| The Hollywood Issue | Spring 2009 |
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Playing Doctor It was only one sentence, a mere ten words: “I’m not a doctor, but I play one on TV.” With those words, uttered in a 1986 commercial, Peter Two decades later, Robert Jarvik, the inventor of an artificial heart and the holder of a real medical degree, appeared in a series of commercials extolling the virtues of Lipitor to help lower cholesterol. One advertisement used a stunt double to illustrate Jarvik’s devotion to exercise as a complement to his medication regimen. The metamorphosis was now complete: Actors had become doctors and doctors had evolved into actors. The dramatization of medicine has long seemed a natural fit for television. “One of the vivid examples of the tactile quality of the TV image occurs in medical experience,” wrote media critic Marshall McLuhan in his landmark 1964 book, Understanding Media. “The sudden emergence of the TV medico and the hospital ward as a program to rival the western is perfectly natural.” From the earliest days of television, the leaders of the country’s professional medical societies grasped the tremendous attraction the medium held for viewers and the enormous power that television could have in shaping the public’s perceptions about doctors and the care they deliver. But Hollywood can be notoriously fickle. Rather than serving up flattering images, medical dramas on television have reflected society’s larger issues by offering increasingly complex—and often troubling—portrayals of doctors. Strong Medicine In the 1950s, the images of the bloody carnage of both World War II and the Korean War remained fresh in the minds of many Americans. The first significant medical show on television was Medic, which debuted in 1954. The show aimed for an admirably high level of realism: Writers spent more than two years shadowing doctors around hospitals in the Los Angeles area to capture the routines of the physicians and the ambience of the institutions. Each episode opened with the narrator reminding the audience that the doctor was “the guardian of birth, the healer of the sick, and comforter of the aged.” The show’s budget was so small the producers couldn’t afford to build a formal set, opting instead to film the series inside the same hospitals in which the writers had conducted their research. By contractual obligation, a designated representative of the Los Angeles County American Medical Association scrutinized and evaluated each half-hour episode to ensure its portrayals corresponded with the organization’s public relations strategy and maintained a reasonable level of medical accuracy. Once the medical association endorsed the script, the televised episode displayed the organization’s seal of approval. Interestingly, the association deemed one episode—one that depicted an African American physician character—to be racially alarming; it never aired. By the 1960s the country’s mood was changing. U.S. society was awed by the sheer breadth and power of technologies: atom bombs, jet airplanes, satellites. Antibiotics and vaccines appeared limitless in their power to conquer diseases that had threatened humanity for thousands of years. John Kennedy was in the White House, and his administration’s New Frontier program, with its zest and enthusiasm—from the Peace Corps to the space program—had seized the public’s imagination. Two new medical dramas on television, Dr. Kildare and Ben Casey, emerged in 1961. These shows, whose scripts the American Medical Association reviewed, were as interesting in their similarities as they were in their differences. Each focused not on experienced physicians but instead on doctors in training. The first was Dr. Kildare, loosely based on a 1930s film character of the same name. Played by Richard Chamberlain, Kildare was boyishly handsome and exhibited a zealous innocence in his devotion to medicine as a calling. His personal needs always yielded to his patients’ concerns. Issues of income, love, and marriage were noticeably absent in the plots. Kildare lived like a medical monk whose vows required him to cloister himself within the confines of the fictitious Blair General Hospital. While Kildare labored toward the divine light of sainthood, Ben Casey was a darker character. Actor Vince Edwards portrayed him as an arrogant, forceful, and headstrong neurosurgeon who was rushed and irritable from an operative schedule punctuated by innumerable trauma cases. While Kildare was caring, solicitous, and gentle, Casey was gruff, disdainful, and prone to tell his patients what was right for them—or wrong with them. His medical authority seemed to extend far beyond his neurosurgical expertise and allowed him to opine at will on any aspect of his patients’ lives, from the state of their marriages to their psychological weaknesses. Casey’s approach to disease tended to consist of aggressive, high-risk surgeries, usually experimental in nature, with a premium placed on procedures that had never been attempted. Almost all his actions took place in open defiance of hospital administrators and with disdain for government regulations. This no-holds-barred picture of “real medicine” even surfaced in the more sedate Dr. Kildare, when Leonard Gillespie, Kildare’s senior faculty supervisor, declared in one episode: “There are always risks, unforeseeable risks, but risks that must be taken. Medicine isn’t worth practicing if I have to stop myself because of legal risks. Until I am free to proceed on the basis of my knowledge and skill, I am not a doctor. I am a slave to outmoded laws.” Television during the 1960s brought medicine—especially surgery—into a raw, confident light, tinged with enormous faith in the technology now available to both bedside and operating room. Doctors were portrayed as glamorous, heroic, self-sacrificing, and willing to dare risky procedures. The best medicine was the boldest; the swiftest action, the wisest. But these characters also had rebellious, defiant streaks, reflecting the emergent political and social attitudes of a new generation rising up against the traditions of the past. The Dr. Kildare and Ben Casey storylines also introduced a new yet important theme: that of the powerful and profound relationship between a younger protégé and an older, wiser mentor. Kildare had his Gillespie while Casey was under the mentorship of the sage yet short-fused chief of surgery, David Zorba. Since the 1960s, the theme of the mentor–apprentice relationship at the heart of medical training has been a staple of every medical drama. Father Time Just as the Vietnam War split the country into widely divergent political camps, the portrayal of doctors on television exposed new professional divisions as well. The main character of Marcus Welby, MD, which ran from 1969 through 1976 and starred Robert Young, seemed to epitomize the silent majority, with its trust in law and order and in the wisdom of seasoned leadership. In keeping with the times, Welby dished out paternal counsel to guide and restrain his younger, more radical partner. Marcus Welby, MD received the endorsement of the American Academy of Family Physicians, an indication of the ascendancy of primary care on the U.S. health care landscape. By then the American Medical Association had abandoned its policy of overseeing and approving television programs. The association’s leadership instead was becoming concerned that television dramas were raising the public’s expectations beyond anything real-life practitioners could deliver. Television was depicting a success rate in resuscitations of greater than 85 percent, when the actual survival rate was well below 15 percent. The wise Welby proved able to resolve familial conflicts in 95 percent of the television episodes while tending to the medical problems of his patient, singular; his practice seemed to allow him the luxury of having to treat, along with the help of his younger partner, only one patient at a time. The 1970s also brought us M*A*S*H. Although the setting for the drama was the Korean War, it was a thinly veiled allusion to the ongoing conflict in Vietnam. The drama satirized military and political authority as well as religious mores. It underscored the inherent paradox of doctors trying to save lives in the midst of a war in which body counts were the measure of military success. M*A*S*H also brought a dramatic shift in the focus of the storylines. The physician characters became almost the exclusive focus of the drama. The patients and their gruesome injuries began to serve as a macabre backdrop to the main action occurring among the doctors. Alan Alda portrayed one of the main characters, Hawkeye Pierce, as sarcastic, cynical, and sadly disillusioned. His drinking habits often verged on outright alcoholism. He was an inveterate womanizer and showed nothing but defiance and disregard for almost any form of military protocol or etiquette. A new kind of physician also appeared in this series: Frank Burns. Burns was a buffoon—a plodding physician who rigidly abided by rules and regulations. He was often depicted as greedy, stupid, and envious of his colleagues. M*A*S*H showed us a world of medicine in which masterful doctors worked alongside witless ones, with all at risk of having their efforts rendered futile by the larger political context. The early 1980s brought us St. Elsewhere, notable for featuring women and African Americans among the main physician characters in the cast. St. Elsewhere took place in a grimy and under-funded inner-city teaching hospital. The physician characters now had quirks and issues, ranging from bulimia to domestic violence, from sexual deviancy to suicidal depression. Another new, somber note entered into the storylines. Patients could not always be saved. Many were routinely lost, and some even died as a result of physician error and incompetence. House Calls The twentieth century closed out with ER, in which physicians were forced to deliver care in a system on the brink of collapse and patients received merciless triage out of sheer necessity. The crisis in health care delivery was viewed against a chaotic, dysfunctional backdrop. A twist that began with St. Elsewhere intensified, as some episodes explored the physician characters themselves succumbing to medical mishap and disease. A sense of mutual vulnerability emerged: physicians and patients alike seemed at risk of falling victim to a health care system that was running amok. Ironically, the same month ER debuted, the Clinton administration’s bid to establish national health care reform was declared dead on the floor of the U.S. Senate. The twenty-first century added Grey’s Anatomy and House, MD to ER as hit medical dramas. Grey’s Anatomy follows a cohort of residents and attendings in a large, fictitious teaching hospital called Seattle Grace. As a medical script consultant for the show for the past three seasons, I’ve worked with the show’s writers as they develop storylines around neurosurgical problems as esoteric as neurocystercicosis and as mundane as an epidural hematoma. Doctors are depicted not just as clinicians who treat disease but also as patients who occasionally fall prey to it. In Grey’s Anatomy, physician characters have struggled with everything from Parkinsonian tremor to post-traumatic stress syndrome to metastatic melanoma. More than ever, the world of medicine seems slightly out of focus, with a blurred boundary between physician and patient that suggests that doctors are far less heroic than human. House debuted in 2004, with Hugh Laurie playing the main character, Gregory House—a misanthropic, cynical, and brilliant physician at the fictional Princeton Plainsboro Teaching Hospital. There House routinely insults, belittles, and ignores his residents and fellows on clinical rounds. Various episodes depict him physically assaulting patients, their family members, and even the occasional colleague. He performs surgical procedures for which he has neither credentials nor privileges. He administers medications to patients without their consent, and when he deems a surgery on another doctor’s patient to be misguided, he wheels that patient right out of the operating room. He steals hospital records, bullies patients into signing consent forms, and even treats children against their parents’ wishes. House adds personal foibles to his professional transgressions. He breaks into the hospital pharmacy to feed his addiction to pain medication, writes prescriptions for himself, and occasionally faces arrest for drug possession. Yet we root for House. He’s a genius and a sociopath—a Sherlock Holmes who solves the crime but never seems able to see the victim. Reality TV Doctors, so often noble icons during the early and mid-twentieth century, have thudded to Earth, and television has reflected this descent. The earlier idealistic depictions of physicians slowly eroded as the health care system became more harried, intrusive, and overwhelming. Medical dramas on television no longer portray physicians as saints but instead delve into multidimensional physician characters who often display a rebellious and sometimes even sociopathic defiance of the medical establishment. As their portrayal has become increasingly more human over the decades, doctors have also become more accessible to the viewing audience. The public’s fascination with the real drama inherent in medicine has not seemed to have faded for more than a half century. Instead, television series have evolved to place medical challenges in the larger context of real societal issues, propelled by the uncanny ability of scriptwriters to take the pulse of their audiences. Allan J. Hamilton ’82, FACS, is a professor of neurosurgery at the University of Arizona. He also serves as a medical script consultant to two television shows, Grey’s Anatomy and Private Practice. Photo caption: The snide and scruffy lead doctor of the hit television series House, MD, Gregory House (played by Hugh Laurie, bottom center), is a far cry from the earnest and clean-cut Drs. Kildare and Casey of earlier medical shows. Photo: Nigel Parry/Fox Broadcasting Company/Photofest |
Bergman parlayed his role as a physician on the soap opera All My Children into an endorsement for Vicks Formula 44 cough syrup. In delivering what would become an iconic statement, he blurred for the first time the distinction between the dramatic portrayal of medicine on television and medicine in real life.
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