Medical education via the mass media

Ever wondered how lounging on a sofa watching mindless soap opera after soap opera can benefit your health? Fiona Kenny explores the education being delivered through your television screen

After a hard day spent on endless ward rounds with problematic patients, all most of us want to do is to curl up on the sofa in front of the television and watch something undemanding and entertaining. Television is a means of escape from our own problems; the irony is that more often than not, what we escape into are television serials presenting the lives and problems of others.

Internationally, viewers seem to choose fictional television series, with soap operas top of the poll. ^1–5 I am sure most of us have experienced an exasperated parent sighing, “Honestly, you aren't still watching that rubbish are you?” after they have walked in to find us slouched on the sofa in front of EastEnders, Neighbours , or any other soap opera that happens to be gracing the screen. But have you ever wondered whether what you are watching is “mindless entertainment,” or are you actually receiving information and, more importantly, retaining it.

Soap operas and society

The popularity of soap operas may be attributed to the enormous variety and abundance of choice, alongside the regularity and frequency with which they are broadcast. Soap operas were first aired on US radio in the 1920s ⁶ and have since become a universal phenomenon broadcast on television and radio alike. They are set in various environments and with characters from every generation and personality range.  The timeless nature of a soap opera means that viewers span generations, and we are able to grow older with characters. The genre is so successful because it portrays a social realism; the characters represent realistic personas enabling the audience to identify with and relate to them. The domestic and personal problems that characters have on screen are reflections of society, albeit with a slightly more melodramatic portrayal. Soap operas are essentially drama and entertainment; a soap opera about your or my everyday life would probably be dull. So while we praise soap operas for their depiction of reality, we have to ask the question: how often do we see anyone in a soap opera suffering from a cold?

Medicine in soaps

Dr Rob Hicks, general practitioner, journalist, and script adviser for the UK soap opera Doctors said: “What happens in medical dramas is incredibly uncommon in life…. If it can happen, then it probably will.”

Health is important and relevant to everyone, whatever age, and it is therefore no surprise that so many medically related soap operas are now produced: Holby City, ER, Doctors, General Hospital, Days of Our Lives, to name a few. However, it is not only the soaps set in hospitals or medical environments that raise health issues. All soap operas have characters experiencing concerns about their physical wellbeing and have the option of providing this combination of education and entertainment—a genre which has been classified “edutainment.” With millions of viewers tuning in every day and the inevitability of a medical storyline, soap operas are a platform from which critical health education could be provided. Indeed, the UK's soap opera Hollyoaks was congratulated by one of England's parliamentary members for its success in raising awareness about the sexually transmitted infection chlamydia. ⁷ The storyline followed the character Lisa through her contraction of the disease and considered various social and medical issues that arise as a consequence of unprotected sex. India and many other countries already use the medium of soap opera as a stand from which to educate viewers about numerous social issues ranging from tsunami donation and women's rights to health concerns. With around 550 000 children dying each year from diarrhoea, the writers of India's most popular soap opera Kyunki Saas Bhi Kabhi Bahu Thi (which means, “because the mother in law was once a daughter in law”) worked with the World Health Organization and the US Agency for International Development to produce a storyline concerning the treatment of diarrhoea via oral rehydration salts.⁸

Distorting the view

While some storylines are successful at educating their audience, writers still have to produce a television programme fuelled with suspense and drama that will continue to please the audience. As a consequence, medical accuracy is occasionally discarded in favour of plot and character progression. American soap operas have already been accused of painting “too rosy a picture” of coma. Eight percent of coma patients in soap operas die compared with the real life picture of 50% of coma patients never recovering.⁹ These mythical survival rates are not restricted solely to coma patients; the television portrayal of cardiopulmonary resuscitation was also acknowledged to be producing unrealistic public expectations. ¹⁰ Tony Etchells, one of the scriptwriters for EastEnders  said, where coma storylines are concerned, “It is incredibly hard to kill off a character… you have to sugar coat the pill.” He also added that as for cardiopulmonary resuscitation, “It is an incredibly dramatic way of kicking off the scene for the character, the defibrillator is a punctuation mark.”

The repercussions of these portrayals are that they raise public hopes about the effectiveness of medical treatments and the optimistic outcomes of disease, causing unnecessary emotional grievance both for the relatives and for the doctors concerned.

Unwanted messages

Even if medical situations are deemed well written and realistic it does not necessarily mean that the message you portray is the one you wish to give. In 1995 an episode of the UK drama Casualty included a depressed airline pilot attempting suicide with a paracetamol overdose. Suicide attempts and depression are important everyday issues that the Casualty scriptwriter wished to address, with the intention of educating the public that overdoses do lead to death. However, the outcome was rather different, and within a week the episode had sparked a 17% increase in suicide attempts. In addition, the number of incidents in which paracetamol was used had also increased. ¹¹ Phil Hammond, general practitioner, journalist, and comedian, said that “it is absolutely impossible to predict the health message” that any fictional programme will portray.

Medical education

It is not only soap operas that can have considerable influence over health awareness and education. Other fictional drama series also provide medical education, but the shorter duration prevents the audience from developing such a strong bond with the characters and as a result the amount of information obtained and retained may be lower.

Documentaries are effective in providing education about specific issues. However, the style is formal and many viewers may not find this as appealing. Films, on the other hand, have the capacity to draw in the audience. From major Hollywood blockbusters to small art house productions, films have provided information about a vast array of important medical issues to millions. Films, however, are also notably bad at conveying sensibility when it comes to certain health concerns.

Smoking

Scientific research has indicated that teenagers are greatly influenced by the smoking culture as portrayed on screen. It is perhaps rather shocking then to note that the amount of smoking in American films in 2000 far exceeded the levels in the films of the 1960s.¹² Hollywood continues to portray smoking as glamorous and something not only for the hardened criminals and the low down and dirty types but also for the James Bonds and the beautiful seductresses of the world.

Smoking in soap operas, on the other hand, is never used to promote fashion. The most notable smoker in British soap opera is Dot Cotton from EastEnders , an elderly, working class woman who rarely appears on screen without a cigarette. Her character has even spawned it's own syndrome: the “Dot Cotton syndrome” is used to describe the elderly population who continue to smoke heavily without registering the health problems they are or will soon suffer from, seeing it as their only pleasure left in life. Although soaps do portray characters smoking, as Mark Porter, general practitioner and print and broadcast journalist, said, Dot Cotton is hardly a role model: “She looks like she stinks like an ashtray… there aren't many women who would want to look like Dot. The problem arises when Brad Pitt smokes on the television.”

In India, the recognition that television has a cultural and social influence over the nation led to the government banning all smoking on television screens and in cinemas. The stringent rules laid down on 31 May 2005 mean that no cigarette packs, hoardings, or any object showing a cigarette brand can be aired. Movies previously filmed will have the offending images blurred out, and when being shown a compulsory statutory warning at the bottom of the screen commenting on the hazards of smoking must be given.¹³

Sexual health

Similarly, Hollywood has been accused of glamorising unsafe sex,¹⁴  with James Bond being singled out as one of the worst culprits. The likelihood of characters suffering any consequences from their sexual encounters, such as unwanted pregnancies or sexually transmitted infections, is minimal. And as for film stars stopping in the midst of some romantic clinch only to fumble around with a condom… well the image doesn't really fit well on the big screen does it?

Although UK television programmes from 2000 onwards contained twice as many references to safe sex issues as programmes from the late 1990s,¹⁵  scenes of sexual content continue to outnumber those dealing with safe sex issues. As mentioned above, however, it seems that messages are being conveyed to the viewers about sexual health issues.

Government action

Governments in Africa and other areas of the developing world are successfully using film and television productions to promote safe sex. One example is Soul City, a soap opera which reaches nine African nations and an estimated 30 million people with its AIDS-fighting message. Sponsored by the US Agency for International Development, this “edutainment” is being shown in barber shops and bus stations, and FilmAid International in New York is even taking film and television into refugee camps to target the vulnerable audience.¹⁶

It was recently revealed that in the past 20 years, up to 10 million girl fetuses have been selectively aborted in India because culture and tradition state that baby boys are preferable.¹⁷ The government has attempted to control the use of ultrasound examinations and in many regions operators are forbidden from divulging the sex of the child in-utero; however, little notice is taken of such restrictions and this “female feticide” continues.¹⁸ . As a result, the Indian government has taken an innovative angle and teamed up with the international charity Plan to produce a soap opera-style short film, “Atmajaa” (“Born from the Soul”), to educate the nation and attempt to change opinion. In view of Hollywood's influential status in India, the founders of the programme believe it will be most effective.¹⁹

Robert Trachtenberg/nbc/zuma/allaction.co.uk/pa/empics

Conclusion

The mass media has a role to promote health education through whatever means it can, and in many areas it has been successful. Soap operas provide a favourable setting from which medical messages can be distributed to the general public; the emotional attachment between viewers and characters enables deliverance of important messages that strike a personal note. They are able to cross that boundary between fiction and reality, producing a realisation that although the illnesses and issues occurring are on the other side of the screen, they are also reflections of our society and are happening all around us.

Competing interests: None declared.

Fiona Kenny , medical journalism student and fourth year medical student, University of Westminster, London
Email: fiona_kenny@hotmail.com 


studentBMJ 2006;14:133 - 176 April ISSN 0966-6494

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