Rows continued to rumble this week about the proper content of general practice in the new NHS. Are GPs ducking their responsibility for out of hours care? Are they being pulled away from medical practice by the new responsibilities of commissioning? Can they be trusted to provide ‘safe and responsive’ care? Do they know their patients’ names?
In the world of children’s television however, doctors are reassuringly present and offering personal care. The show Get Well Soon is currently on the BBC every afternoon. Described as a ‘programme for young children exploring medical conditions, using puppets, music and humour to make going to the doctor’s surgery feel like a natural and interesting experience’ it gives a starring role to ‘a real life paediatrician’ based in a colourful mock up of a GP surgery. The format is the same each episode. One of 5 muppet-style characters visits Dr Ranj to ask about a particular problem. One week it’s itchy spots, another it’s lack of energy, another it’s stomach ache. The programme recently infuriated anti-vaccination campaigners by depicting vaccination as entirely good and normal in an episode ‘Inject to protect’.
Dr Ranj greets each puppet patient enthusiastically, before using the particular case to generate a question. Why do chicken pox itch? Why do we need to eat healthy food? Then he poses the question to a nurse sitting at a gleaming white desktop. Nurse Morag – a ‘practising nurse’ according to the website – asks a set of real children (‘healthy helpers’) to play a game to teach us about the physiological processes at work. Then Dr Ranj and the puppet sing a song to reinforce the simple message. The itch is our body fighting infection. A balanced diet gives us energy. The puppet-child is reassured and informed. Typically he or she is given a balloon animal and a badge to take away and commemorate the encounter.
The programme is a great favourite with my four year old but challenging viewing for me. The staged interactions with both puppet and real children feel clunky and I think they go too far in trying to make their descriptions simple. But I’m also missing anything that indicates the interactional complexity and contemporary politics of general practice consultations.
The power dynamics are frustrating, if unsurprising. The male doctor leads, dictating the terms of assistance from the smiling nurse. The puppet-child offers a problem that speaks not only to physical pain or incapacity, but also a failure of understanding. They need educating: by the ‘expert’ doctor who provides an initial explanation; by the ‘supportive’ nurse who reiterates a general rule; by other children in their role as ‘healthy helpers’. Children are not shown questioning the doctor’s decision, expressing their desires for treatment or being sent away empty handed. Furthermore, there are no parents or adult carers in view at all.
Any number of tensions in medical encounters are therefore absent: about how the ill-health started and whether a parent is morally to blame, or being held to account for its presence; about whether children accurately report on their symptoms and whether these ‘match’ adult categories and worries; and about whether appropriate use is being made of NHS resources.
What does my four year old make of this? She tends to reproduce the simple messages in daily life. She has started to play the ‘nurse’ role in a hospital game, to my fury, getting boys to play the doctor. She wants to take any number of physical problems or concerns to our local GP who she expects to provide neat solutions: a plaster for a graze or medicine for pain. As a result I find myself siding with the anti-vaccination lobby, though not on the specifics of their complaint. Where are the politics of health here? There are real debates as well as political slanging matches about the organisational boundaries of general practice, the meaning of ‘care’, the place of the patient and the boundaries and consequences of responsibility for illness. Issues too big to raise with four year olds perhaps? But we could at least avoid the depressing simplifications of this bland blend of fact and fiction?