The Image of the Doctor: Television and Reality

In NBC's _Hannibal_ Dr. Hannibal Lecter accepts his homicidal tendencies. Here Dr. Hannibal Lecter is chowing down on Web MD showing the inferiority of Web MD in the face of an actual doctor's opinion.

In NBC’s “Hannibal,” Dr. Hannibal Lecter accepts his homicidal tendencies. Here, Dr. Hannibal Lecter is depicted chowing down on Web MD, showing the inferiority of Web MD in the face of an actual doctor’s opinion.

Doctor House. Doctor Cox. Doctor Lecter.

These names, these titles—they have weight. Some of it is their pop culture clout: they are fun, they are snarky, they say it like it is (even if one of them does eat people, and another is a space alien). But there is something more than that. “Doctor.” We know who they are. Stories about doctors are not exactly a new thing. Doctor Faustus gave way to Doctor Frankenstein, and so on. But like any story that doesn’t die, the doctor fable has changed, reflecting the culture around it.

In the doctor drama’s early days, doctors were beacons of hope and perfection and excellence. In the last decade or so, though, their stories have been about medical success at the expense of personal qualities—or in the case of Hannibal Lecter, culinary success at the expense of a few patients. 21st century television’s doctor is a man of contradictions. They’re usually a certain sort of man: conflicted, tortured, talented. They usually have nothing outside their work except random skills they somehow picked up through unquestioned access to superior education; however, they might also have a conflicted decade-old relationship or two, if it serves the plot. They heal the patient, though. The shows’ mantras: these characters are rarely good people, but they are always good doctors.

But what does it matter? Certainly, there is a lot of talk about how “doctors on TV” might change medical practice (for better or worse). Pop culture analysts have suggested a few trends: maybe television doctors raise people’s expectations too high; maybe they give them too many ideas of bizarre diseases they definitely do not have; maybe they give real doctors a bad name. Lots of theories, lots of paranoia—it just depends on whom you ask. Some psychologists have found evidence that prime-time doctors make people hate their physician. Others have found that the most television can do is make you think your doctors are ugly and immoral, but mostly okay otherwise.

Using quantitative data to form these connections is inconclusive at best, outright misleading at worst. However, as pop culture scholar J.R. McLeod writes, “Television has the power to manipulate and to certify, to selectively inform, and to selectively manipulate emotion. All of these effects operate at a level of cultural immersion.” So how might doctor shows reflect our culture of care and the doctors who offer it?

Despite their supposed medical prowess, these tv doctors overlook a serious part of medical responsibility. When researchers cataloged 50 episodes of “House” and “Grey’s Anatomy” for their bioethical dilemmas, they found that, in 57 percent of cases, the doctors committed blatant bioethical violations—not just ignoring consent altogether, but also lying outright to their patients to achieve consent.

Here, we see a certain sort of trend: in every story every week, doctors do the job. They have the knowledge. They’re the best. No matter how nasty they are, they have something the patients need, and they hold life in their hands. But they break the rules, they disregard others, they endanger lives and flout ethics. Their patients often do not even have a choice in their care. Thus, these television doctors become absolute powers, unchecked even by the law. Being a doctor becomes a power symbol more than it is a profession.

This power can extend to the real world, too. Individual experiences with doctors reflect these very real dynamics of power and representation. “Doctors get away with shots in the dark,” said Livvy Bedford, a Yale undergraduate. “When they try something that doesn’t work, there’s no accountability. At one point, I had a test for my stomach condition. I watched the pH test dip down to the number that qualifies for diagnosis. And when I walked into my doctor’s office, she said, ‘Yeah, you don’t have acid reflux.’ No explanation, no test—one sentence. And I wanted to ask: what happened? Why did I see those numbers?”

The problem for her, Livvy said, is not necessarily that misdiagnoses like this can happen; it’s that “you can’t question what the doctors are doing, especially when you’re younger. I think we have this lone wolf image of doctors who act on their own, like in ‘House.’ That’s more harmful than anything.”

Situations like Livvy’s are not uncommon. The National Center for Policy Analysis reports that a believed 10-20 percent of diagnoses are incorrect. Beyond that, 28 percent of surveyed cases were lethal misdiagnoses.

Livvy has since been diagnosed and treated for acid reflux by a different doctor.

It is well known that our health care system does not work as well as it could. However, the structure of the health care system—the way it valorizes doctors as free agents, grants them the power to act independently of each other and sometimes even their patients—prevents its own reform.

Here lies the juncture between media image and reality. Misdiagnosis can be expected. Imperfect systems are not unusual. The relationship between the patient and the doctor, though, and the resistance of doctors and the health industry to revising a relationship that so empowers them—that’s McLeod’s cultural immersion, an image of “health care” created and perpetuated in culture, then reflected outwards through television. Television says: the doctor has the power, the patient has none. And society doesn’t tell anyone otherwise.

Perhaps this is something we—whether we are audience, patient, or future doctor—should think about changing.


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