Doctors in Popular Fiction occupy an extraordinary position in contemporary television and film and we can all probably list our favourite shows and characters. These stories deliver intense drama with high production values and range from the modern but compassionate Dr Kildare to cynical Dr Perry Cox (Scrubs) and misanthropic medical genius Dr Gregory House (House MD). The format attracts multiple awards. For example ER became the most nominated series in TV history, earning 122 Emmy nominations and 22 Awards and attracting the staggering audience of 47.8 million viewers when it aired after the series finale of “Seinfeld” in 1998. These programmes can break new ground in television aesthetics (St Elsewhere popularised ‘pedeconferencing’ – the ‘walk and talk’ tracking shot to signify the supposedly frenetic pace of hospital life). The genre is economically important, too, as medical dramas consistently attract large audiences with ‘gold dust’ demographics for advertisers – the notoriously elusive 18-49 years. Their popularity reaches global audiences with House being syndicated to 66 countries and being seen by 82 million people.
The medical drama is a commercial product but as with any drama it reflects our socio cultural and economic environment and reveals something of the relationship between medicine and society as well as illuminating wider changes in broadcast culture. This post is the first in a series of four blogs and sets the scene for an exploration of how medical drama has evolved. Why are medical dramas important? And what is their influence on the public understanding of health, health care and medicine?
To set this in context there is no doubt that we are witnessing an increased medicalisation of the mass media: medical-related stories appear more frequently than ever in press and television outlets. Entire cable channels are devoted exclusively to our wellbeing and numerous internet websites offer instant access to health information and celebrity health related gossip and speculation. Formats such as lifestyle and physical ‘make-over’ shows also provide opportunities for audiences to witness intensely personal moments and have sparked debate concerning their overly voyeuristic nature. Blogs and tweets allow us instant access to previously ‘hidden’ personal testimonies of ‘ordinary’ people and celebrities alike.
The dominance of medical shows on TV has sparked a serious concern that relatively cheap and formulaic programming is displacing other more challenging ‘quality’ drama. Indeed the ‘soapisation’ of the media in general is seen as a negative consequence of increased competition for audiences and the proliferation of channels. The routine portrayal of ‘hard’ subject matter in prime time ‘entertainment’ slots, and the impact of this on audiences, has sparked a lot of discussion about the cultural role of television drama. Yet these formats and their reach in terms of audiences are highly desirable to health charities, lobbying groups and even governments – all of whom consider television drama to be a useful conduit of policy messages. We also all learn something about ourselves from medical drama:
The integrity of our body is extremely important. We should be concerned about our own body and that lies at the heart of it. Programmes like Casualty are dramatic and exciting – they involve a lot of ordinary people we can relate to directly. It’s not like watching something about nuclear physics or stamp collecting.
Drama with a social message has developed a unique position in television culture, so much so that fictional programmes may themselves become events with social and material consequences. In the UK, Cathy Come Home (1966) focused public attention on the plight of the homeless. In the US, audiences reportedly cheered as Helen Hunt’s character launched a vitriolic attack on her HMO in the film As Good As It Gets (1997) as a mother whose health insurance plan could not cover vital treatment for her son. As the eponymous John Q (2002) Denzel Washington depicted an underinsured father of a critically ill son to highlight the issue of managed care in the US. In the same year the Kaiser Family Foundation organised a public forum, John Q. Goes to Washington, which drew together drama writers, academics and representatives from the American Association of Health Plans to debate the role of entertainment TV in shaping public perceptions. As many as seven in ten of those Americans who had watched this film believed that insurers refuse to pay for treatment ‘a lot of’ the time.
The potential of fiction to shift and focus public opinion means that medical drama and soaps are subject to intense lobbying by diverse groups keen to have their issues incorporated into story lines. Organisations such as Hollywood, Health and Society work closely with script writers on major network shows and connect them with leading health professionals who can answer their questions to enrich or inspire a planned storyline. The entertainment education balance is a tricky fine line given that these programmes generate vital revenue and producers are inevitably constrained by the competing and at times conflicting interests of network/ channel sponsors/advertisers and audiences.
The close collaboration between network, show and medical organisation is not new as we will see in Part II of this occasional blog series which traces the evolving representation of doctors in drama from paternalistic ‘helper’ to front line hero.
A version of this article appeared in Socialist Register 2010: Morbid Symptoms Health Under Capitalism edited by Leo Panitch and Colin Leys