Friday, February 19, 2016

What Medical School Looks Like XXIX: I'm not a doctor, but...

Friday I participated in a group project about "Medicine on T.V." My job was to lead our classmates in charades of popular doctor shows and to discuss the portrayal of medicine and physicians in them. The skits (we let them talk) were hilarious. After each one, I played a clip from the show and invited reaction. Some people shared how watching the show had shaped their desire to go into medicine, or how their views changed about another after they got into medical school. We debated whether depicting doctors as anti-heroes was more realistic than the classic "tv doctors," or whether the episodes were too "soapy" to convey anything about the characters as physicians or surgeons.

The original tv doctors were Ben Casey (5 seasons, 1961-1966) [Primal metaphysics] and Dr. Kildare (5 seasons, 1961-1966) [mashup]; Marcus Welby, M.D. (7 seasons, 1969-1976) [Episode intro] came along at the end of the decade. All three were white, heterosexual, able-bodied men who were beloved by American TV viewers for being compassionate, principled healers who did the best for their patients, even if it was unconventional or required standing up to "the system," narrow-minded specialists, greedy medical malpractice lawyers, etc. Casey was a neurosurgeon, Kildare an idealistic young surgical intern, and Welby--interestingly enough--a general practitioner. It occurs to me that surgery (and emergency medicine) appear flashier and more exciting than internal medicine, which may be why House, MD had to have such exaggerated differentials to make diagnosis look interesting. It is probably why the cases on Mercy Street tend toward the surgical, even though 2/3 of casualties during the American Civil War were from disease.

Handsome intern Dr. Kildaire
in "hospital whites."
The skit for M*A*S*H (11 seasons, 1972-1983) [War is war, Hell is Hell] depended on the audience understanding a reference to at-first unheard "choppers." All of the doctor tv shows address social issues, this one perhaps more than most. I pointed out that the creators had borrowed a page from Gene Roddenberry's book: just as Star Trek was set in the future in space to make commentary about the present possible, so M*A*S*H was set in the recent past during the Korean War, even though it was pretty obviously about the Vietnam War. One person mentioned how foreign the idea of military medicine is, particularly the fact that working and living happen in the same place--the medical staff never really leave the "hospital," which was also true of the original hospital "residents."

Doogie Howser, MD (4 seasons, 1989-1993) [VHS trailer] and House, M.D. (8 seasons, 2004-2012) [tensions on the team] provided examples of socially inept medical geniuses. Doogie made it look like anyone could practice medicine, but no one practices the kind of shot-gun testing, treat-before-the-results-come-back medicine that House did. These doctors have a lot of privilege and were forgiven many things (being too young, being a misanthropic drug addict with no bedside manner) because they got results.

I included Dr. Quinn, Medicine Woman (6 seasons, 1993-1998) [Season 1 opening] as a positive portrayal of a female physician. Set in Colorado Springs in 1867, the show is at least as much about family and community as it is about historical and rural medicine. Someone pointed out that male doctors' families are rarely thematized as often as female practitioners' are.

Starting just a year later but running three times as long, E.R. (15 seasons, 1994-2009) [I think I'm going to be sick] introduced the era of modern doctor dramas, with complicated, often faulty characters. I thought this clip from the opening of the very first episode was an excellent introduction for soon-to-be interns looking for their own wise Dr. Greene mentors.

Scrubs (9 seasons, 2001-2010) [Double secret decoder ring-wearing doctors!] brought comedy back to the genre. Episodes combined J.D.'s surreal daydreams, spontaneous musical numbers, and slapstick comedy with pointed commentary on adulthood, relationships, and work-life balance that ranged from the wry to the melancholy. Somebody mentioned that for all his sarcastic comments, Dr. Cox does in fact mold the interns into better doctors, who turn around and teach the next generation.

Alas, my classmates were not as excited as I was about the clip from Grey’s Anatomy (12 seasons, 2005- ) [surgeon vs researcher] I showed. There were plenty more representative--and salacious--scenes, but I was curious to hear how fellow MD/PhDs balance their dual identities as confident clinicians and researchers uncertain about what they will find. Mostly we talked about the unethical basis for the show (superior physician pursues an intern) and how it is such a soap opera that viewers never get to see the characters mature as surgeons.

Finally, we didn't have time to discuss The Knick (2 seasons, 2014, 2015)  [Surgery 101] on Friday, but I have led a discussion about the first episode for (mostly) medical students about the kind of medicine it portrayed: another unstable, drug-addicted genius who's forgiven because of his heroics in the operating theater; racism and sexism in American medicine c. 1900; and I think a really touching exchange after a surgery goes badly about the difference between taking responsibility for patients and identifying one's work as one's worth. The clip nicely encapsulates the stereotype of "I'm not a doctor, but I play one on tv," as the actors describe gaining the confidence they had to portray on screen. It was a good segue into the next part of the session, looking at the performance of medical authority by real doctors on tv (e.g. Dr. Oz), celebrity spokespersons (Jenny McCarthy, Angelina Jolie), and direct-to-consumer advertisements (click here for a word from our sponsors).

With thanks to E.D., A.J.M., A.L., I.N., and J.S. for being such good team members!



  1. Replies
    1. That's a new one for me! I haven't even gotten around to _Call the Midwife_ or _Mercy Street_ yet.

  2. In the intersection of workplace settings (my preference) and medical settings, I've predominantly enjoyed comedy: MASH, Scrubs, and Becker.

    Great lens to think through such weighty subjects.


Your comments let me know that I am not just releasing these thoughts into the Ether...