AMA Journal of Ethics^®

Mass media are the most ubiquitous wholesalers of social roles in industrial societies. Mass media, particularly television, form the common mainstream of contemporary culture. They present a steady, repetitive, and compelling system of images and messages. For the first time in human history, most of the stories are told to most of the children not by their parents, their school, or their church but by a group of distant corporations that have something to sell. This unprecedented condition has a profound effect on the way we are socialized into our roles, including age as a social role . . . . The world of aging (and nearly everything else) is constructed to the specifications of marketing strategies.¹

The mass media, including film, television, advertising, and radio, reflect and interpret the world for their audiences. But they also select what to cover and interpret, often feeding readers and viewers a narrow portrait of their world. The picture they paint is often neither a full nor representative view of the entire mosaic of humanity. The media, for example, have often served up stereotypical images of minorities, the elderly, those with disabilities, and all people with non-Anglo-American backgrounds. Movies such as Birth of a Nation, radio and television shows such as Amos-n-Andy and television shows such as The Secret Life of Desmond Pfeiffer have been much derided for their racist or stereotypical content.

If images of minorities were rare for much of early mainstream Hollywood, minorities cast as professional physicians and lawyers were rarer still. As Peter Dans explains in Doctors in the Movies, "[The fact that Blacks have been virtually invisible as physicians in the movies is not surprising given the racial discrimination in almost every sector of American society until the mid-1960s]".² In his chapter on black doctors ("Blacks, the Invisible Doctors"), Dans notes only a handful of films that showcase black physicians: Lost Boundaries (1949), No Way Out (1950), Guess Who's Coming to Dinner (1967), The Heart is a Lonely Hunter (1968), Outbreak (1995), and Eve's Bayou (1997). A mere 6 films in as many decades.

In the aftermath of the civil rights era and with the enormous influx of foreign physicians into American medicine, one would expect the media to strive to capture the new diversity in the profession. But this has not happened. Hollywood continues to neglect minority physicians in many contemporary films and television shows. Although NBC's ER has been lauded for its intelligence and verisimilitude, the casting of the show still does not reflect the fact that 25% of physicians in the US are international medical graduates, mostly of Asian and Middle Eastern descent. One tertiary character on the show, played by Ming-Na, is Asian despite the fact that 1 of 6 physicians practicing in America is of Asian descent.

Author Forrest Wood has criticized successful television producer Stephen Bochco for his now-defunct show City of Angels. The show purportedly tried to highlight medicine through the eyes of African American physicians. Yet Wood correctly pointed out in a recent review that this show failed in its attempt to present a realistic portrait of an inner-city public hospital, one mostly staffed by physicians of Asian and Middle Eastern descent. The promising but overly earnest Gideon's Crossing had a token Asian physician, played by Ravi Kapoor. Even the new NBC sitcom Scrubs, billing itself as a farcical take-off on residency training, doesn't risk losing mainstream audiences who prefer their docs to look like them rather than like international residents from East and South Asia.

Portrayal of physicians with disabilities has also been spotty. Although the ER character Dr. Kerry Weaver walks with an arm crutch, the actress who portrays her, Laura Innes, does not have a disability. In fact, an actress who does have a disability, Christopher Templeton, was denied an audition for the part. According to Gloria Castaneda, who works with the Media Access Office, a disability liaison group to the entertainment industry, ER received a great deal of criticism from the disability community. "That was a mistake 'ER' ook a lot of flak for," said Castaneda. "It upset a lot of people in the disability community. ER has been very careful since then as to whom they hire with disabilities." ER has since taken pains to provide greater opportunities to actors with disabilities.³

One would think that the portrayal of women physicians would have fared better than that of other minorities. Yet, outside the female physicians who populate the ensemble cast of ER, one would be hard pressed to name a famous female physician from either the small or large screen. As Dans points out in his chapter on women physicians, "Where Are All the Women Doctors?" "Asked to name a male movie doctor, you might rattle off Dr. Kildare, Dr. Christian, or a television version like Marcus Welby. Chances are, though, unless you're a film buff, you probably couldn't name a woman doctor." Dans goes on to state that although there were women doctors in films from the 1930s, they were not played by self-possessed actresses such as Katherine Hepburn, Bette Davis, or Joan Crawford. Rather, actresses such as Kay Francis were cast in these roles as "long-suffering, unappreciated, and conflicted heroines. . . ".⁴ Besides the popular Dr. Quinn, Medicine Woman that ran from 1993 to 1998 and starred Jane Seymour, few contemporary films or television shows have had a female physician lead. Exceptions include The Prince of Tides, with Barbra Streisand as a psychiatrist, Beyond Rangoon, with Patricia Arquette as a physician, and City of Angels, with Meg Ryan improbably cast as a heart surgeon. Dans notes that "the good news for budding filmmakers is that the great American woman doctor film has yet to be made".⁵

Despite the great interest among the various media in the medical profession, films and television programs too often fail to depict accurately the great diversity among health care professionals and the patients they treat. At its best, the media can perform a valuable service in raising the level of thinking and discussion about social issues and ethical dilemmas that divide Americans. In the past, it has done so sensitively and dramatically in films such as Philadelphia (AIDS) and Dead Man Walking (capital punishment), for example, as well as comedically in television shows such as All in the Family (racism) and Maude (abortion). Filmmakers and television producers are losing a golden opportunity to educate viewers by dramatizing communication problems between patients and physicians of different races, creeds, and descent and by exploring differences in cultural values concerning 2 events that eventually touch all of us—sickness and death. As a result of the media's inattention to the true diversity in American medicine, viewers come away with a skewed and outdated picture that helps neither patients nor physicians.