The Bigger Picture: Dr. Welby, Meet Dr. House

Do you relate to television docs?

Have you seen the latest medical-themed TV shows? They certainly present a curious impression of physicians.

There is the near-criminal Dr. House whose Percoset addiction doesn’t stop him from violating every ethical principle known to medicine in the name of getting a correct diagnosis.

Or perhaps you align more closely with the good-hearted but sometimes clueless and perpetually horny young doctors on “Scrubs” - or their often hard-hearted and even cruel seniors.

Don’t like those options? Maybe you should snuggle up in front of a reality show like “Miracle Workers” or “Face Makers.” At least the physicians on these shows manage to improve people’s lives, even though they tend to make undergoing surgery seem akin to changing your wardrobe or decorating your apartment for under $200. It’s just another self-help project, and the surgeons might just as well be cosmetologists or interior decorators.

Is this how low physicians have sunk in the minds of patients and media executives? Are physicians just a bunch of sex-crazy addicts and makeover artists?

Bob Thompson, director of the Center for the Study of Popular Television at Syracuse University, doesn’t thinks so. He argues that the way doctors are portrayed on TV reflects more about the nature of television than physicians’ declining public image. Television’s early days were rife with one-dimensional figures like Marcus Welby, but by the 1970s, the cultural revolution had come to the small screen. Audiences wanted characters who seemed more authentic - more flawed. Hence the dedicated-but-imperfect doctors from “MASH,” followed by the dedicated-but-imperfect doctors from “St. Elsewhere,” and so on. The new television doctors are just the latest iteration of physicians as rounded, conflicted individuals.

Still, Thompson agrees, “The cultural place of physicians right now is not at its peak.”

Krin Gabbard, professor of comparative literature and media maven at the State University of New York at Stony Brook, says, “These shows provide Americans with strategies for dealing with their ambivalence about physicians.” Patients want physicians they like and can talk to - and who can save them - but they also think physicians “charge too much, make too much, and are too smart.”

In shows like “House” or “Scrubs,” Gabbard says, intelligence is always married to a kind of craziness. More telling, their medical breakthroughs - a diagnosis, a solution to a difficult problem - usually don’t come from academic-style smarts at all, but from a chance, a fluke, or a gut feeling. As Gabbard puts it, “A nurse turns around and adjusts her stocking, and the doctor says, ‘Ah, of course…’ Americans are ambivalent about intellect.”

And, “like any good soap opera,” says Gabbard, the shows “reveal that the rich and successful have miserable lives.”

Another common thread: Healthcare administrators - hospital lawyers, managed-care companies - are always the bad guys.

Now, it would be a stretch to say that television reflects reality, but it certainly helps shape the way we understand our world. And it’s sad to me that physicians are so often portrayed as either smart psychos or dumb hotties. So much for evidence-based professionalism.

Maybe next time you point out to a patient that antibiotics don’t cure viral infections you should swallow a couple of pills, mess up your hair, and start limping. They might buy it coming from a drug-addicted, impulsive neurotic.

Got a gripe? Tell me about it. Write to me at pmoore@physicianspractice.com.

This article originally appeared in the July/August 2006 issue of Physicians Practice.