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New fall TV season seems to reinforce physician-centric vision of health care, largely ignoring nurses

2004 Fall TV preview

September 15, 2004 -- New television shows premiering this fall, including NBC's "Medical Investigation," Fox's "House M.D.," Discovery Health Channel's "The Critical Hour," and CBS' "Dr. Vegas," appear set to continue and expand the dominant medium's prevailing vision of physicians as the heroic directors and providers of virtually all meaningful health care. With the possible limited exception of "Dr. Vegas," initial viewings and available reports suggest that these shows, like their predecessors in recent years, will marginalize or ignore the critical work of nurses. And though each TV season seems to bring several new physician shows, it's been many years since Hollywood has produced any show focusing on the work of nurses.

"Medical Investigation" and "House M.D." follow teams of epidemiology-focused medical experts who solve urgent health care problems ordinary mortals can't handle. Needless to say, it would not occur to Hollywood to give nurse-epidemiologists or forensic nurses prominent roles in this kind of programming, with its focus on cutting-edge issues, intellectual innovation and swagger. Accordingly, neither of these shows seems to have a single significant nurse character.

"Medical Investigation" is a CSI-like procedural about a team of NIH epidemiology hotshots who drop out the sky to deal with outbreaks of unexplained diseases nationwide. The team is led by a somewhat abrasive (but heroic) physician, Stephen Connor, and it also includes two other physicians, a toxicologist, and a publicity liaison. An initial viewing suggests that the show portrays critical ill patients being cared for almost entirely by physicians, who will conduct all on-screen patient interactions and professional discussions about the patients' conditions. The few nurses who appear (fleetingly) seem to be there only to accept urgent commands from the physicians who dominate the codes.

"House M.D.," which may not begin airing until November, is about a cranky genius nurse--ha ha, just kidding--a cranky genius physician named House who uses his peerless diagnostic skills to solve medical mysteries and save patients, even though he apparently can't stand them. House, who seems to work out of a single hospital, leads a team that includes four other physicians: a neurologist, an immunologist, an intensivist, and an oncologist. He also butts heads with yet another physician, the "Dean of Medicine and hospital administrator." Six out of six major characters as physicians is pretty impressive. "ER" at least includes one nurse, dropping its physician dominance score to only around 90%, and even shows with no major nurse characters, like "Nip/Tuck," at least have some non-physician characters.

Discovery Health Channel has just begun airing a 12-part documentary/reality show called "The Critical Hour," which explores the workings of the University of Maryland's world-class Shock Trauma Center. The show might have provided a vehicle for a balanced look at the work of the nurses, physicians, paramedics, and others who make up the Shock Trauma team. Unfortunately, like ABC's recent "Hopkins 24/7," which paid tribute to another venerable Baltimore institution, "The Critical Hour" clearly regards the work of the physicians as the only health care that matters. The first episode relentlessly portrays trauma center medical chief Dr. Tom Scalea and the other physicians as sensitive heroes who do everything of importance there. With the exception of two brief appearances by nurses and several by paramedics, almost all interviews shown are with the physicians. They go on at length about what they are doing, how they are feeling, and even what it's like for the patients and families--as if the physicians would know more about that than the nurses who spend so much more time at the bedside. Critical tasks that the physicians cannot credibly be said to have performed are handled in the standard physician-centric media ways: they are said to have been done by "staff," or a physician says that "we" did them, or they are described in the passive tense (with no specific actor), or they are simply ignored. The nurses' vital team work for these patients is not a focus, and their autonomous work is ignored. It's hard to see how a viewer of this show could regard the Shock Trauma nurses as anything but marginal physician assistants. This tired, regressive vision of care might be surprising, as the series is the work of the filmmakers who won an Oscar for the 1999 documentary "King Gimp," except that the level of understanding of nursing is generally no better in the alternative or elite media than it is anywhere else. The handmaiden stereotype remains ubiquitous. A physician-intensive article about the new series in the Sept. 12 Baltimore Sun reinforced these harmful attitudes, failing even to mention the word nurse. Contact author Dennis O'Brien about his article.

The imaginatively named "Dr. Vegas" is a drama about a house physician (Rob Lowe) at a major Las Vegas casino. Although the CBS web site now includes only three other major characters--the hotel's general manager, his assistant/enforcer, and a "beautiful blackjack dealer"--earlier versions and a clip from what may be the first episode appear to include a nurse practitioner named Alice Doherty, played by Amy Adams. Though this NP's omission from the web site indicates she will not be a major character, several scenes from the clip suggest that she may display a certain amount of expertise and independent thinking. Of course, it's not clear how much that counts for in a show that sounds this limited, but we'll be watching. See our initial review.

The above shows join an existing framework of Hollywood programming that effectively equates medicine with health care, regularly showing physicians as tragic heroes and nurses as peripheral subordinates. These shows include NBC's "ER" and "Scrubs," the WB's "Everwood," Lifetime's "Strong Medicine," PAX's "Doc," and FX's "Nip/Tuck." Together, as recent research suggests, such entertainment programming has a significant effect on the vision of health care shared by tens of millions of people in the United States and around the world.


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