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Grab the popcorn and pop in the DVD. How the images of doctors and movies changed over the years. What does it say about us and what can we doctors learn from that. You are listening to ReachMD XM 157, the channel for medical professionals. Welcome to the clinician’s roundtable. I am Dr. Michael Greenberg, your host and with us today is Dr. Glenn Flores, Professor of Pediatrics and Public Health at UT Southwestern Medical Center in Dallas.

DR. MICHAEL GREENBERG:

Welcome Glenn.

DR. GLENN FLORES:

Hello thank you for inviting me to speak with you today Michael.

DR. MICHAEL GREENBERG:

I think we should turn the lights down now and start the films, but we are radio, so we can’t do that. So listen first tell us about yourself and how you got interested in the images of physicians in movies. Where did you start?

DR. GLENN FLORES:

Sure well I am as you mentioned currently Professor of Pediatrics and Director of Division of General Pediatrics at UT Southwestern Children's Medical Center here in Dallas. I was born in the New York area, grew up in Connecticut, went to Harvard College and then got my MD from the University of California at San Francisco School of Medicine, did my pediatric residency at New York Hospital Cornell Medical Center and then was at Robert Wood Johnson Clinical Scholar at Yale University and basically I have always loved watching movies and I owe much of this passion to my late mother. Growing up, one of the big family activities was gathering around the television to watch movies and I got exposed at an early age to many of the classics in film and this experience has made all the more fascinating by mother’s encyclopedic knowledge of actors and directors and story lines and although my mother was a social worker which is also a big reason why I devoted my life as a physician to helping people, my mother also dabbled in acting and at one point made a cameo appearance in the Mia Farrow film, Reckless. In medical school, I became increasingly fascinated by the portrayal of physicians in the movies and my fellowship as a Robert Wood Johnson Clinical Scholar at Yale provided me the intellectual freedom to take a film studies course and conduct a study of the portrayal of physicians in film. In the study, I analyzed 131 films with physicians as main characters spending 8 decades and originating from 9 countries. Needless to say I ate a lot of popcorn along the way.

DR. MICHAEL GREENBERG:

Do you remember what your first movie was that you ever saw?

DR. GLENN FLORES:

I really don’t, that’s a good question, might have been Wizard of Oz.

DR. MICHAEL GREENBERG:

I remember mine it was called Jupiter's Darling. It was a terrible movie with painted elephants and I remember being dragged off a Hyde Park theater. It is amazing how those images stick in your mind. So you wrote your seminal paper which I have here, but it seems like you are doing more work on it as time goes by.

DR. GLENN FLORES:

Yeah well it is hard to keep me away from movies. It has become more difficult now that I have more responsibilities directing a division and doing other research projects and I would love to get back to analyzing some of the films that have come out over the last 5-6 years or so. Actually I haven’t been able to do as much as I would like.

DR. MICHAEL GREENBERG:

So lets talk about how you are doing? According to your latest paper, images of doctors since the 60s is suffering. Lets go back to the early movies and talk about some of those. What are some of your favorites?

DR. GLENN FLORES:

In terms of the earlier movies?

DR. MICHAEL GREENBERG:

Earlier movies, right and how do they portray us? Actually you talked about the categories of mad scientist and humanitarian, talk to us about that first.

DR. GLENN FLORES:

Okay, well we try to when we are viewing the films, analyze them in a variety of factors and one of the things we try to look at is, you know, could you come up with a summary descriptive adjective and a compassionate healer for example apply to about 56% of cinematic physicians and among those 12% actually had a transformation either gaining or losing their caring and concern after critical experience. A lot of those we saw early on in films and other adjectives that came up including mad scientist, egotist, philanderers, and nymphomaniacs, greedy and materialistic, cold and detached, ambitious and driven, even homicidal, cynical and jaded and unethical. Though obviously there aren’t as many films one can analyze when you are approaching the filmography of physicians in the movies, but we did find the diverse version of Dr. Jekyll and Mr. Hyde early classic from 1920. In the 1930s, we see more films and some of the best films in the group that we looked at were from the year from 1930 to 1939 so for example Arrowsmith based on the book and the Citadel of Dark Victory was also I think one of the best that you can see early on.

DR. MICHAEL GREENBERG:

That’s interesting that you bring up Dr. Jekyll and Mr. Hyde because I think of that more as a horror film and not a physician film, but you are right it is Dr. Jekyll and I never put that in the category. The early films seemed to be pretty good and we seem to come off okay I think and what happens as time progress?

DR. GLENN FLORES:

So from the 1920 to 1950s film physicians were predominantly portrayed in a positive way, with the interesting exception in the 1930s when there were lots of horror films, I am not sure why that was; there was a preoccupation. And then what you see is since the 1960s there has been a general decline in positive portrayals and a steady increase in negative portrayals such that approximately half of all film physicians in the last 2 decades have been portrayed negatively, for example in the 1980,s 52% of portrayals were negative and then in 1990s 48% were negative, again levels exceeded only in the 1930s. The 1990s also saw the highest proportion of films depicting physicians with negative attributes would transform into compassionate and caring healers only after experiencing a major crisis which is kind of a scary trend for our profession. So for example in the 1997 film, Sunchaser, the materialistic and egoistical oncologist, Dr. Michael Reynolds, who actually was played by Woody Harrelson becomes compassionate and concerned only after being kidnapped by a terminal patient who is a convicted murderer and he forces Dr. Reynolds to accompany him on the journey to find a native American holistic healer. In Doc Hollywood from 1991, Dr. Ben Stone was played by Michael J. Fox who is eagerly looking forward to starting his job as a very rich Beverly Hills plastic surgeon and its only after he is forced to practice family medicine in a rural southern town and this is as punishment for a traffic ticket, does he become a compassionate healer and he eventually takes the position permanently renouncing the lucrative plastic surgery practice. One more example on the doctor from 1991 is Dr. Jack McKee who was played by William Hurt is an insensitive, breast cardiothoracic surgeon who is transformed into an empathic caring physician only after being diagnosed with and treated for laryngeal cancer and that is actually based on a true story not a biography.

DR. MICHAEL GREENBERG:

If you have joined us, you are listening to the clinician’s roundtable on ReachMD XM 157, the channel for medical professionals. I am Dr. Michael Greenberg and I am speaking with Dr. Glenn Flores, Professor of Pediatrics and Public Health from the UT Southwestern Medical Center in Dallas about the images of physicians in movies.

So lets talk about these few films like The Doctor. What do you think was happening in society here because I loved The Doctor, actually called the guy who wrote the book because I was writing for American Medical News at the time and I had a nice chat with him What kind of message does that give about the way doctors were behaving then and how does that affect the public?

DR. GLENN FLORES:

Well I think movie physicians in this decade in the 1990s all too often are portrayed as egotistical, materialistic, uncaring, and unethical, and I am concerned for the medical profession. This distorted image of physicians that the movie industry increasingly presents to the public is I think going to do some damage. Movies are a potent force in popular culture because they are so accessible, aggressively marketed, heavily financed, and hugely popular. Negative cinematic portrayals of physicians may create expectations of similar behaviors, attitudes, values, and practices when the patients visit their real-life physicians, and impaired patient-physician relationships are a potential consequence bombarded by these repeated negative cinematic physician stereotypes, a patient might, for example, on the first visit expect his or her physician to be egotistical, materialistic, uncaring, and unethical and communication, trust, adherence, and satisfaction may therefore adversely be affected. In all fairness, however, I think movies about physicians also can be viewed as useful gauges of public opinion about the medical profession. The rise in cinematic depictions of hurried and detached physicians lacking in empathy may, in fact, reflect the public's desire for more time and empathy during medical visits. Such film portrayals might be viewed by physicians as informative warnings about the adverse consequences of an age of medicine increasingly dominated by paper work, shorter visits, clinical productivity pressures, cost cutting, and utilization review.

DR. MICHAEL GREENBERG:

So what do we do as doctors, do we write letters to Hollywood and say please portray us as we are not as you want us to be? Or do we just suck it up and go to movies and laugh at ourselves?

DR. GLENN FLORES:

Well I think one interesting strategy might be infiltration. I think some of the most interesting film portrayals of physicians in more realistic portrayals are those that involve physicians writing the script themselves, and so I would like to see more physicians writing about the profession of medicine, the incredible power one has in terms of the insight into the human condition when you are dealing with families who are going through illness and needy families often, and I think it would be amazing to hear more physician voices in film and also on TV for that matter.

DR. MICHAEL GREENBERG:

Its okay to say that, but so now we have doctors like myself who have a book and written a book and how do you get Hollywood interested?

DR. GLENN FLORES:

Yeah well that is always the big question that I think is outside the realm of physician training, but it involves getting more experience with Hollywood and the process and figuring out how one can nurture those ideas in books and turn them into screenplays and movie scripts that the public has access to.

DR. MICHAEL GREENBERG:

Lets talk specifically about some movies, okay that are really great ones. Lets go back and talk about The Doctor. What do you think about the character of Jack McKee and do you think that the way he changed is actually positive for people showing them that doctors are human too and they can change. How about that attitude?

DR. GLENN FLORES:

Yeah, I think that is why that was such a powerful film because you know you see an interesting acculturation process with medical students and I believe there have been both qualitative and quantitative studies of our medical students in their preclinical years who come in with a lot of compassion, empathy, and motivation to help the needy and care for people and there is something about the acculturation process on both the clinical time during medical school, and I think during residency I think in a sense taken to the extreme in House of God, but with the reason why it resonates with so many physicians is that there is a certain culture, you are put in a highly intense situation with a lot of pressure and often under conditions of sleep deprivation and that sometimes forces you to make decisions and approach the care of patients in a way that you did not think you would originally, and so I think sometimes we are focussing on procedures and outcomes and discharges and not taking a more holistic approach, so that is why I think that particular film was so powerful for physicians because you get into this pattern and particularly, I think for a cardiothoracic surgeon have immense power that you sometimes don’t understand and so unless you have been on the other side of the scalpel and gone through the sometimes humiliating process of being of a patient, you don’t really understand why some of the humanistic aspects of medicine are so important. So I particularly like the end of the film where he forced residents and medical students to actually have to admit themselves as a patient and have the funny gowns showing your rear and getting IVs put in and getting woken up 10 times a night to get vital signs is the only way you can really understand and gain that necessary empathy.

DR. MICHAEL GREENBERG:

You show movies to your students?

DR. GLENN FLORES:

Yeah actually for several years at my prior institution, I had a session just focused on what movies can teach us as physicians, and we would take clips from several different movies that I thought were instructive or humorous, or gave us more insight into how we can improve the patient-physician relationship and I think the students really appreciated that and gave them a perspective that they are not used to have it.

DR. MICHAEL GREENBERG:

And gave them time away from studying some of the boring stuff right?

DR. GLENN FLORES:

Exactly.

DR. MICHAEL GREENBERG:

Glenn thanks for being our guest today and discussing doctors on the silver screen.

I am Dr. Michael Greenberg and you have been listening to the clinician’s roundtable on ReachMD XM 157, the channel for medical professionals. ReachMD XM is here for you to help professionals who care for your patients. We welcome your questions and comments. Please visit us at www.reachmd.com. Our new on-demand and podcast features will allow you to access out entire program library and we thank you for listening.

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