“Doctor, Doctor – Where are thou?” Medics in Movies and Television – Part II

General Hospital and Doctors both sought to change this. Their immense popularity spawned the medical soap opera, in which the hospital setting replaced the home or street, as the main centre for drama. Dr Kildare’s viewership, as the prime time medical series and the soap opera family, were taken over by far more elaborate medical staff, where their hospital settings provided opportunities for the limitless introduction of new characters as hospital patients and personnel.

According to Robert C. Allens, speaking of soap opera, General Hospital and Doctors were the first to break the mould, with their introduction to controversial medical issues, such as incest, impotence, amnesia, illegitimacy and murder as a result of temporary insanity.¹

In the 90s, we were introduced to the phenomenon of ER, which gave us a hardened realistic glimpse, at what happens in a busy emergency room, coupled with the fast, pacy storylines and the introduction of the first controversial African-American female medic, who contracts the HIV virus and is trying to come to terms with her diagnosis.

Over the pond, in the UK, Peak Practice, Holby City, West Way (BBC World Service Radio) and Doctors soon followed  and  there was such a large appeal for medical soap operas, that even non-medical soaps e.g. Heartbeat and Eastenders  included doctors and nurses among their central characters.

In her research paper entitled Medical Education via the Mass Media, Fiona Kenny, a fourth year medical student from the University of Westminster, says that: “Health is important and relevant to everyone, whatever age, and it is therefore no surprise that so many medically related soap operas are now produced.”²

She added: “All soap operas have characters experiencing concerns about their physical wellbeing and have the option of providing this combination of education and entertainment – a genre which has been classified as “edutainment.” ²

Kenny cites the example of the UK’s soap opera Hollyoaks², which was congratulated by one of England’s parliamentary members, for its success in raising awareness about the current, most common STD in the UK, which is Chlamydia.³ The storyline follows Lisa, through her contraction of the disease and considered various social and medical issues that arise as a consequence of unprotected sex.

Facts and Fiction

While some medical soap’s storylines are successful at educating their audience, other medical soap writers, however find themselves falling into the trap of creating unrealistic TV dramas, which rely more on dramatising suspense rather than medical accuracy.

Dr Rob Hicks, general practitioner, journalist, and script adviser for the UK soap opera Doctors said: “What happens in medical dramas is incredibly uncommon in life… If it can happen, then it probably will.”²

As a result, medical accuracy is being grossly discarded in favour of plot and character; this ensures a high turnout in viewership ratings on prime time television.

American medical soap operas have already been accused of painting “too rosy a picture” of coma. 8% of coma patients in soap operas die compared to the real life 50% of coma patients never recovering.²

Likewise when it comes to the big screen, writers and producers either exaggerate the coma or underestimate it. Dr Eelco Widjicks, found only two films – out of the 30 he reviewed, which portrayed well, the state of a comatose patient.⁴ These are: Reversal of Fortune (1990) and the Dream life of Angels (1998).

The other 28 movies lacked an accurate depiction of a comatose patient and often showed ‘miraculous awakenings’, with no real long lasting effects on the patient’s life.⁴ Other flaws included a lack of feeding tubes, unrealistic muscle contractions, and no sign of a tracheotomy to aid breathing whilst comatose patients sustained a muscular, tanned and well groomed look.

These statistics are not reserved only to the way coma patients are depicted on the small screen. The television portrayal of cardiopulmonary resuscitation was also acknowledged to be producing unrealistic public expectations.

The repercussion of these portrayals is that they raise public hopes about the effectiveness of medical treatments and the optimistic outcomes of disease, causing unnecessary emotional grievance both for the relatives and for the doctors concerned.

Bureaucracy in the healthcare system

The 90s doctor’s movies conveyed powerful messages of inefficient healthcare systems, which hinder patient care, and the ugly reality of helping the medically insured patient as opposed to saving lives. In Extreme Measures, Hugh Grant is confronted by a hospital administrator about the costs of multiple lab tests on a patient who died mysteriously:

“Who the hell is Claude Menkins?”

“It’s was, I’m afraid he died.”

“Tell me he had insurance.”

“No. That’s not at all likely.”

“Ok. Let’s get it into your head. This is not England; this is not the National Royal Shakespeare taxpayers pick up the tab health care system. OK somebody has to pay for this.”⁵

Bad hospital management came to the fore in Article 99⁶, starring Kiefer Sutherland where a group of doctors in a soldier veteran’s hospital, must contend with their hopeless situation: too many patients and not enough beds. The main cause of their problems is bureaucratic belt-tightening by the hospital administrators. Despite the obstacles the doctors are determined to give the best service they can, even if that means defying the orders of management and performing unauthorized operations.

The powerful, poignant And the Band played on provided a lot of insight and social commentary on the discovery of the Aids epidemic. The movie portrayed a cast of well meaning, dedicated doctors who were willing to do anything to expose the deadly Aids epidemic, going against politicians’ bureaucratic policies.

Last but not least, The Doctor based on the autobiographical real life story entitled A taste of My Own Medicine: When the Doctor Becomes the Patient by Dr Edward Rosenbaum, MD starring William Hurt, this time examines the doctor becoming the patient. An arrogant heart surgeon finds himself diagnosed with cancer; seeing the system from the other side which is mechanised, unsympathetic where the patient’s comfort is the least concern, the doctor goes through a voyage of transformation and self discovery.

Forensic Medicine

The basis for screen forensics dates to Sherlock Holmes’ fifty-six short stories and four novels, written by Arthur Conan Doyle. Doyle’s creation, based on his mentor at the University of Edinburgh, the gifted surgeon and forensic detective Joseph Bell, was eventually successfully brought to the big screen and television.

Doyle’s fictional character was the original forensic expert dabbling in chemical experiments, as he used to take findings from a crime scene, for example, cigar ashes and deduce the person who smoked it, therefore making important findings as to who committed the crime. In  fact his fondness and contributions to chemistry were so appreciated  that in 2002 Holmes was inducted as an honorary fellow of the Royal Society of Chemistry — the only fictional character so honoured — in appreciation of the contributions to forensic investigation.⁷

The 1970s gave us Quincy, M.E, starring Jack Klugman. The series was catalyst in depicting a Medical Examiner investigating, instead of a police officer, whereas before the pathologist was the last person to be consulted; his laboratory findings proved to be invaluable, in solving the intricate web of crimes. Quincy made it a point to highlight the bickering conflicts between the coroner and the police, both trying desperately to solve a crime and trying to prove that their way is right. Although times have changed some medics may beg to differ.

For a long time, depictions of bodily organs during a post mortem were deemed unfit to be seen on television. This changed in 1996, with the brilliant Silent Witness; for the first time a female pathologist was shown performing a post mortem in considerable raw detail, with the pathologist taking out organs from the corpse, weighing and dissecting them.

The taboo was lifted once and for all, on the way dead bodies were graphically depicted on television, in 2000 with CSI. Crime Scene Investigation changed all of this, with its innovative cinematography that shows clearly, detailed close up sequences of how microscopic DNA traces and fingerprints manage to penetrate bodily organs and murder weapons, giving solid evidence to the forensic investigative team as to who committed the crimes.

CSI was ingenious in its approach, as it broadened the public’s perception on forensics, with its main character, Gil Grissom (William Petersen), hailed by many as the 21st century’s answer to Sherlock Holmes. Grissom’s character nicknamed “The Bug Man”, was educational in its approach to forensics by introducing the study of Entomology (the study of insects), to the general public in a simple manner, thus making the different branches of Forensic Medicine more accessible to the audience.

If Quincy introduced the Medical Examiner onscreen and set the standard for the way Medical Examiners are depicted, CSI went much further in showing how times changed since the 70s, as the Medical coroner was not just confined to the morgue, producing autopsies that determine the time, cause and manner of the victim’s death. In CSI, the medical coroner plays a pivotal role in the investigation, working alongside the police and fellow Crime Scene Investigators, proving that the answer for the unusual circumstances behind the death is found first in the field, then in the morgue.

CSI’s Medical Examiner, Dr Al Robbins played by Robert David Hall, who in real life has two prosthetic legs, was very instrumental in portraying that disability should not hinder a talented pathologist from performing his vocation.

The series has so influenced the public’s perspective on forensic medicine, that faculties of forensic investigative science in universities in the US and Europe, have reported an increase in the number of student applications.⁸ The rise in students studying forensic medicine has been dubbed “the CSI effect”. Even forensic departments are using the show as a marketing ploy, making it a point to show images of the barricade yellow tape stating: “Crime scene: Do not cross” on their websites while their prospectuses emulate the CSI, first season DVD cover.

Despite CSI being praised by critics and viewers alike, this is not to say that the show is flawless or indeed real. At the end of the day CSI is an entertaining show and it’s far from reality. This is shown with the unrealistic speed at which the actors are able to identify, apprehend and prosecute the perpetrators. In the real world, unlike television, where the crime must be solved by the end of the hour, crimes are solved with slow, deliberate and methodical steps. Dr Jennifer Thompson, program director of studies of the forensic science program at the University of Nevada stated that, “CSI is getting more people interested in the science, which is fantastic.”⁹ However she also added that, “The shows themselves are idealized versions of the field, they’ve got wonderful technology that just isn’t available in real life, and everything gets solved in a neat and tidy hour!”

It was inevitable that CSI’s forensic innovative cinematography and Holmesian deduction would be transposed to a hospital diagnostic setting in House, M.D.

In House, computer wizardry has substituted the bullet for the injection, penetrating bodily organs, both holding the same visual effect.

When House was shown on television, the producers and medical consultants made it a point to do away with the simplicities of the compassionate Dr Kildare. Instead we were treated to the most eccentric and sarcastic (that might be mistakenly British!!) medical doctor ever presented on television. Dr Gregory House played by Hugh Laurie is a non conformist, who despises wearing his lab coat, no nonsense medical doctor with no time to waste, who leads a group of young physicians in the department of diagnostic medicine at a teaching hospital in New Jersey.

The show is very questionable as to how in real life hospitals put up with such doctors without being dismissed on ethical grounds. What’s admirable in this medical series is that for once we are not presented with a Clooney heart throb for a doctor, but an average looking, unshaven medical genius with a disability in his foot that is closer to home.

House and his team solve medical mysteries with the flair and resourcefulness of CSI’s forensic investigators, showing how controversially, the head of the diagnostics department, prefers to interact with diseases rather than patients and their feelings. This often leads to the questioning of whether his medical methods are orthodox,  usually resulting in clashes with his medical team and hospital administration.

In his article in The New York Times, Dr Sanjeep Jauhar, MD rants how his wife, a general internist, finds the show absurdly unrealistic, as it portrays a world where doctors have time to solve problems.¹⁰

Jauhar adds, “Young doctors I work with today seem disengaged and mentally fatigued, with patient rosters of fifteen or more, they are preoccupied with getting their work done. Interesting cases tend to generate anxiety, not excitement; mysteries are, by and large, abhorred.”¹⁰

Without a doubt doctors’ movies and television series will continue to be produced, as they are living evidence of the infinite fascination with the medical profession and are a proof of the ever growing public consciousness on health issues. They can be humourous (Carry on Doctor, The Millionaires), thought provoking (The Doctor, Article 99, CSI) or informative (And the Band played on) that make the wonders of medicine comprehendible to everyday folk.

References

1. Soap Opera. Available from: http://www.museum.tv/archives/etv/S/htmlS/soapopera/soapopera.htm. Taken from: Allen, RC. Speaking of Soap Operas. Chapel Hill: University of North Carolina Press, 1985.

2. Medical Education via the Mass Media. Available from:

http://www.studenytbmj.com/search/pdf/06/04/sbmj168.pdf

3. Chlamydia. Available from:  

http://www.hpa.org.uk/infections/topics_az/hiv_and_sti/sti-chlamydia/chlamydia.htm

4. Comas ‘not realistic in movies’. Available from:

http://newsvote.bbc.co,uk/mpapps/pagetools/print/news.bbc.co,uk/1/hi/health/498404

5. Doctors in the Movies c/o the BMJ Journal Archives of Diseases in Childhood. Available from: http://adc.bmjjournals.com/cgi/reprint/89/12/1084

6. Plot Summary of Article 99. Available from:

http://www.imdb.com/title/tt0101371/maindetails

7. Holmesian and Sherlockian deduction. Available from:  

http://en.wikipedia.org/wiki/Sherlock_Holmes#His_knowledge_and_skills

8. The CSI Effect. Available from:  

http://en.wikipedia.org/wiki/CSI_Effect

9. Is CSI for real?. Available from:

http://encarta.msn.com/encnet/departments/elearning/?article=csireal&GT1=6526

10. Magical Medicine on TV. Available from:

http://www.nytimes.com/2005/07/19/health/19comm.html?ex=1279425600&en=1e3a52cb2bb093a1&ei=5090&partner=rssuserland&emc=rss

Justin Camilleri graduated with a Bachelor in Communications in 2004 and has just completed a Masters in Magazine Journalism from the University of Central Lancashire. He regularly contributes to local newspapers and international magazines.