profession

TV doctors' portrayal evolves from saintly to human

Today's fictional medical dramas feature more minority and female physicians. Also, these characters are shown to have more flaws than their counterparts of 50 years ago.

By Carolyne Krupa — Posted Nov. 19, 2012

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In a poignant scene of the 1960s television show “Dr. Kildare,” the young resident the show is named for stands up in a lecture hall of his peers to challenge the speaker, a much-revered surgeon.

Dr. Kildare argues that the experienced physician should not have performed a risky surgery on an elderly female patient. He contends that the operation led her to a quick and painful death. She would have been better served by being left alone to die peacefully, allowing her time to settle her affairs, he said.

Though dramatic and groundbreaking for its time, such a scene isn’t likely to be duplicated in any of today’s medical TV dramas.

The passion, complexity and intensity of the medical profession have long made it ripe for storytelling by TV writers and producers. But the way in which physicians are portrayed has changed drastically during the last 50 years.

Today’s TV doctors are much more diverse and flawed than they were in the first medical dramas. The handsome, all-knowing, all-male and all-white TV doctors of the 1950s and 1960s — from shows such as “Medic,” “Dr. Kildare” and “Ben Casey” — have given way to a motley crew of mostly young physicians of multiple races and ethnicities. Female physicians are abundant and often are cast in leadership positions.

“It’s a lot more representative as a whole than the old TV shows were,” said Jason Marker, MD, a family physician in Wyatt, Ind.

Medical TV shows don’t put doctors on as high a pedestal as they used to, he said. For example, on “Marcus Welby, MD,” which aired from 1969 to 1976, the lead character could do no wrong. Everything typically turned out well when Dr. Welby was involved.

“Now they show the warts and all,” Dr. Marker said. “They show physicians failing, making poor decisions — that’s a major sea change. In some ways it is a much more accurate depiction. Doctors do make mistakes. We are human beings.”

Much of the change has to do with a reversal in the focus of such shows, said Joseph Turow, PhD, Robert Lewis Shayon professor and associate dean for graduate studies at the University of Pennsylvania Annenberg School for Communication. Early medical dramas focused on the personal lives and struggles of patients, and the physicians were portrayed as almost omnipotent “knights in shining armor.” By contrast, modern medical dramas focus on the tumultuous lives of the doctors, with patients serving a more peripheral role, he said. Turow is the author of Playing Doctor: Television, Storytelling and Medical Power.

“Clearly, they have a dysfunctional work-life balance,” he said of today’s TV doctors. “They’re portrayed as totally immersed in their work, and their social lives are totally intertwined with their work life.”

By comparison, the TV show “Medic,” which aired from 1954 to 1956, was a quasi-educational show that was produced in cooperation with the Los Angeles County Medical Authority.

Rarely was there any personal-life drama. On one occasion, the wife of a physician, angered that he was late for dinner, decided to leave him. But she made it only as far as the train station before deciding she could not let go of such a good man who was so devoted to such a noble profession, said Elliot B. Tapper, MD, a fellow in gastroenterology at Beth Israel Deaconess Medical Center and a clinical fellow in medicine at Harvard Medical School in Boston.

“There was a lot of focus on the craft and the specific details of medicine, but the doctor himself was portrayed as infallible and slavishly devoted to medicine,” he said.

Diversity on the small screen

As the focus of medical dramas shifted from the patient to the physician, the look of TV doctors also changed. The first waves of diversity began to appear on shows in the 1970s, but minority physicians weren’t featured prominently until the end of that decade and beyond, Dr. Tapper said. Louis Gossett Jr. starred as Dr. MacArthur St. Clair, one of the first black TV physicians, in “The Lazarus Syndrome,” which began in 1979.

Denzel Washington followed, playing Dr. Philip Chandler in “St. Elsewhere,” which aired from 1982 to 1988. Minority and female physicians became much more common in the 1990s with shows like “Chicago Hope” and “ER,” and are standard fare in today’s dramas.

“I think we’ve been successful in transitioning from thin, tall white guys to more accurately representing the multicultural state of medicine today,” said Mark Morocco, MD, associate clinical professor of emergency medicine at Ronald Reagan University of California, Los Angeles Medical Center.

Dr. Morocco has consulted on numerous TV shows, including “Third Watch,” “Heart of Dixie” and “Miami Medical.” He was medical supervisor and staff writer for “ER” and is working on a new show with Neil Baer, MD — a physician, writer and producer on shows such as “ER” and “Law & Order: Special Victims Unit.”

Producers benefit from having a diverse cast, Dr. Marker said. Not only does it better reflect the current physician work force, it also helps attract a diverse audience. Reverting to the cast of all-male, white physicians of the 1950s and 1960s would be a mistake, he said. “That’s not going to sell a lot of ad revenue,” he said.

Television is good at reflecting and distilling social trends, said Jonathan Emerson Kohler, MD. He is founder of RxCreative, a consulting company that helps TV and film producers accurately portray science and medicine.

Programs like “Marcus Welby, MD” reflected the paternalistic view of medicine during that era.

“Doctors in those shows are saintly, all-knowing, white men,” Dr. Kohler said. “That model got broken by ‘M*A*S*H,’ which showed physician frailty and fallibility in really brave ways.”

“M*A*S*H” was a turning point for the portrayal of physicians on TV, Dr. Tapper said. Suddenly, doctors were more human. One of the show’s lead characters, Dr. Hawkeye Pierce, was presented as a good physician, but cynical from the necessity of practicing medicine in a war zone. He presented a bleak view, complaining that his job was just to nurse wounded soldiers back to health so they could return to the battlefield to be killed.

“It wasn’t that doctors were corrupted, but that the institutions where the doctors work could corrupt the practice of medicine,” he said.

The fast-paced lives of TV docs

Since the 1970s, most shows have depicted physicians as complex characters who struggle with real human problems such as drug addiction and moral failings in their personal lives, Dr. Tapper said.

When he began working on “ER,” Dr. Morocco said some of his colleagues refused to watch the show. They complained that the rapid action and pace of the show created unrealistic expectations for physicians. But they understood more after he explained the challenge of distilling an eight-hour emergency department shift into 40 minutes for television.

“TV audiences want things to happen quickly. They want action,” Dr. Morocco said. “Ultimately, all of these shows are entertainment shows. They are a vehicle to sell ad time, so they have to tell good stories.”

Having real physicians on set and involved in the production of the show makes all the difference. “In medicine, you can’t fake it. And if you fake it, people will know,” Dr. Morocco said.

In 1955, the American Medical Association established the Physician Advisory Committee for Radio, Television and Motion Pictures, which offered consulting services on medical dramas such as “Ben Casey.” For nearly four decades, the committee worked to ensure credible depictions of physicians on television, and its contributions often were noted in the credits of TV shows and movies.

The nature of TV makes it difficult to find accurate depictions of today’s physicians, Dr. Kohler said. Shows such as “Scrubs” and “ER” try to capture the sociology of medicine, but a lot of today’s shows are essentially soap operas that happen to be set in hospitals.

“The commercial necessity of modern television shows make it hard to accurately depict the reality of being a physician,” he said. “You have to condense and dramatize stories to make them compelling, and doing that means that the sort of doctoring you see on television is hard to recognize in any real hospital.”

But Dr. Kohler said he doesn’t think those compromises are necessary. “There’s plenty of real stuff that happens in medicine that would make great television. You have to know how to look for it,” he said.

Elizabeth H. Sinz, MD, professor of anesthesiology and neurosurgery and associate dean for clinical simulation at Penn State Hershey Medical Center in Pennsylvania, is amazed at the sheer number of emergency medicine physicians portrayed on television. TV doctors who don’t work in the ED are usually surgeons or forensic pathologists.

She wonders what happened to the rest of the specialties. “I don’t know where the rest of us ended up,” Dr. Sinz said.

Dr. Tapper has lectured around the country on TV portrayals of physicians. The medical comedy “Scrubs,” which aired from 2001-10, was never close to the most popular show, but he said many doctors say it was the show they most related to.

“These doctors clearly care about their patients, but there is some dark humor too,” he said. “They have real reactions to human interactions.”

Dr. Marker was a big fan of “Chicago Hope” and “ER,” partly because both shows debuted the fall he started medical school. As a medical student, he was able to commiserate with some of the challenges the fictional characters faced.

“The shows were wildly popular with us students,” he said. “Here we were trying to learn how to be doctors, and here was a show about young physicians trying to learn how to be doctors.”

Dr. Sinz is surprised by the amount of free time TV doctors have to lead such drama-filled social lives.

“I have always felt that the TV docs had a much better work-life balance than I do,” she said. “They also have a lot more intrigue in their life — I haven’t had any affairs with co-workers, I haven’t turned up with some sort of rare disease that I need to find the cure for, and I am not being manipulated by the mob to do their dirty work. I guess that’s why I haven’t ended up with my own TV show. I wouldn’t have time to watch it anyway.”

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