Strong Medicine (2000-2006)
Starring Rosa Blasi, Patricia Richardson, Janine Turner, Rick Schroder, Josh Coxx, Jenifer Lewis, Philip Casnoff, Brennan Elliott, Tamera Mowry
Executive Producers: Tammy Ader and Whoopi Goldberg
Produced by Sony Pictures Television
Lifetime's "Strong Medicine" was a drama that seemed designed to empower women by exploring the lives and achievements of strong female physicians, by showing those physicians in command of the health care setting, and by promoting understanding of women's health generally. Sadly, the show's good intentions could not redeem its often ham-handed plotting, dialogue and direction. Its portrayal of nursing was fairly poor. It had a positive nurse character in alterna-hunk Peter Riggs, a nurse-midwife who displayed knowledge and limited autonomy. But even his intermittent appearances were undermined by a persistent vision of physicians as the heroic masters of all health care. And other nurses--when they appeared at all--were almost always faceless servants, silent and submissive.
For most of its six years in production, "Strong Medicine" followed two female physicians who together directed the Women's Health Clinic at Philadelphia's fictional Rittenhouse Hospital. One was passionate, down-to-earth Lu Delgado (Rosa Blasi) (far right), an apparent generalist who ran a free clinic. The other lead role was that of a hotshot surgeon with a more upscale patient group. For the first two seasons, this character was Dana Stowe (Janine Turner--below right), an uptight overachiever who was a leader in breast cancer research. At the start of the third season, Stowe left to raise adopted children in Virginia. She was replaced until the end of the fifth season by rule-bound ex-Army surgeon Andy Campbell (Patricia Richardson--above left). Campbell tended to act as if every human interaction were a formal military one, and she ultimately left the show to become Surgeon General of the United States (really). In the final season, Delgado's surgeon partner was the aggressive but good-hearted Dylan West (Rick Schroder--below right).
The show focused overwhelmingly on the professional and personal lives of these two main characters. They fought over difficult issues in predictable ways, Delgado always outraged at some injustice, and her partner generally more concerned with discipline, order, and working within existing systems. But they regularly managed to come together to do the right thing, or at least agree there was no clear right thing. The physicians' specialties did not stop them from moving effortlessly into other areas, rushing into the ED and taking charge of emergent cases there, especially when their own patients arrived in distress, asking for them by name. West, a surgeon, had supposedly delivered hundreds of babies.
In general, the show approached current health subjects in a frank and fairly responsible way, including some women's issues that are rarely addressed in dramatic television. How many TV dramas have addressed the potential long term sexual dysfunction of former prostitutes? Episodes often started with Delgado leading a circle of patients in an earthy women's health discussion. The brilliant hip hop survivor Mary J. Blige was the guest star in one episode, which also featured her song "PMS." However, the show often undermined its treatment of such issues by cutting huge corners in health care realism, and with its pedestrian, obvious drama. The actors tried to compensate, with some success, but at times they sounded like they were trapped in a modern morality play, where abstract human qualities and experiences actually appeared as characters. You half-expected them to burst out with something like "Behold Domestic Abuse! We must banish Him!" or "I am Troubled Teen Years! Beware my sting!"
A few other regular characters got some screen time, generally as foils for the two leads. One of the more prominent of these was Peter Riggs, RN (Josh Coxx--above), an attractive, holistic, good-hearted vegetarian who worked with Delgado at the free clinic. He was a nurse-midwife, which is unusual for a man, but consistent with his role as the ultimate evolved straight guy. Lana Hawkins (Jenifer Lewis-- right), the good-hearted ex-prostitute receptionist, had a penchant for talking about herself in the third person. Robert Jackson (Philip Casnoff--below right) was the gruff, cost-conscious--yet good-hearted--physician who served as the hospital's CEO through the fifth season. He shared Campbell's habit of calling everyone by his or her surname. Nick Biancavilla (Brennan Elliott) was an ED physician and one-time flame of Stowe's who had some rough edges, but a...um...oh yes, a good heart. Elliott left the show at the end of the fourth season, and the fifth began with the appearance of intern Kayla Thornton (Tamara Mowry--below right). Thornton eventually came to rent a room in Campbell's house, and she became Riggs' girlfriend.
The show ended after six seasons. As it wound down, Delgado married a successful corporate chieftain named Jonas, and although his company imploded, things were looking up for the couple by the end. The series finale ended with the delivery of their baby. West spent much of the last season recovering from having accidentally killed his fiancée in a car crash, and struggling to connect with his troubled teenaged daughter (by another woman) whose existence he had only recently discovered. Finally, West and his daughter seemed to be on track. And as part of the show's final scene, Riggs proposed to Thornton.
Any discussion of nursing on "Strong Medicine" has to start with Riggs, the only regular nurse character. This former Peace Corps volunteer was an almost surreally positive character. He was caring, even-tempered and knowledgeable as a nurse (and acupuncturist, herbalist, massage therapist, you get the idea). He was also gorgeous, hip and sensitive, yet manly--check his motorcycle. At times he even seemed to operate with some autonomy, advising patients on preventative care, handling basic testing, and of course, counseling menopausal transvestites. He was capable of disagreeing with the physicians, though not usually about technical care issues. Riggs was a nurse-midwife, but did not seem to spend much time seeing pregnant patients or delivering babies. Possibly the show didn't really know much about what nurse-midwives do, but just thought it would be a cool thing for a straight man to be. Riggs did present viewers with a fine example of gender diversity in a time of critical shortage. The show acknowledged the male nurse stereotype; apparently, Riggs' own mother was convinced he was gay.
So what's not to like? Well, we did like Riggs, but we could also see a few problems. First of all, he often seemed more like a New Man Composite than an actual character. His function was to be a handsome male subordinate to the female physicians who dominated the show, a reversal of the old paradigm of the powerful male physician surrounded by pretty female nurses. At times he was presented as going off the deep end, with all his alternative therapies and causes, though Delgado could be that way as well. Riggs was usually taken seriously enough. He did not seem to spend too much time in relationships with the show's physicians, until hooking up with intern Thornton. Riggs was a popular sperm donor, including for an unsuccessful pregnancy attempt by Stowe, and one plotline had him posing nude for an aspiring painter. This is one vision of the straight male future: look cute, take orders, give up that sperm, and get out of the way.
Peter Riggs' subservience to the show's physicians was clear. In one episode, in which Animal Rights Peter led a public protest of plans to transplant a monkey's heart to a patient, he assured the surgeons that he did not mean to be insubordinate. In another episode, Riggs believed that a powerful OB/GYN had performed an unnecessary C-section, resulting in a hysterectomy. Riggs agonized over what to do, consulting Delgado, and he actually did confront the OB/GYN. But she simply dismissed him with an apparently credible threat to have him fired if he pursued the claim. Riggs was too fearful to do much effective patient advocacy. The show did not question whether the physician's power would or should exist, it only questioned her abuse of it. The episode concluded with Delgado saving the impotent Riggs from the OB/GYN's wrath, telling the OB/GYN that Riggs could no longer be spared from the women's clinic to work with the OB/GYN.
In fact, nursing and medicine are two autonomous professions, and neither is formally subordinate to the other. Of course, as an advanced practice nurse performing some tasks traditionally done by physicians, Riggs would be in a somewhat different position from other nurses, on those occasions when he was operating as a nurse-midwife. In that role, he would still be an autonomous professional. But he might work in the department of medicine (rather than nursing), and he might report to physicians, as other physicians do (unlike staff nurses, nursing managers and clinical nurse specialists). In any case, we doubt many viewers made that distinction. More likely, they simply had their existing belief that nurses report to physicians confirmed.
The show also made a few laudable efforts to deal with current nursing issues. Most remarkable was a 2002 episode that was perhaps the only serious recent effort by a national television drama to address the epidemic of nurse short-staffing. In that episode, one of Stowe's post-operative patients died after an inexperienced nurse mistakenly gave her blood thinner too quickly. Riggs, as shop steward, defended the nurse, arguing to Stowe and hospital CEO Jackson that hospital nurse staffing cuts had made it impossible for nurses to deliver good care, and errors like this were the result. Jackson, who seemed to view nurses as a costly annoyance, cited budget constraints. The hospital's nurses went on strike over the staffing issue, with Riggs leading the charge. Of course, here there was no question that Riggs was anything but a staff nurse, and as such, the OB/GYN in the episode discussed above would have had no direct authority over him. In any case, Jackson closed everything but the ED, where physicians struggled to provide even limited services.
As discussed in more detail below, the show did not really understand that nurses have unique knowledge and responsibilities--it thought that nurses basically assist physicians, handing them things, giving drugs they "order"--but this episode did at least try to show that nurses are important. Jackson's inadequacy as an ED triage nurse almost cost a patient her life. A strike-breaking veteran OR nurse showed technical knowledge. But the nurses still existed to assist the physicians. A nurse who was having a workplace fling with Biancavilla refused romance until the strike ended, noting wrongly that physicians are management, and nurses are labor. Riggs at one point mentioned a director of nursing, but that person never appeared (she must have been labor too). The physicians finally learned their lesson, or at least a lesson. They struck a deal involving longer nursing orientations and a limit of nine patients per nurse, apparently to be applied hospital wide (a patient load most real nurses would view as dangerous on any unit). Jackson assured Riggs that the nurses would take this deal because they're nurses and they know they're needed. Guess that's enough; as Biancavilla's flame tells him, nurses are one step up from dogs. That and other elements of the episode are enough to make you laugh and/or cry. But its basic theme--that cost-cutting is squeezing nurses and threatening patient lives--is one that has rarely been addressed at length on any television show, much less a serial drama.
In its final season, the show ran several minor plotlines that seemed designed to showcase Riggs' skill, moderate autonomy, and commitment to nursing. In one episode, Riggs got fed up with seeing yet another poor young mother getting inadequate support from her baby's gangbanging father. So he set up a "baby boot camp" for those fathers, which he ran with considerable skill. The episode also briefly highlighted Riggs's skills as a midwife, setting him up in competition with surgeon West in caring for the pregnant Delgado. Other episodes had Riggs working in the ED with his girlfriend Thornton. One plotline explored power issues between the two in the aftermath of their care for a teen who died of hypertrophic cardiomyopathy. The episode did manage to show that Peter had significant knowledge, and the initiative to act on it to save the lives of others who were at-risk. But it also confirmed that at the end of the day, physicians like Thornton were in charge. And the series finale had a minor subplot in which Riggs affirmed that he would rather be a nurse than a physician. In that one, he resisted pressure from Thornton to go to medical school, which she called his "way out of nursing." The episode commendably highlighted the contemptuous views of nursing that some physicians hold. And another scene had Riggs making an ED diagnosis that an intern missed. But it was hard to see Riggs's marriage proposal to Thornton at the end of the same episode as a sign of nursing self-respect. And for the majority of all of these episodes, nurses were portrayed as marginally skilled physician subordinates who did not talk to patients or families, while physicians provided all important care.
Indeed, outside of Peter's occasional plotlines, which is to say for the great majority of the show, the treatment of nursing was virtually always abysmal. There were many inpatient and ED scenes, yet in most cases, physicians simply did everything themselves. Nursing was either not shown, or was performed by the physicians, who provided all significant bedside care, patient advocacy, patient teaching, and emotional support. One memorable scene showed Campbell and other physicians performing a complex operation with no nurses present. When nurses did appear, such as in the ED scenes, you could barely see them, as they flitted around and waited for the physicians to command them to do things they would have already done or suggested in real life. Nurses rarely if ever cared for patients on their own. For the most part they did not even speak to the patients, the physicians, or each other. They were meek servants who performed simple tasks the physicians dictated. Patient advocacy by these nurses? Guess they'd have to be able to talk first.
One revealing fifth season episode offered a vision of emergency care in which only physicians and paramedics played roles of any significance, with nurses so peripheral it wasn't clear you could even say they were handmaidens. This episode was apparently designed to serve as a pilot for a potential spinoff series called "Strong Medicine: First Response." It centered on a white paramedic and her adoptive sister, the black chief of trauma medicine. The trauma physician performed the show's standard amount of physician nursing, handling all important clinical tasks, emotional support, and patient education. The paramedic did a fair amount of nursing herself, visiting admitted patients in an apparently professional capacity, and participating in patient interactions with physicians. The paramedics handed patients directly to the physicians; an anonymous nurse might be seen doing something or other at the edge of the screen. The only line by any nurse character was: "Less than a minute away, Doctor."Despite its dramatic limits, "Strong Medicine" was popular for a basic cable show, and it deserves credit for highlighting key women's health issues, and showing young women some of what they can achieve in health care. Too bad the show's vision of female empowerment did not include the millions of female nurses, who spent the show's six-year run struggling through a global crisis.
Reviewed by Harry Jacobs Summers
Nursing Editor: Sandy Summers, MSN, MPH, RN
Review last updated May 10, 2006
The views expressed herein do not necessarily reflect those of the Board Members or Advisory Panel of The Truth About Nursing.