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Weekly UpdatesUntil recently, a shortcoming within the doctor-patient literature was a dearth of theoretical models to explain the complexities that underlie this unique relationship. The doctor-patient relationship does not occur in a vacuum, thus, attention to environmental factors influencing this relationship is of interest to health communication research. Street's (2003) ecological model takes a step in this direction by advancing an approach that takes into account multiple contexts impacting the healthcare provider-patient relationship. In doing so, the model illustrates how the media, organizational, cultural, and political-legal contexts each impact the doctor-patient relationship, which has received a wealth of coverage during the past 30 years. At the heart of the concept is the relationship between the healthcare provider and patient. In examining the interpersonal context in which this relationship occurs, Street identifies partner and relationship perceptions as cognitive-affective influences for both doctors and patients.
In applying the ecological model to patients' perspectives of doctors, the focus of this investigation concentrates on the media context. Research examining television representations of doctors is not new to the literature (Chory-Assad & Tamborini, 2001; Pfau, Mullen, & Garrow, 1995; Turow, 1989; 1996; Turow & Coe, 1985; Volgy & Schwarz, 1980). Extant research successfully traced historic portrayals of television doctors (Turow, 1989; Turow & Coe, 1985), while others performed systematic content analyses to examine doctor portrayals on television (Chory-Assad & Tamborini, 2001; Pfau et al., 1995); however, less is known about the influence of television in shaping patient perceptions of doctors (Chory-Assad & Tamborini, 2003; Pfau et al.; Volgy & Schwarz, 1980), particularly within the context of a single medical drama.
This investigation extends this line of research by examining the influence of exposure to Grey's Anatomy, spanning Season 2 and the first five episodes of Season 3, on viewers' perceptions of real-world doctor's courage along with how this perception is associated with patient satisfaction. Grey's Anatomy was selected due to its popularity and uniqueness. Nielsen Media Research rankings 2005-2006 indicate that Grey's Anatomy (Season 2) had an average of 19.9 million viewers per episode, giving it a #5 overall ranking. Perhaps a major reason for the show's popularity among viewers rests in the diversity of the cast (Deimen, 2006; Reddy, 2007). The surgical interns and staff at Seattle's Grace Hospital are ethnically diverse, which is in stark contrast to most television shows that do not adequately represent minorities (Deimen). Another factor that makes Grey's Anatomy different is the constant depiction of risky and complicated surgeries. Deimen writes, "Due to the nature of their internship, they [surgical interns] are constantly pitted against each other for the juiciest and most complicated surgeries" (p. 2). While the ecological model identifies the influence of the media within the healthcare provider-patient relationship, the manner in which this occurs is not explicated. Prior to making an argument for applying cultivation theory within the context of a single program across 32 episodes, a brief history of television portrayals of medical doctors is provided.
Television Portrayals of Doctors
The portrayal of doctors on television has shifted significantly during the past 60 years (Chory-Assad & Tamborini, 2001; Turow, 1989, 1996; Turow & Coe, 1985; Volgy & Schwarz, 1980). City Hospital, the initial doctor show launched in 1952, portrayed doctors as omnipotent healers who represented the authority within the hospital. Doctors throughout the 1950s and 1960s were characterized as compassionate heroes dedicated to their patients (Turow, 1996). Audiences followed the likes of Dr. Ben Casey and Dr. James Kildare as they regularly beat the odds and triumphed over illness to save patients. The 1970s introduced doctors such as Dr. Marcus Welby who were on the cutting edge of medical advances and, like their predecessors, always succeeded in improving the lives of their patients. Volgy and Schwarz's content analysis across a 4-week period found that "not a single reference to physicians which could be described as a negative statement toward the medical profession" occurred (1980, p. 152). At the end of the 1970s, the focus switched from patient illness to the difficulties that come with being a doctor (Turow & Coe, 1985). Shows such as St. Elsewhere and Northern Exposure, among others, began showing the stress and strain of being a doctor (Pfau et al., 1995). By giving attention to the often unfavorable dispositions of doctors, media scholars feared that negative portrayals may lead to doctor distrust (Pfau et al.). Although medical shows had begun to depict doctors' struggles, for better or worse, the majority of coverage remained positive.
Most recently, Chory-Assad and Tamborini's (2001) content analysis of 229 television physicians discovered that portrayals of doctors remained largely positive, although these depictions were less favorable than portrayals a decade earlier (Pfau et al., 1995). Specifically, Chory-Assad and Tamborini wrote that primetime fiction doctors "were often mean, unethical, incompetent, insubordinate, and sometimes even criminal" compared to non-fiction portrayals within the media (i.e., news broadcasts, magazines) (p. 514). ABC's Grey's Anatomy continues in this tradition by showing both positive and negative characteristics of medical doctors. With that said, consistent with previous decades of doctor portrayals on television, courageous acts performed by doctors on Grey's Anatomy abound in which they are forced to make critical decisions that determine the fate of their patients. To provide illustrations of these valiant acts, two episodes were randomly selected from Season 2 and the first five episodes of Season 3.
In the episode entitled "Deterioration of the Fight or Flight Response," three courageous acts are performed simultaneously. First, Dr. Burke was shot outside of the hospital. While treating Burke, viewers watch as Dr. Shepherd struggles with the delicacy of dislodging a bullet from a friend, while at the same time performing the surgery without damaging nerves that would prevent Burke from performing his duty as a surgeon. While viewers witness this struggle, Dr. Addison has the daunting task of telling Dr. Richard that his adolescent niece's ovarian cancer has returned. Meanwhile, viewers watch as interns Izzy, Cristina, Meredith, and George struggle to keep a patient, Denny Duquette, alive after Izzy intentionally cut his LVAD wire in attempts to improve the likelihood of him receiving a much-needed heart transplant. In short, within a single episode, viewers see the courage needed to be a medical doctor.
In another episode, "Raindrops Keep Falling on My Head," viewers watch as Dr. Addison Forbes Montgomery and intern Meredith Grey see Julie, a patient with twin-twin transfusion syndrome (two twins connected by blood vessels in the placenta). Addison performs surgery after she detects beginning heart failure in the twins. After the surgery, viewers learn that the babies and Julie turned out fine. In the same episode, viewers watch as Joe, the owner of a bar across from the hospital, suffers from an aneurysm. In order to correct the problem, the doctors must perform courageous acts (e.g., freeze his body, drain his blood, and stop his heart) within 45 minutes to save Joe. Joe survived the procedures. Despite their courageous acts, the doctors on Grey's Anatomy do not always succeed. In fact, often their patients die. Although there is not always a happy ending, the doctors' courageousness is rarely questioned. In order to provide a theoretical framework to understand media influence, cultivation theory is employed to address the underlying process in which heavy viewers of Grey's Anatomy develop beliefs and perceptions consistent with television portrayals of doctors.
Cultivation Theory
Perhaps no theory has been as instrumental as cultivation theory in explaining the long-term effects of repeated exposure to television images (Gerbner & Gross, 1976). Cultivation theorists assert that over time, social reality and TV reality are blurred among heavy television viewers (Gerbner & Gross, 1976; Gerbner, Gross, Morgan, Signorielli, & Shanahan, 2002). The theory suggests that specific themes (e.g., crime) cut across genre boundaries and pervade all programs. In making the case for cultivation theory, researchers frequently compare perceptions between heavy and light viewers. The preponderance of cultivation research suggests that heavy viewers maintain perceptions that mirror television compared to light viewers in general. In fact, the validity of cultivation research has been bolstered by meta-analytic research that suggests Gerbner and colleagues' prediction holds true (Morgan & Shanahan, 1996).
Despite evidence in support of cultivation, the theory has endured its share of criticism (see Hawkins & Pingree, 1980; Potter & Chang, 1990). The assumption that television viewing impacts perceptions is not disputed; however, the underlying assumptions of cultivation remain debated (for a review of these criticisms, see Shanahan & Morgan, 1999). A major criticism of cultivation research rests in Gerbner and colleagues' belief that television messages are a cumulative mass of messages with consistent storylines. That is, cultivation treats television messages as a coherent system of stimuli spanning all genres and programs (Gerbner & Gross, 1976; Gerbner et al., 2002). As a result, cultivation researchers' interests are in the impact of total television viewing as opposed to genre-specific or program-specific effects. While treating television messages as a coherent system was legitimate for the late 1960s, the spawn of cable and satellite programming, an influx of programs aimed at specific target audiences, along with technologies such as television digital video recordings during the past four decades have certainly challenged cultivation's notion of a uniform storyline across genres and programs. Content analyses have disputed the belief that television messages are uniform across genres and programs (Hawkins & Pingree, 1980; Potter & Chang, 1990). In fact, Segrin and Nabi's (2002) study examining marital expectations found that relationship genre explained more variance in eros and expectations for intimacy than total television viewing. Both relationship genre and total television viewing explained a significant portion of variance in fantasy rumination or marital intentions. Similarly, research found that heavy viewing of TV news is associated with concerns about violent crimes (Romer, Jamieson, & Aday, 2003), while others discovered that parents attending to media stories about child abduction cases experience more fright-related feelings than light viewers (Wilson, Martins, & Marske, 2005). Wilson et al. also found that heavy exposure to TV reality/dramas and attention to media stories about child kidnappings are positively associated with concerns about a local threat. Finally, within the context of doctor portrayals on television, Chory-Assad and Tamborini (2001) found that visual and non-visual doctor portrayals varied in physical attractiveness and interpersonal style across prime-time fiction, daytime soaps, network news, news magazines, and daytime talk shows, although doctor competence, ethical character, regard for others, and power did not vary significantly. Together, these studies support the possibility of extending cultivation theory to examine effects within specific television genres.
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