From House Calls to HMOs

The image of doctors has changed a lot over the years--and there’s no better yardstick for that than the way they’re portrayed by Hollywood. For the lowdown, check out “Doctors in the Movies,” by Dr. Peter E. Dans (Medi-Ed Press, 2000).

Dans, associate professor at the Johns Hopkins Medical Institutions, was an avid moviegoer as a kid. He got into the movie-reviewing gig by writing a column, “A Physician at the Movies,” for the medical journal Pharos. Eventually Dans decided to write a book examining the medical genre, from the present way back to the ‘30s, when doctors yelled, “Boil the water!” and scenes were thick with skeletons, medical students fainting at the sight of blood and doctors smoking. (“There’s nothing like a cigarette before a tonsillectomy or after one, for that matter,” says one character in 1935’s “Society Doctor.”)

Dans sat through romantic ‘30s movies (such as “The Country Doctor”) in which superheroes struggle through snow and sleet and get paid in chickens and tomatoes. He watched the entire 1930s-’40s series featuring the brilliant Dr. Kildare, who cures a symphony conductor’s hearing loss with a shot of vitamin B-1 and instantly diagnoses the cancerous lesion on his mentor’s hand.

(“Death? How soon?” snaps the crusty mentor. “With luck, you have one year,” replies young Dr. Kildare.)

Over time, Dans noticed, cynicism and hostility began to replace the soaring, impassioned speeches about the noble calling of medicine (“When he takes the oath, a doctor swears away all his rights as a human being ... he belongs to medicine” from one of the Dr. Kildare movies).

In real life, the cost of health care was rising--as was suspicion of technology and institutions--while the personal touch of doctoring was fast disappearing. As the public’s attitudes shifted, Hollywood mirrored them, leading to dark portrayals seen in movies like “Critical Care” (1997), in which a hospital prolongs patients’ lives solely to get their medical insurance, and “The Doctor” (1991), in which a callous surgeon gets a harsh lesson in the system’s unfeelingness.

Though some of the films were a tad over the top, Dans says, watching them may have been good for those in the medical profession. “When ‘The Doctor’ came out, one of the surgeons here said, ‘If it makes one doctor a little bit more compassionate for even a few weeks, then it was worth it.’”

But the “evil doctor” movies have been easier for Dans to take than the treacly “Patch Adams” (1998). He loathed it, he says, for its depiction of one doctor as caring and enlightened--and everyone else as unfeeling idiots. (“I don’t like framing things that way. It’s a cheap shot,” he says.)

Meanwhile, maybe doctors are poised to get some slack because managed care has become the villain. “As Good as It Gets” (1998) slams HMOs and even features a doctor making a house visit. Full circle?

One of the fun things about old medical movies is the jargon that doctors spout. Amazingly, a lot makes medical sense. (I once met a woman who made a career out of medical consulting, happily researching such things as pustule shape and color so the makeup department would make the gore look right.)

So, for instance, a pathologist friend of Dans told him there is a “Rokitansky method for performing autopsies” (“Not as a Stranger,” 1955). And it does make sense to spout things like “16,000 with 89% polys” when reviewing a patient’s blood work (“Welcome Stranger,” 1947). On the other hand, you’re not going to cure someone’s deafness by giving them a quick jab of vitamin B-1 as Dr. Kildare did.

“Screenplays for the Kildare films were written when things like vitamins, vaccines, sera and procedures were new and exciting,” Dans says. “So the screenwriters used new terms to jazz up the scripts.”

Similarly, Dans has never heard of a surgical method called the “Steiglitz procedure,” though this is a fine point to dwell on when you consider the wackiness of the scene, one of Dans’ all-time faves (“Society Doctor”). Our hero doctor, shot through the abdomen, is lying there wracked with pain directing an operation on himself to remove the bullet.

“You must do the Steiglitz procedure, you sap,” he says to his assistant intern. “He had only animals to experiment with. We’ve got me. Here’s a chance to try it out.... Give me a spinal, I want to know what’s going on. Arrange a mirror, so that I can see it.... Better cut right through there. Now just a little bit more. Careful! Better take a look at the transverse colon.... Cut.”

They just don’t make ‘em that way anymore.

If you have an idea for a Booster Shots topic, write or e-mail Rosie Mestel at the Los Angeles Times, 202 W. 1st. St., Los Angeles, CA 90012, or rosie.mestel @latimes.com.