AMA Journal of Ethics®

Illuminating the art of medicine

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AMA Journal of Ethics®

Illuminating the art of medicine

Virtual Mentor. July 2001, Volume 3, Number 7.

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Take One: the American Medical Association; Lights, Camera, Action

The media helps shape the general public's perception of the American Medical Association as the emblem of organized medicine.

Kayhan Parsi, JD, PhD, and Sara Taub, MA

A glance at your local television listings will quickly reveal that the interest in medical theme shows is not abating anytime soon [1]. ER, the juggernaut of the 90s, is still watched by millions of people. Lately, as part of the "reality TV" trend, medical shows with a penchant for titillation have been filling the airwaves. These shows typically focus on individual physicians, nurses, and patients, with the hospitals playing a backdrop role. One show, Hopkins 24/7, gives the hospital itself a starring role. No television shows have featured the AMA in such a way. The inner workings of organized medicine certainly don't have the same appeal for the general public as the individual practice of medicine in the acute care setting, with its fast pace, heroic measures, and high stakes. Interestingly, however, the AMA has figured in the storylines of several recent programs, where it is offered as a symbol of organized medicine—either to emphasize notions of professionalism or, in a lighter vein, to poke fun at the power the institution of medicine has over our lives.

The AMA has never been a stranger to the media. Its journals' articles are frequently cited in the popular press. Policy decisions at its annual meetings are immediately disseminated by the major wire services. In addition, the AMA's achievements and setbacks are all thoroughly covered by the media. But lately the AMA's name has been popping up in some rather unlikely places: television sitcoms and dramas. Take, for instance, a recent episode of the highly popular West Wing in which one of the White House lawyers confronts the First Lady, Abigail Bartlet, who also happens to be a physician. Dr. Bartlet has surreptitiously written interferon prescriptions for her husband, the President, to help him conceal his MS diagnosis. The lawyer, played by Oliver Platt, states flatly that she violated Opinion 8.19 "Self treatment and treatment of immediate family members" of the AMA's Code of Medical Ethics by treating a family member. Further, she failed to maintain proper medical records—a violation of Code Opinion 7.05, "Retention of Medical Records" at which the lawyer only hints.

The AMA's code, in the lawyer's conversation with Dr. Bartlet, is invoked as an arbiter of proper physician conduct. Viewers familiar with the Code could glimpse its purple and gold cover in the presidential counsel's hand.

Sometimes, the AMA is invoked with an aura of deference. One of the tabloid television shows, Extra, recently devoted a segment to a rare disorder called multiple chemical sensitivity (MCS). The segment focused on Cynthia Wilson, who offered testimony of her personal experience with MCS. The image then shifts from Ms. Wilson to the American Medical Association's official insignia. In the background a voice narrates: "Even the esteemed American Medical Association will not recognize this as a disease." The image of the association that this segment reflects is dual: on the one hand, its "esteemed AMA" suggests a prestigious body that sets the standard for what constitutes a disease (though in reality, the association does not play this role). On the other hand, it highlights the association's refusal to call MCS a disease, after the viewer has just heard how greatly the condition interferes with Ms. Wilson's physical and mental wellbeing. With little explanation given for the rationale behind the association's stance, the position seems uncaring towards the patient whose experience it does not validate.

A less serious invocation of the code comes in an episode of the Simpsons ("Pokey Mom" aired 1/17/01), where Homer creates the "miracle spine-o-cylinder," a device intended to help alleviate back pain (actually a trash can over which he shoves people backward). Chiropractor "goons" soon appear to rough up Homer ("stop chiropracting," they say) [2]. In response, Homer reminds the goons that they are doing to him what the AMA did to them—trying to keep him out of the business and profession. "Think about the irony," Homer says repeatedly.

Another comic interpretation of the AMA occurred in an episode of the enormously popular sitcom Seinfeld ("The Package," aired 10/17/96). When Elaine, a Seinfeld regular, realizes her medical chart flags her as a difficult patient, she is determined to see this language eliminated, even if doing so requires her to steal the chart. Not long after a failed attempt at purloining the record, Elaine receives a phone call in the middle of the night. A cold, impersonal voice at the other end addresses her with a threatening tone: "We're with the American Medical Association, the AMA. Can you confirm the spelling of your last name?" Having obtained the desired information, her interlocutor rudely dismisses her questions before ordering her to hang up the phone to free the line so that he can make another call. Here, the AMA comes across as a policing agency that tracks down problem patients—either to deter them from "inappropriate" behavior or to reprimand them for it. The viewer is asked to believe, as the intrigue unfolds, that Elaine could very well be blacklisted by the AMA or penalized for her actions—when in fact it does not fall under the AMA's prerogative to do either to a patient. There is no question that Seinfeld's portrayal of the association is exaggerated, meant to evoke laughs from an extreme situation. Still, it's worth noting that the show plays on the idea of a patient-level enforcement role for the AMA.

These television shows use the AMA to tap into different ideas—perhaps even hostility—that viewers may have about the power medicine wields over our lives. In an effort to ridicule and, hence, make light of this power, the Simpsons and Seinfeld conjure exaggerated "big brother" images of enforcement as part of AMA activities. There is a sense that the shows' writers are playing off a staid, conservative image that often has characterized the association. The West Wing and Extra direct the viewer's attention to a different AMA, one that is recognized for its standard setting and prestige. They invoke the association with very different intentions than the above mentioned comedies, as a model and standard for the profession of medicine. If there is one cohesive message in the diverse portrayals, it's that, whether someone wishes to mock or celebrate organized medicine, the AMA is the general public's emblem for it.



References

  1. Booth, B. The physician mystique: Why so many are on TV. AMNews. June 18, 2001; http://www.amednews.com/2001/prca0618. [Website last visited 06/22/2001].
  2. Most of the program's dialogue around this intrigue can be found in TV's Homer Simpson Gets a Chiropractic Referral at http://www.chiroweb.com/archives/19/05/06.html. [Website last visited 06/22/2001].

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