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
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