Everyone who applies to medical school has imagined themselves striding around a hospital, issuing orders consisting mainly of a string of acronyms and saving lives. You may have even have imagined scenarios where somebody shouts “Is there a doctor in here?” and you could legitimately stand up and do something to help. Some of you may be shaking your heads and thinking that clearly some people had watched too much television before coming to medical school. Those of you with family members in the medical profession may have a better idea of what doctors really do, but for others, their ideas about doctors were probably gleaned from fictional versions of doctors from sources such as TV shows, films and books. How much of your perception of being a doctor has been shaped by the media? This essay discusses the portrayal of doctors in the media, both negative and positive, in light of the increasingly important role of media in our lives.
Since the 1950’s, over 70 medical dramas have been aired, notably ER, House and Grey’s Anatomy, to name a few. 1 Often these dramas seem to offer insight into the workings of a real hospital. The public’s persisting interest in medical shows is understandable, given the dramatic life or death situations involved in hospitals that doctors have to grapple with on a daily basis.2
The representation of doctors on TV is important as it influences public opinion of doctors It also reflects the attitudes that the general public associates with the medical profession as a whole. Most shows will play once a week and that is probably more exposure that the general public will get to doctors than in real life unless they are ‘frequent flyers’ to their local A&E department!
Portrayals in Fiction
Just like bacteria which have evolved on hospital wards to become resistant to multiple antibiotics, the evolution of doctors on our television screens has resulted in a shift towards the darker side of human nature. They have gone from being mostly caring, good looking, white gentlemen (they were almost always white men) to more complex characters in recent years.1
House is a great example of this. For those of you who have not watched this TV show, Dr House is a cynical and misanthropic narcissist. Surprisingly, viewers voted him as the most trustworthy doctor on TV.3 In addition to these character flaws, there are several problems with Dr House’s medical practice. Firstly, Dr House hardly ever meets his patients – instead preferring to diagnose them from afar (and he always reaches a diagnosis). Secondly, there seems to be no limit to the lengths that he will go for a diagnosis, which include routinely breaking into patients’ houses and ordering seemingly limitless costly investigations. Finally, each diagnosis has a single cure with seemingly no side effects. This is a convenient plot device but unfortunately bears little resemblance to reality.
What does it mean to have Dr House as a fictional member of the medical profession? It perpetuates the belief that doctors are merely diagnostic machines whose sole purpose is to churn out diagnoses and cure their patients. In reality, the bulk of a doctor’s workload lies in the management of long term conditions which are not instantly curable. Alongside this, doctors frequently have to address patients’ psychosocial issues. This involves asking patients about how they cope with their condition and its impact on their life. If their condition affects their ability to carry out daily activities, the consultation will involve working out a management plan that attempts to minimise the disruption to their lives. However, if this approach was shown on TV, it would make for a very dull episode.
As prospective medical students, you may be familiar with common stereotypes about doctors in different specialities. First there is the arrogant surgeon – scalpel in hand and more interested in seeing the inside of the patient rather than having a conversation with them. Then there is the pallid pathologist, deep in the bowels of the hospital, with their morbid preoccupation with dead bodies. GPs are perhaps too diverse a group to make generalisations about but elbow patches and corduroy trousers may come to mind.4 As with all stereotypes, there may be a grain of truth within the clichés which may affect the way patients interact with these doctors unconsciously. For example, patients may be more reticent with their surgeon than their GP, if they hold preconceived notions that a surgeon is not interested in hearing them speak. Similarly, some patients may see their GP as a confidant and view an appointment as a time to chat even if they do not have a particular medical problem.
Common things are common
When unusual or rare medical conditions crop up consistently onscreen, the public begin to expect them. However, in reality, when a patient comes in with a painful, red swelling on their thigh, it is more likely to be cellulitis (a relatively common skin infection) than necrotising fasciitis (a rare, life threatening bacterial skin infection).5 Similarly, when it comes to the treatment, people expect miracle cures as they are used to seeing it on their screens.
The differences between television and reality is particularly marked when it comes to familiar scenarios such as a cardiac arrest. According to a 1996 analysis in the New England Journal of Medicine, nearly 70% of patients on TV dramas who received CPR survived, however in reality it is 0–16 %.6 What is striking about a real-life CPR situation is how many people are around the patient’s bed and also how a manager is in charge of the situation, instead of a doctor.
Doctors and social media
Medicine has always been a hot topic in the press. Switch on the TV, and there is almost always a doctor in scrubs saving lives; open up a newspaper for a glimpse of dedicated health sections filled with heart stopping headlines. Media outlets are constantly churning a curious mixture of fact and fiction which has far reaching consequences on public opinion and on medical practice itself. For example, the frequent overstatement of preliminary research may give patients the impression that a treatment has been approved for use when it has not even been through clinical trials which can have ethical implications.7
With the arrival of social media such as Twitter and Facebook, the medical profession has never been so exposed or so easy to ridicule. Thus, the internet has changed the way patients interact with doctors both on a large scale and individually. Anybody can look up a doctor on the GMC website or a GP practice for patient reviews – it is unrealistic to expect that this will not alter the relationship between patients and doctors. Doctors themselves are worried about this – the number of doctors with concerns about social media has risen by 74% since 2013.8 Social media can create ethical challenges for doctors even if it is as seemingly innocuous as a friend request from a patient. Scenarios like this may present difficulties as they can interfere in the doctor-patient relationship and can affect objectivity when making clinical decisions.
Throughout history, society has viewed doctors in a flattering light. A recent survey carried out for the Royal College of Physicians found that 9 in 10 people would trust a doctor above any other profession including teachers, judges and priests.9 The expectation that doctors are to be trusted filters down to the level of medical students. One of the first lectures given to medical students is about professionalism and confidentiality. This proves useful when meeting patients who may divulge information which they have not shared with anyone else. This most likely occurs because medical students are regarded by members of the public as part of a trusted profession. With this trust comes responsibility – this can have an unintended unfortunate effect as it raises public expectations of doctors as professionals who can cure all diseases. In reality, doctors are limited by time, money and their own fallibility unlike fictional doctors.
The media’s portrayal of the medical profession and individual doctors is described by a 2013 report as “overwhelmingly negative”.8 An analysis of articles on doctors between 1980 and 2000 found that stories portraying doctors in an unflattering light are 2-3 times more common than positive stories.10 Unsurprisingly, the main culprit is the Daily Mail (as well as the Guardian) and the stories tend to fall into four main categories; criminal doctors such as Dr Shipman, foreign doctors10 12, maverick doctors and the patient as a victim of the doctor’s wrongdoing.13
The impact of negative media portrayals has consequences for patients, for clinicians, and for society as a whole. Lack of trust in doctors can lead to patients looking for help from other sources, using ‘Dr Google’ to search symptoms and treatment. This approach contributes to hypochondria in patients and can lead to harm as patients self diagnose and self treat. However, the same article also states that the ratio of positive to negative stories is not increasing.10 This means that other factors may be to blame for the increasing number of doctor-related complaints. Even in the wake of high profile media cases such as the Bristol heart scandal, a poll found that public trust in doctors had not diminished.14
The General Medical Council (GMC)
The GMC is an organisation that aims to promote medical education alongside its role in protecting patients.15 In recent years, the GMC has raised its online profile through social media sites such as Twitter and Youtube. This increased accessibility through social media platforms has made it easier for members of the public to speak out about their experiences of medical care they have received. However, by raising their profile in this way, the GMC may inadvertently have increased their workload, as the number of complaints skyrocketed from 5,168 in 2007 to 10,347 in 2012.16 However, many of these complaints (2755 complaints from the public were resolved at an early stage in 2012)16 expressed dissatisfaction with ‘something to do with doctors’, demonstrating a lack of understanding about the role of the GMC. This is understandable given that the media refers to the GMC as a “watchdog” or as an “overseeing body” for doctors in many instances.9
A myriad of reasons exist for this rise in complaints including an increased access to online sources, increasing social acceptance of complaint making and a lack of understanding of the GMC’s role. The frequently negative press about doctors focused on fitness to practice cases and the tendency of the media to portray the GMC as an organisation biased towards doctors may also have an impact on complaint making.
You and the media
In this age of smartphones and the internet, the prudent advice is not publish anything online anonymously or otherwise that you would not be happy to be traced back to you. The GMC ethical guidance for doctors using social media, boils down to the first principle in medicine of “first do no harm”. Much of the advice is common sense and can be applied to medical students and any social media user. One of the main points for doctors is to avoid compromising patient confidentiality in exchanges on the internet.17
Another key fact is to remain conscious of the responsibilities that you hold as a member of the medical profession and to remain professional on the internet. Any social media account prefixed with the word “doctor” can be seen to represent the medical profession. Medical students and doctors should also bear in mind that when it comes to the internet, nothing is ever really private. 18
Looking to the future
Despite all the issues outlined in this article about the relationship between doctors and the media, the positive impact of the media cannot be overlooked. Doctors can provide medical advice and information on the internet as a counterweight for the misinformation that is so freely available for any member of the public to view. Similarly, social media can be utilised by doctors, GP practices and hospitals to disseminate information in public health campaigns and in raising awareness of health related issues. One example is the successful promotion of the WHO surgical checklist which has improved safety in operating theatres across the world.19 Social media is also used to strengthen professional networks between doctors nationally and internationally. This provides opportunities for information exchange such as new surgical techniques and treatments. Another example of appropriate social media use is writing up an interesting case history, taking care to preserve patient confidentiality. This can prove to be a useful learning tool for other students and also in strengthening the bond between doctor and patient. The hope for the future is that the power of media can be harnessed in a positive way to benefit patients and doctors alike.
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5 Emedicine.medscape.com. Necrotizing Fasciitis: Background, Pathophysiology, Etiology [Internet]. 2015 [cited 19 September 2015]. Available from: http://emedicine.medscape.com/article/2051157-overview
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8 Rimmer A. More doctors are raising concerns about social media. BMJ Careers 2013; doi: issues, Rural medicine, Appraisal, GP principal
9 Ipsos MORI Social Research Unit. Poll conducted for the Royal College of Physicians. Available at: http://www.rcplondon.ac.uk/news/mori_results.asp. Accessed September 16, 2015.
10 Ali N, Lo T, Auvache V, White P. Bad press for doctors: 21 year survey of three national newspapers. BMJ. 2001;323(7316):782-783.
11 Adams, S. Exposed: The foreign doctors milking the NHS for drugs… to send to their families back home. Mail Online 2015.
12 Martin D. Hiring too many foreign doctors ‘puts lives at risk’: Senior surgeon criticises poor language skills and lack of training. Mail Online 2013.
13 Metro.co.uk. NHS surgeon ‘used rusty saw’ to amputate leg because B&Q was shut [Internet]. Metro. 2015 [cited 17 September 2015]. Available from: http://metro.co.uk/2015/05/24/nhs-surgeon-used-rusty-saw-to-amputate-leg-because-bq-was-shut-5213130/
14 Davies HT, Shields AV. Public trust and accountability for clinical performance: lessons from the national press reportage of the Bristol hearing.J Eval Clin Pract. 1999;5:335–342.
15 Good medical practice. GMC. 2015.
16 Archer J, de Bere S, Bryce M, Nunn S, Lynn N, Coombes L, and Roberts, M. 2014 Understanding the rise in Fitness to Practise complaints from members of the public. Plymouth University Peninsula.
17 Doctors’ use of social media (2013). GMC 2013.
18 Greysen S, Kind T, Chretien K. Online Professionalism and the Mirror of Social Media. J GEN INTERN MED. 2010;25(11):1227-1229.
19 Vohra R, Cowley J, Bhasin N, Barakat H, Gough M. Attitudes towards the surgical safety checklist and factors associated with its use: A global survey of frontline medical professionals. Annals of Medicine and Surgery. 2015;4(2):119-123.