Doctors and the media

Over the decades fictional doctors have been portrayed in very different ways. Some have been father figures whilst others have been deeply flawed. The presentations reflect a very different view of the medical profession and this is especially evident in television dramas over the decades. At the same time news channels have reported some doctors saving lives and others committing crime. In this editorial I review the portrayal of doctors on screen from the 1960s to the present day. Often these reports or stories have reinforced trust in the medical profession. However occasionally they have led to calls for closer regulation. To place the issue in context I first review the published view of the ‘ideal’ doctor.

What is the ideal doctor?

A random sample of 192 people who consulted doctors from any of 14 different medical specialties in the United States of America were interviewed. The interviewers generated seven ‘ideal’ behavioural themes that emerged from their data. A paper subsequently published in the Mayo proceedings reports the ‘ideal’ traits of a doctor as defined by patients: ¹

• Confident: "The doctor's confidence gives me confidence."

• Empathetic: "The doctor tries to understand what I am feeling and experiencing, physically and emotionally, and communicates that understanding to me."

• Humane: "The doctor is caring, compassionate, and kind."

• Personal: "The doctor is interested in me more than just as a patient, interacts with me, and remembers me as an individual."

• Forthright: "The doctor tells me what I need to know in plain language and in a forthright manner."

• Respectful: "The doctor takes my input seriously and works with me."

• Thorough: "The doctor is conscientious and persistent."

Doctors on television: 1960-1970

Doctors on screen in the 60s and 70s displayed many of these ideal traits. For example Ben Casey played by Vince Edwards in the 1960s was an icon for the best and the brightest of his generation. A surgeon with a saintly demeanour, a deep reassuring voice, always perfectly groomed, with the uncanny ability to know the right thing to do, sometimes taking sage advice from his boss, Dr David Zorba (Sam Jaffe), or the anaesthetist Dr Maggie Graham (Bettye Ackerman). Casey worked at the County General Hospital. He and his colleagues dealt with racism, drug addiction, the plight of immigrants, child abuse, and euthanasia. In each of the 153 episodes screened we saw his patients, usually children with neurological tumours, walk out of County General waving affectionately to Casey as they were driven home by chastened parents committed to doing better to deal with their other problems thanks to the heroic efforts of Casey and colleagues in saving their child’s life. The show was very successful for ABC and broke into the Top Twenty shows for its first two years.²

Similarly Dr. Kildare was a television series which ran from September 27, 1961 until April 5, 1966, encompassing a total of 190 episodes. The show, which premiered at the same time as Ben Casey , quickly achieved success and helped spark a number of new programmes dealing with medical drama. Dr James Kildare (Richard Chamberlain), worked as an intern at a fictional large metropolitan hospital (Blair General ). In the series' first episode, his boss Dr Leonard Gillespie tells the earnest Kildare, "Our job is to keep people alive, not to tell them how to live." Kildare ignores the advice, which provides the basis for stories over the next four seasons, many with a soap opera touch. ³

Similar issues were tackled in The Interns , a medical drama series that aired from 1970 to 1971. It was based on the 1962 film The Interns and the 1964 sequel The New Interns . The stories centered on the life of Dr Peter Goldstone (Broderick Crawford) and five medical interns at New North Hospital . The series dealt with issues of the day including racism. The other interns included a newlywed, two bachelors, and a female.⁴ Other favourably depicted TV doctors included John Sullivan from the Australian series The Sullivan ’⁵ and Dr Hiram Baker (Kevin Hagen) from Little house on the Prairie . Indeed when Hagen died in 2005 some of his fans were moved to write the following on an internet memorial site ⁶:

Dearest Doctor Baker,

When my family and I first settled in Walnut Grove you gave us our first set of Laying Hens. You reached out to us with warmth and generosity. In a new town you made us feel very welcome.

Over the years you watched over all of us as we grew. Rescuing some of us when we "fell" into trouble. You were there to welcome a second generation when some of us had children of our own. Your patients were your family and you were a member of each of ours. Your Love, Kindness, and Generosity will always be remembered fondly. Doctor Baker, you will always be missed but your gentle and patient ways will never be forgotten.

All My Love Always,

Carrie Ingalls

Doctors on screen from the 1980s and 1990s

Medical television dramas in the 1980s began to reflect a different perspective. For example St. Elsewhere , appeared on NBC in 1982.⁷ The network considered it Hill Street Blues ⁸ in white (both shows were produced by Mary Tyler Moore (MTM) Productions). Elsewhere was in many ways similar to the groundbreaking police drama. Like Hill Street , the show featured a large cast and serialised plot lines. But St. Elsewhere broke with American medical drama tradition by being set in a declining urban teaching hospital in Boston (St. Eligius). The show’s title referred to the derisive nickname it earned from both employees and patients. St. Elsewhere was a real drama: doctors made mistakes; patients were challenging, some even refused to recover; and the American medical system was shown to be flawed.

Along similar lines in Britain Casualty remains on air as a weekly television show broadcast on the UK channel BBC One. It is now the longest running emergency medical drama television series in the world.⁹ Created by Jeremy Brock and Paul Unwin, it was first broadcast on 6 September 1986.¹⁰ The programme is based around the fictional Holby City Hospital and focuses on the staff and patients of the hospital's Accident and Emergency Department. The sea change in the portrayal of doctors in the media was illustrated by the introduction of the character Ruth Winters (portrayed by actress Georgia Taylor from 2007) at the beginning of its twenty second series.¹¹ The BBC describe the character as "clever, hardworking and focused", stating that she has wanted to be a doctor since she was eight, and graduated top of her class – working hard at the expense of her personal life.¹¹ Taylor herself has commented: "Ruth's very responsible and articulate, and seems pretty confident. But underneath it all, she's something of a troubled soul”. But, for most junior doctors, the first year in a hospital is about learning new skills and acquiring clinical experience. Ruth, although junior, is depicted as reticent to seek help from anyone.¹² During her first few months in the show, Ruth misdiagnoses a patient with a ruptured ectopic pregnancy. One could hardly imagine Ben Casey or Dr. Kildare depicted in these circumstances. What is worse she blames her mistake on a nurse. She accidentally gives a patient a morphine overdose. When she misdiagnoses yet another patient, resulting in his death, she hangs herself.

Doctors on television since 2000

By 2000, on screen doctors were depicted as having lots of faults. House , which debuted on Fox in 2004, broke the mould of the kindly and gentle doctor.¹³ Staring Hugh Laurie as Dr Gregory House, the lead character has all the bedside manner of a ‘rude waiter you would refuse to tip’ – yet he would be the man you would want if no other doctor could figure out what was wrong with you. House and his team at the fictional Princeton-Plainsboro Teaching Hospital take on unusual cases. House’s abrupt manner is aggravated (or is it explained) by losing much of his upper leg muscle, requiring him to use a cane. (He is also in pain, leading to his reliance on prescription medication to dull the ache). House is also characterised as having misogynist attitudes.

Real life heroes

In reality, some doctors have become heroes. America in the 1950s, was a time of fear and anxiety for many parents; summertime was the season when children by the thousands became infected with poliomyelitis. This burden of fear was lifted forever when it was announced that Dr Jonas Salk had developed a vaccine against the disease.¹⁴ When news of the vaccine's success was made public on April 12, 1955, Salk was hailed as a "miracle worker", and the day "almost became a national holiday". His sole focus had been to develop a safe and effective vaccine as rapidly as possible, with no interest in personal profit. When he was asked in a televised interview who owned the patent to the vaccine, Salk replied: "There is no patent. Could you patent the sun?" A few years later Dr Christiaan Barnard from Cape Town South Africa became the first surgeon to perform a heart transplant. On the day this was announced (December 3, 1967) it would seem he had performed a miracle almost equal to that performed on Lazarus of Bethany.¹⁵ For years afterward his smiling face appeared in magazines and newspapers doing daring and dramatic things, standing next to presidents and prime ministers, sitting next to attractive young female celebrities or receiving awards, medals and all manner of other accolades. More recently Australia’s Ian Frazer was celebrated for developing the vaccine against cervical cancer, in 2009 it was patented.¹⁶ However the most lauded doctors continue to be surgeons, including the team that separated conjoined twins Krishna and Trishna in Melbourne on 17 November 2009.¹⁷ The surgeons spent more than 27 hours separating the girls, aged two years and 11 months. Then in 2010 a team of Spanish surgeons performed the first full face transplant.¹⁸

Villains

Medicine has also had its villains. None more odious than Dr Josef Mengele whose murderous experiments on the Jewish victims of the Nazis were filmed in the 1940s and played to the world as testimony to the depravity to which the regime had sunk.¹⁹ Mengele experimented on 3000 sets of twins. Prior to experimentation, some of the child victims were given clean clothes and sweets. They called him “Uncle” and were driven in his car. Then they were subjected to surgery without anaesthetics, blood transfusions, the deliberate injection of lethal germs and sex change operations.

Much less well known is the story of Shan Mohangi a medical student in 1963 Dublin. Mohangi did not did not just kill his 16-year-old sometime girlfriend, Hazel Mullen. He dismembered her body and attempted to boil her remains in the basement kitchen of a fashionable Dublin restaurant where he worked part-time as a chef.²⁰ Since then the villains have been much less easily dismissed as lunatics. Take for example Harold Shipman, the most prodigious mass murderer in British history. He was pictured before his trial wearing a sports jacket, glasses and a beard. He came across as more like the grandfatherly Doc Baker from the Little House on the Prairie than Josef Mengele and yet he was convicted of deliberately injecting his elderly female victims with fatal doses of morphine and then signing cremation certificates to dispose of the evidence.²¹ More recently Jayant Patel was accused and then jailed in Australia for performing surgery for which he allegedly had neither the skill nor the resources. Many patients died, and others were maimed.²² In November 2011, the jury found Conrad Murray, the pop star Michael Jackson’s doctor, guilty of manslaughter after about eight hours of deliberation. He was sentenced to four years in prison.²³ All of these villains or alleged villains were doctors and within seconds of their conviction or indictment their identity, conviction or alleged crimes were reported across the world. The legacy of Harold Shipman’s actions was a major reform of the law and the reaccreditation of doctors in the UK. Since Harold Shipman was convicted, doctors attending patients with a terminal illness and in need of large doses of opiates have had to consider if their actions could be construed as accelerating death rather than relieving pain.

High profile doctors

Doctors have been portrayed in a more favourable light as government advisors. Examples include the American Surgeon General or the UK’s Chief Medical Officer. These doctors are seen to put the nation’s health interests as a top priority. The Surgeon General serves as America's Doctor by providing Americans with the best scientific information available on how to improve their health and reduce the risk of illness and injury. Dr Regina M. Benjamin is the current Surgeon General. The Surgeon General is nominated by the US President and confirmed via majority vote by the Senate. The Surgeon General serves a four-year term of office and is the highest ranking uniformed officer of the United States Public Health Service Commissioned Corps (PHSCC), holding the grade of a three-star vice admiral while in office.²⁴

There are four Chief Medical Officers (CMO) in the UK appointed to advise their respective governments on health related matters: Her Majesty's Government, the Northern Ireland Executive, the Scottish Government and the Welsh Assembly Government. The CMO is the most senior advisor on health matters in each government, and each CMO is assisted by one or more Deputy Chief Medical Officers. In England, the CMO is a member of the board of the National Health Service (NHS), a civil servant in the Department of Health, and head of the medical civil service. The Republic of Ireland has a similar officer. The CMO is a qualified medical doctor whose specialty is in public health and in the health of communities, rather than the health of individuals. The CMO is one of the six chief professional officers, one for each of six professions, who advise the government in their respective specialty.²⁵

Other appearances in the media

Many doctors serve as presenters or experts in the media. Dr Raj Persaud, convicted of plagiarism in 2008 regularly appeared on radio and TV programmes in the UK, as either interviewee or presenter, and was resident psychiatrist on the well-known daytime television programme This Morning . In addition to writing regularly for The Daily Telegraph and The Independent , Persaud also had columns in the Times Educational Supplement , Cosmopolitan and Canary Wharf CityLife magazine. He is a former presenter of the BBC Radio 4 psychology and psychiatry programme All in the Mind . He was a presenter for Travels of the Mind for BBC World Service. Persaud has appeared on numerous talk-shows such as Richard & Judy and Anne & Nick promoting psychiatric treatments for mental health-related issues. With the GP Mark Porter, he co-presented the live medical-talk and phone- in TV programme Doctor, Doctor on Channel Five.²⁶

Hilary Jones is a general practitioner and also a television and radio presenter, and a writer on medical issues.²⁷ Jones writes a weekly column for the tabloid newspaper the News of the World dealing with medical problems and health issues. He also answers readers health questions in the newspaper's Sunday Magazine. He also answers readers' health problems in Rosemary Conley's Diet and Fitness magazine, and edits and contributes to his own magazine Family Healthcare with Dr Hilary Jones. Jones has written a number of books on health, and recorded supplementary relaxation tapes and health videos. In August 2009 Jones released the semi- autobiographical book, What's Up Doc?

Doctors have also been involved in advertising. In the 1950s doctors heavily endorsed Camel cigarettes.²⁸ The consequence, not only related to the doctors’ actions was a dramatic rise in lung cancer and other cigarette-related morbidity and mortality as smoking was perceived as acceptable. The impact of smoking is still being felt across the world.

Doctors have also been seen as victims of crime, especially assault. There are cases of doctors being attacked going about their business of caring. High-profile examples include Mukesh Haikerwal, a former president of the Australian Medical Association who was badly injured in an attack in 2008.²⁹ There have been similar cases around the world including the GP who was murdered in Sheffield UK.³⁰

Trust in doctors

According to the literature most patients still trust their doctors. The proportion of people expressing complete confidence and trust in health professionals in the UK NHS for example is generally high and has remained stable as reported in a study published by Angela Coulter and colleagues.³¹ However the authors also report there are some notable caveats. A minority of patients felt the staff they saw were insufficiently knowledgeable about their medical history or treatment:

• In 2004, 19% of outpatients said the specialist they saw did not seem fully aware of their medical history; the same proportion as in the previous year.

• In 2004, 17% of Accident and Emergency patients felt that some of the staff they saw did not know enough about their condition and treatment; exactly the same proportion as in 2003.

• In 2005, 89% of stroke patients thought their stroke had been diagnosed in time. Of those who did not receive a fast diagnosis, 33% felt their GP had not recognised that they had had a stroke and 40% blamed a hospital doctor.

• Some patients felt more could have been done to control their pain.

• In 2004, 85% of cancer patients said staff did all they could for their pain, an improvement on 2000 when the proportion was 81%.

• In 2004, 27% of inpatients and 44% of emergency department patients said they felt staff could have done more to ease their pain. This proportion had not improved since the previous surveys.

• Among children and teenagers in hospital, 23% said they were in pain all or most of the time and 31% felt that staff could have done more to help.

These findings suggest that some patients may not experience the ‘ideal’ behaviours described by Bendapudi et al.1 and that a significant number of people may find the characters depicted in recent television dramas to some extent consistent with their own experiences.

Conclusions

Doctors have been cast as heroes and villains, public figures, poster boys and celebrities. They have been celebrated as lifesavers, e.g. Jonas Salk or demonised as life takers e.g. Josef Mengele or Harold Shipman. Sympathetic and kind, Ben Casey in the 1960s and rude and objectionable Gregory House in 2004. Society has had a love-hate relationship with on-screen doctors. This may reflect the attitude to doctors in reality, who exhibit every shade of moral behaviour and whose triumphs and misdemeanours are now reported almost instantly on the internet. Sometimes stories about doctors in the media have reinforced positive impressions of medical practitioners. However occasionally, and especially more recently, the media has sown seeds of distrust in a profession that is committed above all else to doing no harm.