By Rose Brazilek, Writing Competition First Prize 2016

Topic 3: Does popular culture’s depiction of medicine do more harm than good?

From Scrubs to Grey’s Anatomy, television shows depicting doctors appear to be sure-fire media sensations. Initially omnipotent and superlative in early shows such as Ben Casey and Dr Kildcare, portrayals have shifted to the ‘anti-heroes’ of today in House, Grey’s Anatomy and  ER.  ‘Cultivation theory’ proposes televised narratives are the basis of cultivation of assumptions and conceptions concerning cultural norms, memes and values. It is this theory which may explain the importance of physician portrayal in all forms of media, and how perception of medical professionals has altered as the televised climate has similarly shifted.

Older portrayals of physicians have depicted their young, male protagonists as the Adonis’ of the hospital, infallible and to be revered and respected.(1) Their powers extended far beyond the biomedical, empowering patients with the will to live or reconciling estranged couples.(2) Despite the occasional ephemeral representation of the antagonistic incompetent doctor, who was difficult or frustratingly by-the-book (and often physically unattractive), depictions were largely positive. At the time, this directly influenced the doctor-patient relationship: audiences perceived doctors as all-powerful, and thus a very didactic approach to patient care emerged.(3) At the time, patients were reluctant to question the decisions of their all-knowing physicians – after all, their televised heroes were almost never wrong. Older shows that focused on the hero that is the doctor reflected faith in the profession. However, as concerns increased with controversies surrounding rising healthcare costs, medical consumerism and the role of the doctor, so too did negative portrayals of the medical profession.

Decreased consumer confidence  may explain increasing demand for alternative medicines and information sources. Increasingly, today’s patients state their primary medicine source is the media, and their doctors are presumably only approached when practical approaches are needed.(3) The doctor is fallible now, and when humanised is no longer a figure of unquestionable authority. In newer portrayals, the doctor is portrayed as an antihero of sorts, their sometimes unethical practices warranted by a “means justify the ends” approach to practice. In most of House’s highly formulaic episodes, the disregard and disrespectful treatment of the patient is forgiven – the patient has been cured.(4) The patient merely acts as a problem to be solved, and is often completely dehumanised or reduced to stereotypes to showcase House and his team, and their exceptional diagnostic prowess. Viewing audiences come to understand that it is House’s unparalleled biophysical knowledge that makes him a great doctor, and other doctors depicted (who are more empathetic),  can therefore never equal his medical proficiency.(5) Potential patients learn that they should expect preference of the biomedical over the biopsychosocial if they are to expect proficient care – an approach which has been consistently shown to be damaging to patient care.

Alternatively, televised shows that focus more heavily on the emotion and personal lives of physicians also have their dangers. Grey’s Anatomy depicts its doctors as people first and medical experts second.(6) The humanisation of its medical staff is to the detriment of patient care; patients are often seen as exhibits to be viewed, and the rarity of the diagnosis dictates the interest of the treating team. Such shows which aim to reveal the “hidden side” of medicine may have unintended consequences, as by portraying their protagonists acting on their basest desires of lust, pride, greed and envy, it alters public perception and faith in their treating team. Eroding trust in physician care has direct consequences for provision of healthcare, as patients show increased reluctance to visit medical centres or share relevant information of a sensitive nature.(3)

Doctors, medical students and medical staff are not immune to the cultural representation of their profession.(7) The idea of the “hidden curriculum” depicted in medical shows is a pervasive one – persistent cultural memes that fall outside the formal medical curriculum, but are a set of rules that all engaged with medicine nonetheless eventually come to learn.(8) In essence, it a representation of the ‘culture’ of medicine.(9) Most frequently television shows depict the hierarchical nature of physician’s teams – an aspect of hospital life which has often been implicated in the rise of bullying of medical trainees. By normalising belittlement of junior doctors, or the loss of idealism of trainees, such programs also compound these issues, and trainees may even experience anticipatory trepidation at the thought of entering the clinical environment. Additionally, the portrayal of nurses as ancillary assistants to the more important role of the doctor contribute to the solidification of institutional power squarely at the hands of the doctors – whom, such shows argue, are the sole arbiters of life and death in patient treatment. This is sometimes reflected in the respect shown for nurses by both patients and their peers, when they are often expected to be the unthinking drones to follow doctor’s orders.(7)

The impact of such televised dramas on aspiring medical students cannot be understated. The glamorisation of the medical profession is commonly believed to be a contributing factor in the increase in applications to US medical education programs. However, upon consequent exposure to real-life clinical scenarios, students may become disillusioned with the true nature of medicine, fuelling life dissatisfaction.(10) Depictions of the hospital environment, such as the representations of the expectations of work-life imbalance, are dominant within such shows, normalizing these experiences. Patient dehumanisation is another common theme, particularly in shows such as Grey’s Anatomy, in which the patient’s pathology (and by extension, the patient themselves) is a bane of physician’s lives – a problem to be solved.(6) These depictions act to normalise the unethical and unequal treatment of patients, and students are more likely to see such instances in the hospital as expected events, rather than deviations from the norm.

Of course, attention now turns to the cure: how do we entertain without cultivating unrealistic expectations of the medical profession and hospital environments? Concentrated and concerted efforts to diverge from portrayals of doctors as in turn heroic or defective must be made to instill consumer confidence in their treating team. While for most shows, there is physician consultation for the medical aspects of writing, perhaps it is time to consider consultation with all medical professionals on the societal aspects of medicine, to prevent detrimental ideals being ingrained in the next generation.(7) Finally, encouraging patients to divorce the idealised depiction of hospitals from their expectations should they need to enter such an environment, will allow improved uptake of treatment and repair the rapport damaged by depicting doctors as either flawless or deeply damaged.

If nothing else, the persistence of popularity of medical fiction through the years has proven the unrelenting fascination with medicine as an art and a science. Achieving the delicate balance of edification and enjoyment could go a long way in fixing the toxic professional environment that pervades our hospitals and clinics.

Bibliography

1. Chory R, Tamborini R. Television Doctors: An Analysis of Physicians in Fictional and Non-Fictional Television Programs. Journal of Broadcasting & Electronic Media. 2001 Sep;45(3):499-521.
2. Tapper EB. Doctors on display: the evolution of television’s doctors. Proceedings (Baylor University Medical Center). 2010 2010 Oct;23(4):393-9.
3. Pfau M, Mullen LJ, Garrow K. The influence of television viewing on public perceptions of physicians. Journal of Broadcasting & Electronic Media. 1995 1995 Sep 01;39(4):441-58.
4. Strauman E, Goodier B. Not Your Grandmother’s Doctor Show: A Review of Grey’s Anatomy, House, and Nip/Tuck. Journal of Medical Humanities. 2008 Jun;29(2):127-31.
5. Goodier B, Strauman E. The Doctor(s) in House: An Analysis of the Evolution of the Television Doctor-Hero. Journal of Medical Humanities. 2011 Mar;32(1):31-46.
6. Quick BL. The Effects of Viewing Grey’s Anatomy on Perceptions of Doctors and Patient Satisfaction. Journal of Broadcasting & Electronic Media. 2009 Feb 27;53(1):38-55.
7. Turow J. Nurses and doctors in prime time series: The dynamics of depicting professional power. Nursing Outlook. 2012 Sep;60(5):S4-S11.
8. Stanek A, Clarkin C, Bould MD, Writer H, Doja A. Life imitating art: Depictions of the hidden curriculum in medical television programs. BMC Medical Education. Dec 2015;15:156.
9. Jain P, Slater M. Provider Portrayals and Patient–Provider Communication in Drama and Reality Medical Entertainment Television Shows. Journal of Health Communication: International Perspectives. 2013;18:703-22.
10. Charpy J-P. Medical Thrillers: Doctored Fiction for Future Doctors? Journal of Medical Humanities. Dec 2014;35(4):423-34.

Featured image is an icon of Saints Cosmas and Damian, taken from the Grandes Heures of Anne of Brittany (circa 1503 – 1508).