When "City Hospital" premiered on network television in 1952, it set the standard for generations of tremendously popular TV series with physicians as central characters.
Since then prime-time TV has brought Americans more than 60 doctor series, including "ER", "Chicago Hope", "Dr. Kildare", "Ben Casey", "MASH", "St. Elsewhere", "Heartbeat", "House Calls", "The Bold Ones" and "Emergency!"These series always gave viewers a warped view of medicine.
During the 1960s, for instance, TV executives let the American Medical Association (AMA) review and censor scripts, according to Joseph Turow. He is a University of Pennsylvania expert who reported on TV doctor series in The Lancet, a respected medical journal.
The AMA made sure that physicians in TV doctor series were "incarnations of intelligent, upright, all-caring experts" who rarely made mistakes. They also had modest lifestyles. They drove inexpensive cars and never appeared too wealthy.
Turow says the AMA's influence over TV medical series diminished in the 1960s, with the AMA seemingly uninvolved in molding today's programming. And Turow argues that the current crop of doctor series still is ignoring economic and health policy issues - like cost-cutting and managed care - that are shaking medicine's foundations.
Week after week, viewers get images of gleaming hospitals and operating rooms, where doctors use state-of-the-art technology to treat patients with little regard to costs. Doctors are portrayed as fully in charge of medical decisions. They appear as fiercely independent authority figures, usually successful in fending off any interference from administrators.
In the real world, of course, medicine is an institution undergoing tumultuous changes. The changes, for instance, often make physicians subservient to managed care and insurance company personnel who review and can overrule their decisions. Physicians are losing control of health care, and many forms of care are no longer available to all patients quickly, whenever needed.
What's the impact of these story lines that week after week conceal medical reality from millions of TV viewers?
Don't be so naive as to think that these programs are simply fictional dramas and comedies that entertain and amuse. Like the rest of television, they teach viewers about how the real world works.
Indeed, Turow believes that entertainment can be more effective than news programs in giving people a sense of institutions such as medicine. Doctor series, for instance, give viewers behind-the-scene images of health-care workers that viewers rarely get in short news stories.
"By acting out tales of life and death, competency and incompetency, and morality in persuasive ways, TV fiction about health care can present compelling scenarios about what caregivers might do and what they should do when different types of people get sick," Turow says.
Turow cites several possible impacts. TV doctor series may, of course, confuse viewers, and make it more difficult for voters to understand the changes occurring in health care today.
Likewise, the plots may give viewers a norm, a consistent standard against which to judge any further changes in health care. The plots, Turow said, tell viewers that physicians should control health care, and that all medical care should be available quickly to all patients.
Turow cites another possible long-term effect of TV's Utopian images of physicians in authority. Patients may expect physicians to have more power over health care than they really have in today's corporate-medicine, managed care environment.
Uninformed about the true politics and structure of health care, the public may increasingly blame physicians for decisions that managed care clerks and administrators make and enforce.
(Distributed by Scripps Howard News Service)