IN A 1986 COMMERCIAL, in a landmark moment for the

portrayal of the medical profession on television, a soap opera actor

uttered what would become an iconic phrase: “I’m not a doctor, but I

play one on TV.” Peter Bergman parlayed his role as a physician on All

My Children into an endorsement of Vick’s Formula 44 cough syrup

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Doctors as portrayed on television have

evolved from noble saintsto irascible sinners.

B Y A L L A N J. H A M I LT O N

“I’m not adoctor,butI play oneon TV.”

PRICKLY SITUATION:U.S. troops servingwith army engineersduring World War IIgive blood for tests toprev ons.II

enced physicians but instead on doctorsin training. The first was Dr. Kildare,loosely based on a 1930s film character ofthe same name. Played by RichardChamberlain, the Camelot-era Kildarewas boyishly handsome and epitomizeda zealous innocence in his devotion tomedicine as a calling. His personal needsalways yielded to his patients’ concerns.Issues of income, love, and marriage werenoticeably absent in the plots. Kildarelived like a medical monk whose vowsrequired him to cloister himself withinthe confines of the fictitious Blair Hospi-tal.

While Kildare labored toward thedivine light of sainthood, Ben Casey wasa darker character. Actor Vince Edwardsportrayed him as an arrogant, forceful,and headstrong neurosurgeon who wasrushed and irritable from an operativeschedule punctuated by innumerabletrauma cases. While Kildare was caring,solicitous, and gentle, Casey was gruff,disdainful, and prone to tell his patientswhat was right for them—or wrong withthem. His medical authority seemed toextend far beyond his neurosurgicalexpertise and allowed him to opine, atwill, on any aspect of his patients’ lives,from the state of their marriages to theirpsychological weaknesses.

Casey’s approach to disease tended toconsist of aggressive, high-risk surgeries,usually highly experimental in nature,with a premium placed on proceduresthat had never before been attempted.Almost all his actions took place in opendefiance of hospital administrators anddisdain for government regulations. Thisno-holds-barred picture of “real medi-cine” even surfaced in the more sedateDr. Kildare, when Leonard Gillespie, Kil-dare’s senior faculty supervisor, declaredin one episode: “There are always risks,unforeseeable risks, but risks that mustbe taken. Medicine isn’t worth practic-ing if I have to stop myself because oflegal risks. Until I am free to proceed onthe basis of my knowledge and skill, I am

not a doctor. I am a slave to outmodedlaws.”

Television during the 1960s broughtmedicine—especially surgery—into araw, confident light, tinged with enor-mous faith in the technology beingbrought to both bedside and operatingroom. Doctors were portrayed as glam-orous, heroic, self-sacrificing, and willingto dare risky procedures. The best medi-cine was the boldest; the swiftest action,the wisest. But these characters also hada rebellious, defiant streak, reflecting theemergent political and social attitudes ofa new generation rising up against thetraditions of the past.

The Dr. Kildare and Ben Casey story-lines also introduced a new yet impor-tant theme: that of the powerful and pro-found relationship between the youngerprotégé physician and his wiser, oldermentor. Kildare had his Gillespie whileCasey was under the tutelage of the sageyet irascible chief of surgery, DavidZorba. In a later series, Marcus Welby,MD, the title character dished out pater-nal wisdom to guide and restrain his

younger, more radically inclined partner.[fold this statement into the followingparagraph?] Since the 1960s, the theme ofthe mentor–apprentice relationship atthe heart of medical training has becomea staple of every medical drama up to thepresent.

Father Time

Just as the Vietnam War split the coun-try into widely divergent politicalcamps, the portrayal of doctors on tele-vision exposed new professional divi-sions as well. Played by Robert Young,the main character of Marcus Welby,MD seemed to epitomize the silentmajority, with its trust in law and orderand the wisdom of seasoned leadership.The show ran from 1969 through 1976,straddling the transition from LyndonJohnson’s presidency through RichardNixon’s resignation.

Marcus Welby, MD received theendorsement of the American Academyof Family Physicians, an indication of theascendancy of primary care on the U.S.health care landscape. By then the AMAhad abandoned its policy of overseeingand approving television programs. Theassociation’s leadership instead wasbecoming concerned that television dra-mas were raising the public’s expecta-tions beyond anything real-life practi-tioners could deliver. Television wasdepicting a greater-than-85-percent suc-cess rate in resuscitations when the actu-al survival rate was well below 15 per-cent. The wise Welby proved able toresolve familial conflicts in 95 percent ofthe television episodes while tending tothe medical problems of his patient, sin-gular; his practice seemed to allow himthe luxury of having to treat, along withthe help of his younger partner, only onepatient at a time.

The 1970s also brought us M*A*S*H.Although the setting for the drama wasthe Korean War, it was a thinly veiledallusion to the ongoing conflict in Viet-

During the next few years, the fictitiousdoctor would stretch the limits ofcredulity by marrying the same womanno less than four times. The actor whoportrayed him had already stretched adifferent realm of believability, blurringfor the first time the distinction betweenthe dramatic portrayal of medicine ontelevision and medicine in real life.

Two decades later, Robert Jarvick, theinventor of the artificial heart and theholder of a real medical degree, appearedin a series of commercials extolling thevirtues of Lipitor to help lower choles-terol. One advertisement used a bodydouble to illustrate Jarvick’s devotion toexercise as a complement to his medica-tion regimen. The metamorphosis wasnow complete: actors had become doc-tors and doctors had evolved into actors.

Medical dramas have long seemed anatural fit for television. “One of thevivid examples of the tactile quality ofthe TV image occurs in medical experi-ence,” media critic Marshall MacLuhanwrote in his landmark 1964 book,Understanding Media. “The suddenemergence of the TV medico and thehospital…is perfectly natural.” From theearliest days of television, the leaders ofthe country’s professional medical soci-eties grasped the tremendous attractionthe medium held for viewers and theenormous power that television couldhave in shaping the public’s perceptionsabout doctors and the care they deliver.

But television and Hollywood can benotoriously fickle. Rather than servingup flattering images, medical dramashave reflected society’s larger issues byoffering increasingly complex and trou-bling portrayals of doctors.

Strong Medicine

In the 1950s, the country was under theadministration of President DwightEisenhower, former supreme comman-der of the Allied forces in Europe dur-ing World War II. The United States

was the uncontested, dominant worldpower, but images of the bloody car-nage of both the Second World Warand the Korean War were still fresh inthe minds of many Americans. The firstsignificant medical show on televisionwas Medic, which debuted in 1954. Theshow aimed for an admirably high levelof realism: writers spent more than twoyears following doctors around LosAngeles County Hospital to capture itsambience. Each episode opened withthe narrator reminding the audiencethat the doctor was “the guardian ofbirth, the healer of the sick, and com-forter of the aged.” [author: possible toconnect Medic to the era better?]

The show’s budget was so small theproducers couldn’t afford to build a for-mal set, opting instead to film the seriesinside the same hospital in which thewriters had conducted their research. Bycontractual obligation, a designated rep-resentative of the American MedicalAssociation scrutinized and evaluatedeach half-hour episode to ensure its por-trayals corresponded with the organiza-tion’s public relations strategy and

maintained a reasonable level of medicalaccuracy. Once the AMA endorsed thescript, the televised episode displayedthe organization’s seal of approval. Inter-estingly, one episode that depicted anAfrican American physician characterwas judged to be too racially alarming toair; instead, it was shelved and nevershown on television.

By the 1960s the mood of the countrywas changing. U.S. society was awed bythe sheer breadth and power of tech-nologies: atom bombs, jet airplanes,satellites. Antibiotics and vaccinesappeared limitless in their power to con-quer diseases that had threatenedhumanity for thousands of years. JohnKennedy was in the White House, andhis administration’s New Frontier pro-gram, with its zest and enthusiasm—from the Peace Corps to the space pro-gram—had seized the public’s imagina-tion.

Two new medical dramas on televi-sion, Dr. Kildare and Ben Casey, emergedin 1961, as interesting in their similaritiesas they were in their differences. Eachfocused not on fully trained, experi-

54 HARVARD MEDICAL ALUMNI BULLET IN • AUTUMN 2008 AUTUMN 2008 • HARVARD MEDICAL ALUMNI BULLET IN 55

PRICKLY SITUATION: U.S.troops serving with army

engineers during WorldWar II give blood for

tests to prev ons.II

MEDIC

The first significant medical showon television was Medic, which debuted in 1954. Theshow aimed for an admirably high level of realism.

THE DIVINE LIGHT OF SAINTHOOD: Dr. Kildare as protrayed by Richard Chamberlain as caring, solicitous andgentle while Ben Casey (Vince Edwards)was arrogant, forceful and headstrong.

DR. KILDARE

render their efforts futile. The early 1980s brought us St. Else-

where, notable for featuring women andAfrican Americans among the mainphysician characters in the cast. St. Else-where took place in a grimy, under-fund-ed, inner-city teaching hospital. Thephysician characters now had quirks andissues, ranging from bulimia to domesticviolence, from sexual deviancy to suici-dal depression. Another new, sombernote entered into the storylines. Patientscould not always be saved. Many wereroutinely lost, and some even died fromphysician error and incompetence.

Subhed

[author: Chicago Hope ran from Sep-tember 1994 to May 2000; do you wantto link it with the ER era?]

The twentieth century closed outwith ER, where we saw physicians askedto deliver care in a system on the brink ofcollapse, where patients were triagedmercilessly out of sheer necessity. Thecrisis in health care delivery was viewedagainst a chaotic, dysfunctional back-drop. A twist that began with St. Else-where intensified, as some episodesexplored the physician characters them-selves succumbing to medical mishapand disease. A sense of mutual vulnera-bility emerged: Regardless of our profes-sional status, we’re all patients at onetime or another.

The twenty-first century addedGrey’s Anatomy and House, MD to ER as

hit medical dramas. Grey’s Anatomy fol-lows a cohort of residents and attendingsin a large, fictitious teaching hospitalcalled Seattle Grace. Far more dramaticattention is paid to the personal lives andromantic entanglements of the physiciancharacters than to their professionalduties. Monetary concerns— reimburse-ment issues, salary levels, financial com-petition among physicians—are stilllargely taboo topics, however. [author:please expand this section slightly,adding your role and personal perspec-tive]

House debuted in 2004, with HughLaurie playing the main character, Gre-gory House—a misanthropic, cynical,and brilliant physician who specializesin infectious disease and nephrology atthe fictional Princeton–PlainsboroTeaching Hospital. There House routine-ly insults, belittles, and ignores his resi-dents and fellows on clinical rounds.Various episodes depict him physicallyassaulting patients, their family mem-bers, and even the occasional colleague.He performs surgical procedures forwhich he has neither credentials norprivileges. He administers medicationsto patients without their consent, andwhen he deems a surgery to be misguid-ed on another doctor’s patient, he’llwheel that patient right out of the oper-ating room. He steals hospital records,bullies patients into signing consentforms, and even treats children againsttheir parents’ wishes.

House adds personal foibles to his

professional transgressions. He breaksinto the hospital pharmacy to feed hisaddiction to narcotic pain medications,writes prescriptions for himself, andoccasionally faces arrest for drug posses-sion. Yet Princeton–Plainsboro is proudto have him as its head of diagnosticmedicine. The depiction of medicine hasbecome one of human eccentricity andfragility. House is a compelling characterbecause he’s such a brilliant sociopath,and we root for him because his unortho-doxy gets results: He saves lives.

Reality TV

Doctors, so often noble icons during theearly and mid-twentieth century, havethudded to earth, and television hasreflected this change. The earlier idealis-tic depictions of physicians slowly erod-ed as the societal and administrative con-text of the health care system becamemore hurried, intrusive, and overwhelm-ing. Medical dramas no longer portrayphysicians as self-sacrificing saintsdevoting themselves to humanity. Dra-matic series instead delve into multidi-mensional physician characters whooften display a rebellious and sometimeseven sociopathic defiance of the medicalestablishment.

Medical dramas on television no longexempt physician characters from thetemptations and pressures of outside life.In fact, rendering them more susceptiblemakes them more accessible to the view-ing audience. Doctors have grown lessheroic and more human. The public’s fas-cination with the real drama embodiedin the medical profession has not seemedto have faded for more than a half centu-ry. Instead, television series evolve toreflect it in the larger context of societalissues, propelled by the uncanny abilityof scriptwriters to take the pulse of theiraudiences.

Allan J. Hamilton ’82, FACS, is a professor ofneurosurgery at the University of Arizona. He

nam. The drama satirized military andpolitical authority as well as religiousmores. It underscored the inherent para-dox of doctors trying to save lives in themidst of a war in which body countswere the measure of military success.M*A*S*H also brought a dramatic shiftin the focus of the storylines. The physi-cian characters themselves now becamealmost the exclusive focus of the drama.The patients and their gruesome injuries

began to serve more like a macabre back-drop to the main action occurringamong the physicians themselves.

Alan Alda portrayed one of the maincharacters, Hawkeye Pierce, as sarcastic,cynical, and sadly disillusioned. Hisdrinking habits often verged on outrightalcoholism. He was an inveterate wom-anizer and showed nothing but defianceand disregard for almost any form of mil-itary protocol or etiquette.

A new kind of physician alsoappeared in this series: Frank Burns.Burns was a buffoon—a plodding physi-cian who rigidly abided by rules and reg-ulations. He was often depicted asgreedy, stupid, and envious of his col-leagues. M*A*S*H showed us a world ofmedicine in which masterful doctorsworked alongside witless ones, and theyall seemed at risk of being overwhelmedby a larger political context that would

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House routinely insults, belittles, and ignores his residents and fellows on clinical rounds.

Various episodes depict him physically assaulting patients.

THE DIVINE LIGHT OF SAINTHOOD: Dr. Kildare as protrayed by Richard Chamberlain as caring, solicitous andgentle while Ben Casey (Vince Edwards)was arrogant, forceful and headstrong.

HOUSE

SOCIOPATHIC GENIUS:U.S. troops serving witharmy engineers duringWorld War II give bloodfor tests to prev ons.II