Dr. Clinton's Prescription : Can Politicians Take On Dr. Welby?

Steven D. Stark, who has written for the Atlantic Monthly, is a commentator for National Public Radio

Because the images of popular culture provide a mirror of public sentiment, they can tell us what Americans think about various issues and professions. President Bill Clinton's long- awaited health proposal is now before the public. According to many polls, Americans are eager to reform the mammoth system. Yet if the mythology created by Hollywood is to be believed, the task of comprehensive reform will be far more difficult than either surveys or critics have made it seem.

The reason is simple: From Edward G. Robinson's Dr. Ehrlich to Dr. Kildare, from Ben Casey to Marcus Welby, from Hawkeye to Dr. Westphall, from Doogie Howser to Trapper John, doctors are among Hollywood's most venerated icons. As early as 1911, D.W. Griffith set the tone in "The Country Doctor," where a physician's ill son dies because the doctor has selflessly left to treat another patient.

"Guardian of Birth . . . Healer of the Sick . . . Comforter of the Aged" was the way the hit '50s TV show "Medic" described doctors, ascribing to them qualities such as "the eye of an eagle, the heart of a lion and the hand of a woman."

Though the descriptions have been updated in the 40 years since to account for things such as the women's movement and a baby-boom sensibility, the basic depictions haven't changed much. Just watching today's likeable Joel Fleischman on "Northern Exposure" or the heroic Dr. Quinn on "Dr. Quinn, Medicine Woman." According to a 1991 survey of TV characters in "Watching America," doctors are among the most popular professionals on TV.

No one should be surprised that television and the movies have always been drawn to the medical profession. Its dramas take place in a fairly controlled setting that is easy to film. Medical stories present dramatic "life-and-death" crises, an opportunity to show blood and a wide array of characters of both sexes. (In contrast, Westerns or adventure shows tend to be male-dominated.)

But what is unusual is the degree that TV and the movies almost always glorify the profession. Even in advertising, doctors lead a charmed life ("I'm not a doctor, but I do look like one and I'm here to tell you . . . . "). Though even cowboys have now found a critic in Clint Eastwood, we're still waiting for the TV show where Marcus Welby's patients wait an hour and a half, much less find he accidentally prescribed the wrong drug. With a few exceptions, doctors get even better treatment in popular culture than religious figures, which tells you who has become our new high priests in a secular age. Ever wonder why they called it "Saint Elsewhere?"

As for malpractice, it doesn't exist much in pop culture, except to be explained away as the necessary cost of doing good. As Dr. Gillespie put it on an episode of "Dr. Kildare," "Medicine isn't worth practicing if I have to stop myself because of legal risks. Until I am free to proceed on the basis of my knowledge and skill, I am not a doctor. I am a slave to outmoded laws." So much for Hollywood's attitude toward government regulation of medicine. (Maybe Hillary Rodham Clinton missed that episode).

To be sure, doctors in popular culture tend to conform to unusual conventions that defy reality. Many are general practitioners in a small practice, and many work for the government in some capacity--Fleischman on "Northern Exposure;" the doctors on "M*A*S*H," and Chick Hennessey on "Hennessey."

Many are also younger physicians or interns in public hospitals, meaning they project an image of selfless service; they'll treat anybody, anywhere, anytime. House calls? On TV, doctors have been known to drive patients home and even clean their houses. After all, the biggest cliche line in medical dramas has never been, "Let's hit the golf course!" or "Get these hypochondriacs out of my office," but "You've been working for two days straight. Go home and get some rest."

It's true that pop-culture depictions of the medical profession have changed somewhat in recent years. There has been a spate of '90s anti-doctor films such as "Lorenzo's Oil," "The Doctor" and even "The Fugitive,"--which, with its Clinton-inspired revisions, somehow ends up blaming drug companies and greedy doctors for Dr. Richard Kimble's predicament. Yet even in those films, the fault often lies less with individual doctors than with a medical Establishment that has lost touch with patients.

Similarly, television depictions of doctors have changed over the years as the focus has shifted from the concerns of patients (as on "Marcus Welby") to those of the doctors themselves (as on "St. Elsewhere.") But that's primarily a reflection of a larger cultural shift. Today's pop-culture doctors may no longer respect their elders, as Steven Kiley did. They may be younger, more ambivalent about their role and more self-absorbed. But so are most heroes today.

Thus Clinton has a problem. These images don't exist in a vacuum; they have become part of our national consciousness. It's possible Clinton can frame his crusade as a fight against big business and bureaucracy, and win.

But it's not likely. Though Americans may sense something is amiss in our health-care system, their idealized visions of the medical profession are bound to get in the way of significant reform--particularly if doctors work to oppose these efforts. It's difficult to tamper with national myths: Just as no one would think of passing a law saying Mr. Smith can't go to Washington, it will be difficult to go after the medical profession.

Face it: There have been many great doctors in television and movies but it's hard to remember many great politicians. In a cultural clash between Clinton and Marcus Welby, Clinton gets the early headlines--but put your money on Welby. The doctor always knows best.

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