April 20, 2017
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The Good Doctor: The Evolution of a Media Identity
by Tom Soter and Doniphan Blair
Hugh Laurie, as Dr. House, invites us to accept the knowledge of our own inadequacies AND thereby accept his brilliant analysis. photo: courtesy Fox
WESTERN CIVILIZATION'S CRANKIEST
but most creative MD used to be Louis-Ferdinand Celine, the French doctor whose “Journey to the End of the Night” (1932) joined the 20th century’s top troika of modernist novels, after James Joyce’s “Ulysses” (1922) and before Henry Miller’s “Cancer in the Tropics” (1934).
Although Celine cemented his reputation as the world’s greatest misanthrope by collaborating with the Nazis, he continued working as a dedicated doctor in a poor Parisian clinic and writing innovative, prejudice-free novels, which inspired many, including Jewish authors like Phillip Roth.
Fox Television obviously updated this “mean doctor” tradition with “House M.D.” (2004-12), created by David Shore, a Canadian producer/writer, despite attempts to draw parallels with Sherlock Holmes: Dr. House as a dedicated investigator and musician, with a Watson-like assistant, etc.
Testily portrayed by Hugh Laurie, the English actor, musician AND comedian (now in much demand as a villain), House fights constantly with his bosses and colleagues. Celine similarly loathed all authority as well as contemporaries, even declining a visit from the adoring Miller, whom he reviled as an “intellectual.”
House is injured, with leg as well as emotional problems, and requires so much self-administered narcotics that getting him to rehab becomes a central theme in Season Three. Although Holmes injected cocaine, it was only to occupy his mind when not working on a case, not to relieve existential pain.
Every generation has its popular medical show. Today’s well-rated “Grey’s Anatomy” (2005-, ABC) focuses on the transition from intern to doctor in a modern, multicultural hospital—it was created by Shonda Rhimes, a screenwriter, director and producer who is African-American.
Despite a continuity error in the first non-flashback scene of Episode One, “Grey’s Anatomy” is still going strong—but it doesn’t make for as good drama as “House”.
The ongoing and popular 'Grey's Anatomy' is hip, young and multicultural but not the runaway hit of 'House, MD' which went off the air in 2012. photo: courtesy ABC
Indeed, after becoming a top-ten rated show in the US from 2006 to 2008, “House” earned distribution in 66 countries and became the MOST-WATCHED program in the world in 2008, ultimately taking home five Emmy Awards, two Golden Globes and a Peabody.
Things weren’t always this way, of course. The industry standard used to be the upstanding, morally-uplifting doctor.
"I became a doctor in part because of ‘Ben Casey’ and ‘Dr. Kildare’," noted Dr. Peter Hesslein, a professor of pediatric cardiology at the University of Minnesota. "When I was coming out of college in the early ‘70s, I had a strong urge to be a public servant, and those shows made medicine seem very attractive.”
"I saw ‘Dr. Kildare’ as a kid,” agreed Dr. Thomas Barnard, a New York cardiologist. “It was exciting and glamorous."
Ironically, “Dr. Kildare” and “Ben Casey” ran simultaneously, from 1961 to 1966, as NBC and ABC went toe-to-toe trying to dominate the lucrative medical genre. At their height, they were watched by 32 million teenagers a week while comic books, board games and even a "Ben Casey" medic's shirt flooded the market. “Kildare”’s star, the sexy Richard Chamberlain, became a recording artist, starting with a version of his show's theme.
Meanwhile, among actual doctors, "(w)e were made into a kind of demi-god," recalled Dr. Christine Edwards-Freeman, a New York-based obstetrician and gynecologist, a claim borne out by polls from the 1960s. One found that the public rated physicians second only to Supreme Court Justices for compassion, integrity and sagacity.
No longer. In our ever-burgeoning "Age of Cynicism," doctors—like most establishment figures—are viewed with increasing mistrust. While the public used to see doctors as geniuses able to perform miracles, not anymore, despite vast improvements in medicine.
Richard Chamberlain starred in the '60s medical hit, 'Dr. Kildare', wowing the girls til he came out in 2003, at 68. photo: courtesy CBS
"We now get a lot of negative press," said Dr. Steven Lamm, a professor at the New York University School of Medicine, estimating that the trend started in the late-1980s.
"We can no longer assume that the interest of the health provider is in the best interest of the consumer," a New York Times op-ed opined in 1989. Its concluding sentence: “Health care is big business.”
Aside from the obvious corporatizing, which drove doctors from general practitioners to rushed clinicians, while stripping clean the patients, how did this come about? What role did media play?
"[The television doctor] was usually strong-willed and humanitarian," noted Dr. Mark Goetting, a Detroit pediatrician. "He was good, but shallow, in the sense that there was almost never a struggle about the right or wrong of what he was doing. There would never be a questioning of medicine or of the procedure."
This stereotype started early, in films like “Calling Dr. Kildare”, the 1939 prototype for the TV show, “Magnificent Obsession” (1954), with Jane Wyman, Reagan’s first wife, and even “The Quiet Duel” (1949), by the Japanese master Akira Kurosawa.
In “The Citadel” (1938), a popular English film set among Welch miners, the idealist doctor (Robert Donat) battles mistrust and hatred to cure his patients of tuberculosis. "I'm not going to be influenced by ignorance and superstition!" he cries in the climactic scene. "I'm working for these people and will not let their stupid prejudices stop this work!"
To Ben Casey (played by Vince Edwards, whose only other big role was the 1968 war film “The Devil's Brigade”), the "operating room was like a church," with the surgeon not so much preacher but divine messenger. His colleague, the elderly Dr. Zorba (Sam Jaffe), put it simply: "We are not just men. We are doctors.”
As it turns out, the American Medical Association was aggressively lobbying for such an elevated status, offering producers and writers lists of preferred doctors as consultants and supplying journalists with reports on the latest medical breakthroughs or packaged physician interviews.
An actual video still from a scene dealing with marijuana legalization from 'St. Elsewhere' which pioneered the decadent doctor theme on TV. photo: courtesy NBC
In such TV shows as “The Doctor“ (1952-3), “Medic“(1954-6), “D. Hudson's Secret Journal“ (1955-7), “Doc Elliot“ (1973-4), “The Nurses“ (1991-94), “Marcus Welby M.D.“ (1969-76), and “The Interns“ (1970-1) as well as “Casey“ and “Kildare“, physician as missionary was the standard.
They also became magicians, psychologists, even matchmakers, with obvious effects on the public.
"The physical appearance of the doctor on TV is of a suave, sophisticated, and elegant person,” noted Dr. Lamm of New York. “On TV, hospitals are always neat and orderly—not frenetic as many hospitals are. We can't meet those expectations."
"Most of these shows succeed in terms of technical accuracy,” added the NY cardiologist Barnard, “except that the doctors always had a textbook case, with the latest state-of-the-art therapies available. In real life, however, usually you have an array of complicated problems: diabetes, heart disease, hypertension, problems at home… problems that don't fit into a slot."
In this way, the media created dangerous stereotypes. For example, in cardiac arrest, less than ten percent of patients survive, even in 2014 and much less in the ‘60s, with some survivors suffering serious brain damage. Yet if you watch a medical show, you'd think once the paramedics arrive, everything will be fine.
"The TV producers have, if you'll pardon the expression, 'doctored' things up a bit,” quipped Dr. Edwards-Freeman, the New York obstetrician.
"Television has greatly exaggerated our ability to cure everybody,” Dr. Lamm lamented, which fosters incomprehension among the ill. Why is there is no cure for my ailment, they wonder?
Then there are the mundane issues. "The media want a cure for cancer every day," complained Dr. Alan Matarasso, a New York plastic surgeon. "They're not interested in the nuts and bolts. Fifty percent of an intern's time is doing ‘scut’ work: drawing blood, taking someone to a chest X-ray."
Alan Alda's trickster—but good--doctor, in 'MASH', allowed for humor, social commentary and some good drama. photo: courtesy CBS
By not showing such aspects of a physician's day—not to mention the ridiculous paper work—these programs made it difficult for patients to understand why doctors couldn't spend more time with them. "On television," said Dr. Lamm, "a doctor sees one patient throughout the show. I'm seeing 30 patients a day."
"The costs of doing health care, malpractice insurance, and hiring a well-trained staff caused physicians to become businessmen," explained Dr. Richard Stein, chief of cardiology at the State University of New York Health and Science Center. "We have to charge more, see more people, and our incomes are still diminishing."
Such cost-cutting contradicts the humanitarian themes often depicted in earlier television. Dr. Matarasso remembered a colleague who did Medicare work but was reimbursed only 37 cents on the dollar. “So he said, 'To hell with it. I won't see indigent patients.'”
Showing physician’s self-interest was not really explored until “MASH”, a hit movie and then television show, which is now enjoying a revival on Netflix.
In Robert Altman’s award-winning film (1970), Donald Sutherland played the lead, Hawkeye Pierce, a doctor in a frontline medical unit during the Korean War, but Alan Alda took over on the TV show (CBS, 1972-83). Alda came to embody the independent, iconoclast, even hipster (he was alcohol-abusing and anti-war) BUT still excellent MD.
Ever the dedicated doc, Hawkeye was always friendly to Korean locals, to his patients and, especially, to women (except for "Hot Lips" Houlihan, played by Loretta Swit, the square foil of the show)—but not authority figures.
Although “MASH” struggled against threats of cancellation in its first season, the finale, 11 years later, was the most-watched episode in television to-that-date, with 125 million viewers!
Alda went on to many big parts, from co-starring with Woody Allen in his “Manhattan Murder Mystery” (1993) to starring as the President in Michael Moore's “Canadian Bacon” (1995), but “MASH” was his career-maker.
Despite San Francisco's supposed reputation, 'Trauma', a television series (2009-10), which followed a group of San Francisco paramedics, was too much action and not enough edge. photo: courtesy NBC
In fact, when Evan Flatow graduated from Columbia Medical School in the 1980s, the keynote speaker was not a cardiologist or a surgeon but Alda.
"Ours was the first to have a non-medical figure address our college," recalled Flatow, who now practices in New York. "Everyone was impressed by his [television] character.”
Indeed, Alda so elevated the television doctor as a stand-in for wise man, the medical show stereotype “MASH” was supposed to debunk, he became PBS’s host for “Scientific American Frontiers” from 1993 to that show’s conclusion in 2005.
In the end, the problems of the profession were not publicly aired until “St. Elsewhere”, which premiered on NBC in 1982. Set in a seedy hospital in Boston, a typical episode might include a doctor getting mugged in the emergency room, a mentally ill patient wandering the halls and two doctors making love on a slab in the morgue.
"That series came closest to my experience as an intern," noted Dr. Elissa Ely, a Cambridge psychiatrist. "The doctors suffered. They laughed. They cried. They lost patients. It was bloody."
AND they made mistakes. In one “St. Elsewhere” installment, a patient died because of the faulty drug dosing. "The doctor involved falsified the records," recalled Dr. Goetting. "The program also showed conflicts that go on at hospitals: nurses bickering with doctors, rivalries and mistakes among interns."
The central character, Dr. Craig (played by William Daniels who has a massive filmography, albeit mostly “B” films, as well as an extensive television career) was dogmatic, condescending and arrogant.
"Technically, he's a good surgeon,” continued Goetting. “He offends people because he's so arrogant. On occasion, he would make a mistake. But you could understand why," a plot twist foreshadowing Dr. House’s arrival 20 years later.
For all its realism, some physicians felt “St. Elsewhere” was still too fantasy. "There's just more drama than you'd find in an average hospital," complained Dr. Barnard. Others, however, insisted it helped offset the omnipotent doctor image through the realism missing from “MASH”.
"I don't know if the stereotype of the decadent doctor first appeared on TV or if TV just reflected a public perception," observed Dr. Goettling, "but television doesn't depict physicians as missionaries anymore."
"What's good about these [more realistic] medical shows is that they show a side that nobody in medical school bothers to explain," remarked Dr. Charles Goodrich of New York. “Students are taught medicine but not how to help the human being to get better and healthy, which is a complex affair, involving science and sociology."
"From a patient's point of view, a lot of what we do is magic," concluded Dr. Hesslein, the professor from Minnesota. "I firmly believe that if a patient believes in what you're doing, you're on the right track. Patients like to look on us as almost faith-healers, and we may be happy to foster that belief. It might not be an honest view. But it's what people want doctors to be."
Although faith healers, like Brazil's John of God, shown here doing an 'operation,' are routinely dismissed as charlatans, new research shows the efficacy of 'the placebo effect', which he uses. photo: courtesy João de Deus
Indeed, Dr. Hesslein is onto something. Recent research indicates the efficacy of the "placebo effect," where simple sugar pills work up to 40% of the time due to the mind’s healing powers, or actual faith healers, like João de Deus (John of God in English) of Abadiania, Brazil.
“I do not heal, God is the one that heals,” John of God explained in the 2005 documentary of that name, directed by Anne Macksoud and produced by Emma Bragdon, see
“I am like a car with a good battery giving a car with a dead battery a jump,” he added, an unsurprising analogy from a man who doesn't charge for healings and earns his living as a used car salesman.
Although the film was not released (it was scooped by a "60 Minutes" report), this author (Doniphan Blair) was the film's in-country producer and learned a lot about faith healing on the shoot, from the National Institute of Health doctors, who were there doing research, from some of the hundreds of people coming daily to be healed, and by talking to John himself.
In addition to his obvious calming and probably healing presence, John of God is a master of the placebo, from administering mild herbs and colored light "baths" to surgery-like performances, including shoving a hemostat up a "patient"’s nose and spinning it, which I witnessed. The procedure doesn’t produce blood or injury but it certainly shocks the individual, sometimes providing the life changing experience that can start them on the road to health.
Of course, faith healing relies on a positive attitude, which would appear to be contradicted by the cranky Dr. House. BUT, perhaps, that very fact allows patients of little faith to truly believe in their doctors, a process sometimes called "white coat placebo." Certainly, in the realms of mind-body, as medicine has been proven to be, the stories we tell ourselves are paramount. In this light, the media's portrayal of doctors is much more significant than we might have previously imagined.
Much of the research for this article was adapted from an older piece, “The Doctor’s Dilemma”, by New York City-based author, Tom Soter, who recently published “Driving Me Crazy”, available from Amazon or his
Posted on Jul 20, 2015 - 09:27 PM