Abstract
Sending doctors out on the streets of our most unhealthy cities to cure the sick? The result is pompous and patronising television, finds Margaret McCartney
The idea of this series is to send doctors out onto the streets of Britain to meet members of the public wherever they happen to be—in shopping centres, at their office, on the bus home—to diagnose their illnesses and treat them. The BBC press release says that these “unique open air surgeries offer instant reassurance and treatment to patients with a wide number of common complaints and help those unsuspecting members of the public who may have been previously unaware they had a health problem.”
The four “street doctors” are visiting some of our “unhealthy cities” (the first two programmes are in Liverpool and Glasgow), where “there are countless people living with undetected illness and health problems.” But do not fear, for “it's up to the street doctors to turn the city around.” The doctors carry large signs announcing their presence and are furnished with a patient's trolley, skeleton, and luminous orange medical bags. They unashamedly tout for business by quizzing innocent passers-by. (“Anyone got any medical problems?”) The doctors, with film crew, take abbreviated medical histories and do partially or completely clothed examinations in full view of whoever is passing. As the voiceover proudly proclaims: “Nothing's too private, nothing's too personal.”
In television this might be true. The more personal, dramatic, private, and preferably tortured the revelations, the better the expected ratings. Hence people are warned that they “might” have diabetes before an anxious wait reveals that they don't. Young women are cautioned that they “could” have tuberculosis, before a chest radiograph is subsequently declared normal. Even some men who are at work despite the fact that they think they have the flu must be questioned and examined, apparently to make sure they have nothing sinister wrong with them. In other words, even if you are sensibly at work, self managing your mild viral illness, you may not be safe unless a doctor checks you for the conditions you may have but don't yet know about. You may have been given a false alarm about your health in front of the BBC audience, but you should be grateful for all the conditions that you have been reassured you (probably) don't have.
Then there is the medical advice. Back pain can be sorted “once and for all” with the help of a “physiotherapist, osteopath, or chiropractic,” even though the evidence that the second and third help long term back pain is lacking. And before we even get to the medical advice, the dull but important things—history taking, clinical examination, and a review of previous investigations—are either abbreviated or absent. Even before we get to that stage, how possible is it for the “patients” to give fully informed consent? Everything is prey in the Big Brother era, but we don't have to degrade further the concept of confidentiality.
Are people in such dire need of medical care that they should interrupt their shopping, watching horse racing, or minding their own business to be seen by a street doctor (and television crew)? No. In fact, many of the people who featured had already seen their doctors for their various conditions. Chronic diseases have a habit of lasting a long time, after all. A woman with a long term ear condition—who, she told us, had been in hospital for treatment with intravenous antibiotics and had undergone several surgical procedures—was seen by a street doctor. He had the idea of taking a swab and testing it for antibiotic sensitivity, which we were told resulted in the problem being cleared up for the first time in 13 years. Imagine, it took a BBC programme to think of that! Except that I rather doubt it was a new suggestion: what we see, of course, is the edited, cut, spliced, and reassembled version of events, especially made for short attention spans. The perky aura of quick fixes and instant solutions fizzes effusively from the show. Viewers, unfortunately, might just believe it.
On this point the programme has no disclamatory riders. So we are left believing that doctors and nurses in Glasgow and Liverpool have been doing nothing useful till now and thus hail the heroic street doctors who have arrived to save their city. Except that the street doctors have now gone and left town. The concept of this programme is pompous and patronising. Perhaps if the street doctors saw people who actually did need to see a doctor—and most people are pretty good at judging that for themselves—and then stuck around to take responsibility for long term care, they will have done something useful. There are, of course, schemes already doing this. Such schemes tend to prefer confidentiality, and as such probably wouldn't make such anxiety inducing, crowd pleasing television.
I'll tell you what is great television, though: Green Wing. I watched the last ever episode straight after the previews of Street Doctor, which cheered me up. Green Wing seldom has any conscious patients in it, or any real doctors, but it does manage to be pretty medically accurate. And it is much more entertaining.
Are people in such dire need of medical care that they should interrupt their shopping, watching horse racing, or minding their own business to be seen by a street doctor (and television crew)?