trauma cases from accident to emergency room. Over 2 seasons, NYMed followed stories at New York-Presbyterian Hospital, Lutheran Medical Center, University Hospital (NJ), and St. Luke’s Roosevelt Hospital. Similar shows include Hopkins, Boston Med, Save My Life: Boston Trauma and Boston EMS. The idea behind these productions was to be a real-life counterpart to successful scripted medical shows like Grey’s Anatomy.

One episode in the last season of NYMed featured the story of Mark Chanko who died after being struck by a truck when he was crossing the street. He was seen at New York-Presbyterian/Weill Cornell Medical Center during the time of taping. The family was brought into a room and told the bad news. Sixteen months later, the patient’s wife is watching TV and finds an episode of NYMed that featured her husband. Although his face was blurred, she could tell it was him. The rub is that no one in the family ever consented for his story to be broadcast. The family filed complaints with the New York State Department of Health, ABC, USDHHS and other agencies. They also sued ABC, the hospital, and the chief resident for damages. The appellate court dismissed the case a year ago. ABC said because their news division produces the show, they are protected under the First Amendment. The family has appealed and the video is no longer publicly available.

Producers approached a major Chicago hospital in recent months about becoming a site for a similar series. For the hospital, this is an unparalleled opportunity for public relations: One cannot buy 8 hours of television exposure during prime time. The series also offers an opportunity to educate the public about the practice of medicine, which is needed to help manage unrealistic expectations generated by scripted medical dramas.

However, having heard about the incident with Chanko, the hospital wanted some assurances for the production. For example, there were several allegations from previous versions that were of concern to staff. Among the allegations were:

• That camera crews in the ER wore scrubs so as not to stand out. This was of concern that patients might mistake the crew for health care professionals or for the filming being for medical purposes.
• That crews film first and consent later. The crew films all of the stories that might be of interest. Since this is real life, not every case will make for compelling television, nor can every outcome be scripted. Allegedly, consent was sought only after it was determined a case would be used in the show.
• That in some cases, the filming consent documents may have been just slipped in with other medical consent forms.
• That patients, families, and health care personnel do not have a right to ask material to be edited, deleted, or changed. This is pretty standard for news stories. What would happen if the cameras recorded a medical error or someone behaving less than professionally? This could be damaging to individuals, the hospital, and the health professions.
• That residents felt that there would be coercion to participate. Even if someone did not consent, as the Chanko case shows, the simple fuzzing out of a face is no guarantee that a person would not be identifiable. This might effect future employment and licensing.

The American Medical Association has adopted statements expressing concern about these shows, in part, because they do not show a real physician-patient relationship and may mislead people about what is involved in surgery and other medical procedures. CEJA Opinion 5.045 expresses concern about such filming and its potential violation of patient privacy and confidentiality. In addition, the Opinion says, recorded patients should consent, patient care should not be influenced by the filming, patients have a right to request filming to stop, and physicians should realize their behaviors and actions may influence how the public perceives medical care.

The American College of Emergency Physicians revised a statement this June stating the “commercial filming of patients or staff may be done only if patients and staff give fully informed consent prior to filming.” The patient should be fully capacitated and have the right to rescind before broadcasting.

These shows offer an opportunity to demonstrate real medicine. But how real? Cases are chosen for their dramatic effect. The knowledge that one is being watched changes behavior (thus the argument to put the crew in scrubs and use hidden microphones on doctors so that people are less aware they are being watched).

The hospital made similar requests as part of their contract. Allegedly, the producers did not care for the restrictions. Thus, this institution courageously decided not to participate in the production based on the desire to put “patients first. ” Confidentiality and privacy could not be assured with a commercial camera crew around. Putting patients above commercial advantage is appropriate. Putting patients above self-promotion should be what we expect of our physicians, nurses, and other health care providers. As the Hippocratics stated in their oft-quoted oath:

“Whatever, in the course of my practice, I may see or hear (even when not invited), whatever I may happen to obtain knowledge of, if it be not proper to repeat it, I will keep sacred and secret within my own breast.”

Whether shared on parchment, in conversation, or on video, at the end of the day patients ought to have their privacy protected, and in the health care sphere, their confidentiality respected. That is real medicine.