Abstract. Analyses ofthe representation ofthe medical profession in the mass media have frequently pointed to the ways in which doctors are held up as secular ...
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G.P.: Apostmodern medical drama? !
Deborah Lupton Abstract Analyses of the representation of the medical profession in the mass media have frequently pointed to the ways in which doctors are held up as secular saints, as heroes in white coats. This portrayal, which has been common for some decades in the news media as well as in medical dramas on television and in film, may be described as modernist in that it upholds the post-Enlightenment ideals of science and rationality as the source ofhuman progress and the mastery ofthe vagaries of nature. However, more recently, the doctor as hero archetype has been challenged by highly negative portrayals of doctors and biomedical practice in the media. This perspective on medical practice could be described as late modern or postmodern in that it is highly reflexive, incorporating a critique of the ideals of modernity. To what extent is the postmodern perspective on biomedicine evident in the Australian mass media? To address this question in relation to medical drama, this article presents an analysis of the 1994 season of the television series G.?, focusing on the topics explored, the characterisation, and the narrative. It is argued that, while G.? does incorporate aspects of the traditional modernist representation of doctors and biomedical practice, it also includes elements of a postrnodern perspective, including a lack of resolution around medico-social conundrums, an emphasis on the relationship between illoess and the social context, and a portrayal of medical science as replete with uncertainty and doctors themselves as often foolish or ineffectual.
Introduction Sociological accounts of the medical profession have frequently attested to the power of doctors as a social group, the high status of the occupation, and the dominance that medicine exerts over more and more spheres of social life. For Talcott Parsons, one of the first socioloDeborah Lupton is a senior lecturer in the Faculty of Humanities and Social Sciences at the University of Western Sydney, ~epean.
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gists to write extensively about the social role of medicine, doctors fulfilled a necessary role in society by making pronouncements on who should be permitted to enter the sick role and how long they should remain in it. The prevailing sociological approach to medicine in the 1970s was more critical, viewing members ofthe medical profession as intent on increasing their power, consistently defeating the attempts of other parties to challenge them, and oppressing patients in the medical encounter to serve their own interests (see, for example, Freidson, 1970; Illich, 1975; Zola, 1972). Debate has subsequently centred around the extent to which medical dominance has been maintained. Some sociologists have suggested that the power ofthe medical profession has begun to erode, with patients beginning to demonstrate a greater willingness to challenge the traditional authority of physicians, and to exercise consumerist behaviour in their dealings with physicians (see, for example, .Haug, 1976; McKinlay & Stoeckle, 1988). The mass media have been implicated in changing attitudes towards the medical profession via their dissemination of information, hence contributing to a closing of the gap in knowledge between patient and doctor, the doctor's traditional power base (Haug, 1976, pp. 85-87). It has also been argued that the news media's questioning of medical authority and expertise has contributed to a diminishing of medical status. According to Elston (1991), in Britain '"[d]octor-bashing" and calls for reform have become major sports in ·the mass media' (p. 60). She notes that the British Medical Association has felt obliged to publicly protest at what it perceives to be highly critical reporting of the medical profession by the mass media. Bury and Gabe (1994) similarly refer to a 'trial by media' of British doctors working in controversial areas (p. 65). These comments raise the question of the role played by the contemporary mass media in constructing and reproducing meanings and discourses around biomedicine and the medical profession. There is no doubt that the medical practitioner is a dominant figure in the entertainment and news media. The news media rely on medical and public health stories to fill their bulletins (Chapman, McCarthy, & Lupton, 1994); medical television dramas have proved staple fare for audiences in countries such as Australia, Britain, and the United States. Since the 1960s, Australian audiences have been treated to the British and American-produced dramas Ben Casey; Marcus Welby, MD; Dr Finlay's Casebook; Dr Kildare; Angels; Medical Centre; Emergency Ward 10; Trapper John, MD; St Elsewhere; Doogie Hawser, MD; General Hospital; and Casualty. While medical dramas seemed to suffer somewhat of a loss of popularity in the late 1980s and early 1990s, a recent outcrop of high-rating American series, including ER and Chicago Hope, has signalled a renaissance ofthe genre. Long-running Australian-made medical television dramas have included The Young Doctors, A Country Practice, and C.P. Over the past
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few decades, most analyses of the representation of doctors in the mass media have argued that both the entertainment and news media tend to portray them as benevolent and authoritative white-coated heroes, successfully treating illness using both their high level of training and their personal wisdom with the aid of the latest technology and drug therapies (see, for example, Gerbner, Gross, Morgan, & Signorielli, 1981; Karpf, 1988; McLaughlin, 1975; Turow & Coe, 1985; Turow, 1989). This representation is common in the Australian news media. When, for example, the well-known and respected heart surgeon Dr Victor Chang was murdered in Sydney in 1991, the news coverage was overt in its description of Chang as saintly figure, genius, and man of vision, struck down tragically well before his time (Lupton & Chapman, 1991). This type ofrepresentation ofthe medical profession might be described as modernist in that it rests upon the post-Enlightenment belief in medicine, based on rational thinking and scientific·principles, as the key to human progress, a means of mastering the vagaries of nature. Consonant with post-Enlightenment ideals are the Cartesian notion ofthe mind as separate (and superior) to the body, the identification and treatment of diseases as independent entities, and the scientific model of illness as cause and effect (Comaroff, 1982; Gordon, 1988; Lupton, 1994). This understanding of medicine is highly individualistic: doctors are trained to isolate symptoms and define them as emerging from a named illness or condition using rational and deductive processes of decision-making. However, while the modernist perspective of medicine may have clearly dominated media representations in the 1950s and 1960s, over the past three decades there has emerged growing evidence of challenges to this portrayal. As suggested above, contemporary mass media texts have by no means been uniform in presenting a sanitised, all-positive portrayal of the medical profession. The current portrayal of medicine in the mass media provides contradictory representations of doctors and medical care that serve as a counter to the dominant discourses of medicine itself. In the news media, reporting of negligence, sexual harassment, assault, fraud, HIV infection, and other scandals is a central feature of the coverage of medical issues (Chapman & Lupton, 1994; Lupton, in press); and dramatic portrayals of doctors have shown them as suffering from mental or personality disorders (for example, the film Dead Ringers), or as incompetent or uncaring (for example, the film The Doctor). Karpf (1988) locates changes in the representation of the medical profession in the 1970s. She contends that the emergence of the patient consumerist and advocacy movement in that decade was accompanied by a growing critique of medicine in the British news media: 'How could you fill dramas with flawless, unfailingly empathetic doctors while the documentaries and news programs were busy featuring malpractice suits, allegations of medical greed, and examples of the peremptory
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treatment of patients?' (p. 193). Karpf argues that the result of this change was the introduction in the 1980s of medical dramas that portrayed 'the doctor as human being', complete with human foibles and emotional and physical problems. She observes, however, that, even in the 1980s, the figure of the 'good', altruistic doctor remained central to medical dramas (pp. 201-203). Similarly, American medical dramas screened in the 1980s, such as St Elsewhere, focused more attention on the personal lives of the doctors and other medical staff (Turow, 1989, pp. 232-233). The structure of St Elsewhere, with the use of hand-held cameras' and overlapping storylines and dialogue (Hill Street Bluesstyle), presented a more chaotic and therefore 'realistic' approach. The deliberate attempt was to 'demystify doctors'. As one of the program's production workers noted, 'We put them into a work situation where you understand how they function as human beings, not gods'. Another member of the production team remarked that the message the program attempted to convey was that patients should behave as consumers and be wary of medical care (Turow, pp. 249-250). This previous research suggests that what might be described as a late modem or postmodem perspective has emerged in mass media representations of biomedicine and the medical profession. Postroodem is a term that by its very nature has many meanings and uses and its meaning is therefore difficult to 'pin down'. As Ross (1989) argues, this slipperiness of meaning is itself 'one of postmodernism's most provocative lessons; that terms are by no means guaranteed their meanings, and that these meanings can be appropriated and redefined for different purposes, different contexts, and more important, different causes' (p. xi). However, for the purposes ofthis article, the postmodem perspective is assumed to incorporate elements of reflexivity and a certain cynicism towards the ideals of modernity. This understanding. follows Smart's (1993) definition of postmodernity as 'a more modest modernity, a sign of modernity having come to terms with its own limits and limitations' (p. 12). Therefore, rather than being a new epoch as such, the postmodem perspective is more like a steady accretion, the increasing pervasiveness of a condition of disenchantment with the claims of modernity that has gathered momentum since the end of the nineteenth century (p. 26). Other social theorists, such as Anthony Giddens (1992), have preferred to use the term late modernity to characterise this social condition. In the context of the growing reflexivity of postroodemity, people are beginning to challenge the assumptions of early modernity, particularly those that unproblematically view science and rational thinking as the vanguards of 'truth' and inexorable human progression (Beck, 1992; Giddens, 1992). The postmodem perspective is particularly evident in the new social movements that emerged in the 1970s and 1980s, central to which was the break from the communist party and Marxism as the
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centre of left politics organised around labour resistance. Instead, local struggles, such as student movements, the feminist movement, gay rights movements, and the ecology movement, surfaced as oppositional (Seidman, 1992, pp. 49-51). The critique of science emerged from those movements, for science was positioned as being central in the representation ofsocially disempowered groups as marginalised and deviant. The women's health movement, gay movements, self-help groups, and patient advocacy groups have been particularly critical of the claims to neutrality and universality of biomedical knowledge. These groups have vociferously argued that developments in biomedical treatment may be harmful rather than beneficial to the health and well-being of many individuals. The growth in litigation for medical negligence and the increasing turn towards alternative therapies are also evidence of . such disillusionment (Williams, Gabe, & Kelleher, 1994, p. 186).
G.P.: The 1994 season How are members ofthe medical profession, and medical practice itself, represented in contemporary Australian television drama? To what extent is the postmodern perspective on biomedicine evident in this genre? To address these questions, I analysed a year of episodes of the long-running medical drama series G.P., with a particular focus on topic, narrative structure, and characterisation. G.P. (the initialism for 'general practitioner') has been produced and telecast 'for six years by the Australian Broadcasting Commission. A 50-minute episode of G.P. is screened once a week in a season of 40 episodes a year. G.P. features an ensemble cast that in the 1994 season included the characters ofthree general practitioners and one psychiatrist working together in a group practice in a middle-class, inner-city suburb of Sydney. The doctor characters were William Sharp (aged in his 60s), the patriarchal, white-haired founder and leader of the practice, who is a surgeon as well as a G.P.; Tessa Korkidas (aged around 40), a G.P.; her husband Ian Browning, a psychiatrist; and Martin Dempsey (aged in his early 30s), a newcomer to the practice and to general practice itself. The practice's secretary, Julie Winters, was a fifth regular character; and Tessa and Ian's three teenage children, Zoe, Donna, and Peter Browning, were semi-regular characters. The documenting of a season of G.P. was part of a broader project examining contemporary Australian media representations of the medical profession and audiences' responses to such coverage'. For the purposes of the present study, all episodes of the 1994 season of G.P. were video-taped and a plot synopsis was written for each. In addition, the set of the program was visited in late 1994 by a member of the research team and some of the cast members, script writers, and crew members were interviewed 2 . G.P. has the dramatic and serial elements
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of 'realist' soap opera but boasts higher quality production values, acting, and scripts. The production team prides itself on medical accuracy and attempts to cover contemporary issues in a sensitive yet entertaining manner. In 1994, there were six script writers and four directors working on G.P., each writer and director working on one episode at a time. It takes about a week to film each episode, and filming takes place four or five months in advance of screening. Medical consultants attend the filming to advise on the authentic way to depict medical procedures. According to one of the script writers, ideas for the storylines come from a range of sources. Two nurse researchers are employed to visit doctors to discuss with them the issues they face on a regular basis in their practice, and news clippings and documentaries are surveyed to provide inspiration. Experts or representatives from community groups are also invited to discuss with the production team potential issues that might eventually be dramatised on the program. The doctor characters on G.P. are designed to be 'typical' ofpractitioners in a Sydney inner-city practice. The intention is to maintain the regular characters as sympathetic yet realistic. To enhance authenticity, -medical equipment is often borrowed from Sydney's Royal North Shore Hospital and scenes are sometimes filmed there. As evidenced from the plot synopses for the 1994 season, G.P. covers a wide range of medical and social issues. Each episode usually revolved around one particular medical condition, but often others were included, and many related social issues were also canvassed. Indeed, some episodes concerned topics that did not include medical treatment or illness at all but rather centred around social issues. The diseases, conditions, or medical treatments that featured in the 1994 season included car accident injuries and deaths, lupus erythematosus, alcoholism, kidney disease and kidney transplants, HIV/AIDS, Alzheimer's Disease, the health effects of unemployment, cardiovascular disease, puberty, gender indeterminacy, adolescent sexuality and contraception, health farms, occupational stress, chicken pox, stroke, alternative therapies, Ecstasy use, asthma, illness and death in the elderly, mental disability, pregnancy late in life, abortion, hyperactivity, lead poisoning in children, physical disability, marijuana use for pain suffered by cancer patients, genetic disease and testing, colon disease, tonsillectomy, diabetes, breast cancer, back pain, therapeutic massage, migraine, youth suicide, child sexual abuse, and cervical cancer. The list of social issues canvassed during the season is almost as long: drunk driving, racism against Aboriginal people, school bullying, the disposal of dead bodies, fundamentalist Christianity, divorce and its effects on families, child welfare issues, rape, domestic violence, marital relationships, homosexuality and gay politics, adultery, insurance fraud, the financial problems of farmers, the stresses upon medical students, politics in South Africa,
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gender roles, the stresses of motherhood, mid-life transitions, adoption, brother-sister incest, sexual assault in marriage, the adjustment of ex-prisoners to life outside bars, sexual harassment in the workplace, delinquency, single motherhood, fatherhood, the ethics ofthe priesthood, priests and sexuality, religious belief, lesbianism, loneliness, homophobia, the plight of elderly immigrants, cultural differences in mixed marriages, and the death of a parent. Topics related to psychiatric practice included schizophrenia, manic-depression, post-traumatic stress disorder, suicide, adolescent depression, maternal depression, paranoia, burn-out, violent tendencies, and self-mutilation. The regular doctor characters in G.P. are uniformly caring towards their patients, spending much time in private discussing their problems with other characters (almost to the point of obsession), always willing to make house calls, and frequently 'dropping' around just to check on their patients' well-being. In this respect, Drs Sharp, Korkidas, Browning, and Dempsey conform to the archetype of the benevolent, empathetic doctor, with the highest of morals, that has been a mainstay of medical drama (and that is rarely found in real life). In one episode, for example, Martin Dempsey is offered a bribe by a patient to be involved in medical fraud and he responds with shock and moral outrage at the very idea. However, the doctor characterisations are far more complex than this archetype, going well beyond the simple 'doctor as hero'. In the 1994 season of G.P., a number of controversial issues were aired that depicted the doctor characters in rather unfavourable lights. In relation to their personal relationships in particular, the doctor characters were shown as often ineffectual or foolish, and even as testing the limits of ethical behaviour. Two episodes, for example, depicted William Sharp having a romantic relationship (culminating in a sexual encounter) with Eva, the wife of one of his patients who had had a stroke. While it was made clear in the episodes that Eva's marriage had been in trouble for some time (and that her husband had been about to leave her at the time of his stroke), issues were still raised concerning the ethics of such a relationship. In one scene, William is directly confronted by Eva's son, who angrily accuses him of 'screwing your patients' wives'. Several episodes featured William Sharp behaving in overly conservative and inflexible ways, particularly in relation to his female patients. William's position as the 'wise-man' of the practice was also undermined on several occasions by the women working there-Dr Tessa Korkidas and secretary Julie Winters-who often chided him about his propensity for patriarchal behaviour, both towards themselves and towards female patients. In this context, William was shown as meaning well, but behaving inappropriately. One example is an episode in which a 14-year-old girl, Cass, requests from William a prescription for the contraceptive pill. William is highly discomforted by
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the idea of Cass being sexually active at such a young age, and by the fact that she doesn't want her parents to know about the consultation. He warns her against HIV/AIDS and suggests that she wait until she is older before having sex. It emerges that, in any case, Cass is not yet menstruating, and she leaves without a prescription. A bill is sent to Cass's house by mistake, and her parents discover that she has been seeing a doctor behind their backs. Cass subsequently bursts in on William in his surgery, distraught, and accuses him ofviolating patient confidentiality. She leaves, and Julie upbraids William for lacking sensitivity and dealing with the whole issue incorrectly. William counters that it is not his place to tell his young female patients how to behave. Julie responds, 'William, this time you screwed up'. Another episode featured a hyperactive child of about three years of age, Jake, whose young, working-class mother, Christine, takes him to see William because he is virtually uncontrollable. She suggests to William that J ake is hyperactive, but William does not agree. He thinks it is Christine's problem, that she can't cope as a mother, as he knows that she had a problem with depression after the birth of her second child. William comments to Ian Browning, the psychiatrist working at the .practice, that he thinks that hyperactivity is 'over diagnosed'. Ian disagrees, and accuses him of discrimination against Christine because of her previous mental condition. Tessa Korkidas notices Jake's behaviour in the surgery and also agrees with Christine's diagnosis ofhyperactivity, and tells William that he is wrong. Christine, at her wits' end, eventually feeds Jake child sedatives to calm him down. He becomes overly drowsy and unresponsive, alarming her husband Dan, who again takes J ake to see William. Christine suffers guilt from giving J ake the drugs and there is marital conflict over it. It turns out that Jake has an overly high blood lead level, a finding that William ignored as unimportant when he received the results of Jake's blood test results. Tessa insists that this might be causing his behaviour. William admits that he has made a mistake. He apologises to Christine and her husband Dan, and suggests that they move to the country to avoid lead emissions in the air, warning that their younger child might also start to be affected. It is discovered at the end ofthe episode that lead in the air is not the problem: J ake has been eating bits oflead paint that have peeled off the house, the cause of his hyperactivity. In another episode, William is consulted by a woman in her early thirties, Kate, who has a history of breast cancer in her family-her sister Sue is currently dying ofit and is being treated by William. Afraid that she too will contract breast cancer, Kate requests that William give her a referral to a surgeon for a prophylactic double mastectomy followed by a breast reconstruction. William refuses, thinking she is being unreasonably anxious about the risk. When he will not change his mind,
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Kate seeks Tessa's advice and finds a more sympathetic ear. Tessa thinks Kate has a good case, and after reviewing her medical records gives her a referral, albeit warning her of the unsightly effects of the surgery. A regular feature of television medical drama has been the partnership of the 'older mentor', the experienced doctor figure, and the idealistic 'young turk', the heart-throb doctor, who regularly clash in opinion and manner (these character types are also invariably male) (Karpf, 1988, p. 189). G.P. upholds this tradition with the William Sharp and Martin Dempsey characters, with one major twist: Martin is gay. At first, Martin's homosexuality is the source of dramatic conflict between him and stuffy William. At the beginning of the 1994 season, William meets Martin on a visit to the country, and invites him to join the practice and share accommodation with him above the surgery. It is not until the fifth episode that William (and the audience) discovers that Martin is gay, a fact that initially William finds confronting and perturbinlf. Martin's sexual orientation is the source of an inversion of the traditional 'wise old mentor' and 'young turk' relationship, in which it is generally the former who advises the latter; it allows him a position from which to lecture William about such issues as the politics of homosexuality and HIV/AIDS. In one episode, for example, involving a storyline in which a young HIV-positive woman suffers discrimination at her workplace, William ventures to ask Martin how she contracted the virus. Martin replies with a lecture about the importance of avoiding victim-blaming, arguing that this information is not relevant-'Not unless you're interested in prescribing guilt'. Psychiatric practice, largely as represented through the professional activities of the lan Browning character,. was subject to a number of trenchant critiques in the 1994 season. In one episode, lan's brother Justin comes to stay with the BrowninglKorkidas family. Justin is a recovered alcoholic, and has found religion as a cure and a substitute for alcohol. lan, a confirmed atheist, does not approve of Justin's newfound religious beliefs. Justin responds by labelling lan's psychiatric practices as 'brain washing' and as overly reliant on drug therapies, exacerbating rather than helping patients' problems. In another episode, lan sees a patient, Neil, who has been forced to come to him for treatment by the police after a history of violence towards his wife. When he visits lan, Neil talks about suicide and killing his family. lan has him involuntarily admitted to a psychiatric hospital under the care of lan's friend and colleague, who eventually discharges Neil after finding nothing wrong with him. This causes a dispute between lan and his colleague. Neil loses his job as a result of his stay in the hospital, and arrives home to find his wife has left him, taking the baby. He becomes vengeful and dangerously angry, blaming lan for his misfor-
G.P.: A postmodern medi
