Does reality inform fiction or fiction inform reality? If you ask Joseph Turow, Robert Lewis Shayon Professor of Communication at the Annenberg School, he would say it is a little bit of both.

Turow has spent the past decade probing the relationship between the television and medical establishments, putting popular prime-time medical programs like “ER,” “Scrubs” and “Gideon’s Crossing” under his critical eye.

He said that today’s medical shows usually involve complicated ethical storylines where “the power of doctors often just falls apart.”

“ What we found is that doctor shows portray an ethically complex environment in which physicians are no longer the captains of their fate, in which mistakes are often made, and malpractice is omnipresent,” said Turow. “And often when malpractice happens it’s the physician’s fault.”

According to Turow, these shows tend to filter the medical world through the physician’s eyes and do not adequately incorporate other players in the healthcare arena, for example lawyers, insurance agents and federal legislators.

In a Henry J. Kaiser Family Foundation study titled “As Seen on TV: Health Policy Issues in TV’s Medical Dramas,” Turow found that medical dramas only touch upon health policy issues briefly and often go out of their way to emphasize the complexity of the issues they do focus on. A reason for this, he explained, is Hollywood’s need to capture viewer’s attention through “life-and-death” storylines.

But what may work well for Hollywood is not necessarily good news for real physicians. Turow said there’s reason to believe that what patients see in their living rooms may affect how they react at the doctor’s office. “What doctor shows do is they allow people to go behind the scenes to see ‘what’s going on’. Whether it’s realistic or not they may not know how to tell the difference.

“ The notion of how an ER works, the problems, the mistakes, the difficulties that people get into, the way physicians protect other physicians. All of these things may be cultivated to some extent through the watching of television… TV may reinforce those kinds of concerns and fears about the institutions impinging upon doctors. Some people may think doctors need more power, some people may not.”

Still, not all of Hollywood’s images are working against doctors. There’s a positive side too, one that depicts physicians as individuals who care a lot about their patients.

Turow said he wants tomorrow’s physicians to be informed about the impact of the media on their relationships with patients. Together with the Robert Wood Johnson Foundation, he is producing a CD-Rom that addresses the issue. Approximately 20,000 first-year medical students are expected to receive the disc. He said he hopes the program will spur a discussion on how physicians talk to patients about television and spark more critical analysis of such dramas.