Analysis of social determinants of health in medical dramas to enhance emergency medicine training.

OBJECTIVE: Social determinants of health (SDoH) influence emergency department (ED) outcomes, access to care, and health equity. Television medical dramas often depict these issues and may shape learners' and the public's understanding of the challenges of emergency care. This study examined how medical dramas portray SDoH among patients presenting for ED care. METHODS: We conducted a systematic content analysis of consecutive episodes from prime-time medical dramas using a standardized coding framework. For each included series, the most recent complete season was reviewed for portrayals of SDoH affecting care in the ED. The coding scheme was based on ICD-10-CM Z55-Z65 categories, which capture social and psychosocial factors that affect patients' health status and access to care. Each incident was also classified by how it was addressed within the narrative encounter. One investigator conducted a blinded review of a random 10% sample of episodes to assess coding reliability using Cohen's kappa. RESULTS: We reviewed 236 episodes from 15 prime-time medical dramas and identified 287 SDoH incidents. The most portrayals occurred in Grey's Anatomy, ER, Chicago Med, and HawthoRNe. The most common SDoH categories were the social environment, housing and and economic circumstances, psychosocial stressors, and unemployment. Of all incidents, 26.1% were successfully addressed, 42.2% were partially addressed, 21.6% were recognized but not addressed, and 10.1% were ignored. Unaddressed or neglected SDoH were generally associated with worse patient outcomes in the storyline. Interrater agreement was good (κ = 0.76). CONCLUSIONS: Medical dramas frequently portray SDoH relevant to emergency care. When paired with structured reflection, these narratives could serve as a potential adjunct to teaching social emergency medicine, professionalism, and health equity, but their educational effectiveness remains to be tested in formal intervention studies.