Saving Hope at Physician Med

Fall 2012 TV Preview

 
September 2012 -- More new health-related shows arrive in the fall U.S. television season, and there is actually one new nurse-focused show--the six-part BBC drama Call the Midwife, which focuses on Anglican and lay nurse midwives (apparently eight of them!) who care for poor women in 1950's London. The show, a big hit in the U.K. earlier this year, will air on PBS (premiering Sept. 30). Hollywood-wise, there do seem to be a couple sidekick nurse characters, but the primetime landscape will still be dominated by physician characters--we count 47 physicians to 2 nurses. This year, the four new network shows have different spins on Hollywood's health care portrayals, but none seems likely to question the prevailing view that only physicians really matter in health care. Fox's The Mob Doctor (Sept. 17) tells the story of one of the nation's "most promising young surgeons" who is "caught between two worlds as she juggles her promising medical career with her family's debt to Chicago's Southside mob." Right. And although the surgeon's "protective best friend" is nurse Rosa Quintero, the other three hospital characters are all physicians. In Fox's sitcom The Mindy Project (Sept. 25), created by and starring The Office veteran Mindy Kaling, the lead character is a romantically challenged OB-GYN; in addition to the four physician characters, there is a "male nurse" who is a "reformed ex-con." In the new NBC drama Do No Harm (mid-season), the lead neurosurgeon character has a "dangerous alternate personality," but aside from that unusual concept, the show seems to be dominated by its five physician characters. The CW's Emily Owens, MD (Oct. 16) sounds like the most conventional new show. It's not just the name; with all six major characters apparently pretty young surgeons struggling valiantly to grow up, it's Grey's-tastic! And speaking of which, among veteran shows, ABC's Grey's Anatomy (Sept. 27) still has about 14 surgeon characters and no nurses as it starts its ninth season. A few episodes last season did feature "Nurse Eli," the boyfriend of star surgeon Miranda Bailey and a nurse who displayed some health care skill and patient advocacy, but even that plotline ultimately confirmed that nurses are physician subordinates, with Bailey dumping Eli in a way that implied it was because he was just a nurse. The Grey's spinoff, ABC's Private Practice (Sept. 25), limps back for what may be its last year with plenty of heroic physicians but no significant nurse characters. ABC's Body of Proof (mid-season), about an elite surgeon-turned-medical examiner, returns for a third season having lost all its police characters, but none of its four physicians. The CW's romantic comedy-drama Hart of Dixie (Oct. 2) returns for a second season with the concept of a cute young New York physician who finds herself in a small Southern town. Lest we forget the one bright spot on premium cable, Showtime's powerful Nurse Jackie (spring 2013) will return early next year for a fifth season of Jackie's clinical expertise and creative patient advocacy, and if last season is any guide, some unfortunate suggestions that nurses report to physicians. On the whole, Hollywood looks set to continue telling viewers that health care is all about smart, commanding physicians, and nurses are their low-skilled helpers.

Maybe we should be happy about Call the Midwife, as limited as its broadcast time and its PBS audience will be, and about the two nurse sidekicks in the new Hollywood shows. The past two prime time broadcast seasons had been essentially nurse-free, something that had not happened in more than 40 years. Up until 2010, there had always been at least one (usually only one) major nurse character on some health-related prime time broadcast show. Of course, in 2009, an amazing three nurse-focused shows were introduced, including one on a broadcast network, NBC's Mercy, and TNT's summer show HawthoRNe. Mercy lasted one regular season and HawthoRNe three summer seasons, so the only one left is Nurse Jackie, with its fierce, vastly talented (and flawed) central nurse character Jackie Peyton and her skilled protégé Zoey Barkow. Still, it is a premium cable show with 12-episode seasons and even fewer viewers than HawthoRNe had.

Other shows have featured nurses or nurse characters. During this past summer, ABC broadcast the latest of producer Terence Wrong's reality series about prominent hospitals. This one, the 8-part NY Med, focused on New York Presbyterian Hospital, and like Wrong's Boston Med (2010), there were occasional appearances by nurses among the extended scenes presenting physicians, particularly surgeons, as moral and intellectual heroes. As before, the nurses did display a minor amount of knowledge and some slight skills, but no viewer will come away thinking that nursing is a great health profession like medicine is. The summer menu also included NBC's Saving Hope, which sounds like a parody of TV health melodrama, but which was actually a serious drama about a surgeon who lies in a coma while those around him try to cope with his absence. There were three minor recurring nurse characters, Victor Reis, Jackson Wade, and "Olivia," but the 10 major physician characters dominated in the standard ways. There is also a recurring nurse character on A&E's The Glades, which just finished its third season. In that show, the lead detective character's girlfriend Callie Cargill remains a competent nurse with occasional chances to show clinical skill, but she also seems to remain a medical student, reinforcing the wannabe physician cliché. And during the regular season, one character on NBC's sitcom Parks & Recreation (Sept. 20), Ann Perkins, is a nurse.

These characters are generally positive, at least within the contexts of their shows, and perhaps there is some benefit to that--the implied message that nurses can be strong and decent and have normal intelligence, which mildly counters some nursing stereotypes. But none of the shows really displays much nursing, and none is likely to greatly alter anyone's views of the profession.

So what remains? A wave of serial dramas whose faces and premises may shift, but which still embody the core assumption that physicians do everything that really matters in modern health care, including many key tasks that nurses do in real life, with the occasional direct insult to nursing thrown in for good measure.

Call the Midwife

The PBS website describes Call the Midwife as "a moving and intimate insight into the colorful world of midwifery and family life in 1950’s East London." The focus of the show is Nonnatus House, where the Sisters of St. Raymond Nonnatus and a group of wide-eyed young lay midwives try to cope with a high number of births and other health issues in the poor community. The main character is young lay nurse Jenny Lee, whose "mature" self (voiced by Vanessa Redgrave!) provides the narration for the series. Brief previews suggest that the nurse midwives are operating with complete autonomy--we really saw no evidence of physicians at all--and that the nurses will be presented as tough and masterful in their care, though we'll have to see how much clinical expertise that care will include. We'll also have to see if the U.K. hit will get a similar reception in the States; an earnest show about nurses in 1950's London isn't exactly NCIS or Dancing with the Stars. On the other hand, neither is the popular Downton Abbey, so we'll see. Call the Midwife's website is: http://www.pbs.org/programs/call-the-midwife/ See the intro clip below.

Do No Harm

The NBC website describes Do No Harm as a "modern Dr. Jekyll / Mr. Hyde drama" featuring "highly respected neurosurgeon" Jason Cole, who really does have it all--not just the awesome career and the "confident charm," but also his "borderline sociopathic" alternate personality Ian Price, who has recently managed to overcome the powerful drug that Cole has used to keep him at bay and is now seemingly bent on causing havoc. Like when Jason "wakes up disoriented in a wrecked hotel room amidst several near-naked women he's never seen before." The website sums things up:  "Hell hath no fury like an alter scorned." Be that as it may, the show seems to have four other physician characters and no nurses. That imbalance, together with the familiar surgeon glorification in the show descriptions, give us little reason to think that nurses will play any significant role in the show's clinical depictions. The show's website is at: www.nbc.com/do-no-harm/

The Mob Doctor

According to the Fox website, its new Mob drama follows the complex life of Chicago physician Grace Devlin, "one of the country's most promising young surgeons" who, to "pay off her brother's life-threatening gambling debt," "agrees to work 'off book' for the mafia men she once despised." That is, in addition to doing the standard pretty young surgeon stuff at the hospital, Grace moonlights doing things like "operating in illegal backrooms, treating hit men hiding from the law, performing emergency surgery on a high-end call girl, even saving a juiced-up race horse." There are three other physician characters--Grace's boyfriend, her boss, and her "rival"--and one nurse, Grace's "protective best friend, nurse Rosa 'Ro' Quintero." As you might expect, there are also characters from Grace's family and from the Mob, so it's not clear how much health care we'll see. Our guess is that the Rosa character will act primarily as Grace's friend and confidante. Of course, it's possible that she will do more--like display some nursing expertise--but we wouldn't bet money on it. The show's website is at www.fox.com/programming/shows/?sh=the-mob-doctor

The Mindy Project

Mindy Kaling's Mindy Kaling project is a single-camera sitcom about a new OB-GYN, and the most important other characters seem to be physicians, particularly two men who are potential matches for Mindy. However there are also two receptionists and "male nurse" Morgan Tookers, who is described as a "reformed ex-con" and "the hospital's resident cheerleader" who "just wishes that he and his colleagues spent more time together outside of work." We're actually afraid to find out what all that means, because the character sounds like he just escaped from Men in Black. Anyway, the character did not even appear in the series premiere, which was released early, and it's not clear how much of a role he will have. In fact, since the show seems to be mainly focused on Mindy's romantic misadventures, it's not clear how much actual health care we'll see from anyone. The premiere did feature some of the insult-driven, hospital-of-the-absurd elements of Scrubs, as well as a bit of the childish competition among medical residents that has been a central theme in Grey's Anatomy. So to the extent there are clinical scenes in The Mindy Project, we have no reason to think they will vary much from the physician-focused Hollywood model.The show's website is at www.fox.com/programming/shows/?sh=the-mindy-project

Emily Owens, MD

In describing this new show, in which every character seems to be a hot young surgeon, the CW website is remarkably honest about its vision of the hospital:  it's just like high school. So the lead character may feel "like she is an actual grown-up" who "can finally put her high school days as the geeky-girl-with-flop-sweats behind her," but "why does everyone keep warning Emily that the hospital is just like high school?" Maybe it's because one intern there is "her high school nemesis, the gorgeous, popular Cassandra Kopelson," and another intern, Tyra Dupre, warns her "that the cliques at the hospital are all too familiar: the jocks have become orthopedic surgeons; the mean girls are in plastics; the rebels are in the ER, and Tyra has her own awkward place as the principal's kid -- her father, Dr. Tim Dupre…is the chief resident." So…he had Tyra when he was maybe 5 years old? (We guess he could be a second-career physician.) Tyra also confides that she "is a lesbian, that she hasn't come out to her father, [and] that she is interested in dating a certain nurse." Did we mention "the brilliant Dr. Gina Bandari," "a world-famous cardiothoracic surgeon who has been an inspiration and role model to [Emily and Cassandra] for years"? Of course, there are also smart, handsome male residents, but you get the picture. It's pretty difficult to see that nursing is going to come off well on this show, unless the object of Tyra's crush is, like, super-cute. The show sounds very much like Grey's, except that by comparison it seems to be woefully short of physician characters. The show's website is at www.cwtv.com/shows/emily-owens-md

Grey's Anatomy

ABC's Grey's Anatomy remains popular heading into its ninth season, and it now features roughly 14 regular physician characters, every single one a surgeon (at least one of these characters died in a plane crash at the end of last season, but we imagine she will eventually be replaced by another surgeon). In prior years, nurse characters did occasionally appear, usually embodying stereotypes, particularly the helpless handmaiden and the bureaucratic battleaxe, which contrasted sharply with the professional path that the show's modern female stars had chosen. In most episodes, the show includes no identifiable nurse characters.

But last season, Grey's did have one minor nurse character worthy of note. This was the forceful "Nurse Eli," the sort-of boyfriend of star surgeon Miranda Bailey and perhaps the best nurse character the show has ever had. Eli appeared in eight episodes spanning the seventh and eighth seasons, and on a few occasions he displayed some health care skill and some spirited patient advocacy, standing up to physicians at a few points, though some of his advocacy was absurdly shrill. But Eli was more of an intuitive traditional healer than a modern science professional, and he eventually (wrongly) seemed to concede that the senior physicians were in charge. He became little more than a sexual interest for Bailey, and when an old flame anesthesiologist re-appeared, she promptly ended the relationship with Eli in a way that implied there was no real future for them because Eli was just a nurse. Now it looks like Bailey will marry the anesthesiologist. Sadly, on the rare occasions that Grey's does include a nurse character, even a sympathetic one, the plotline still ends up being overwhelmed by bias--and arguably does even more damage than if the show had simply continued to pretend nurses do nothing but say "yes, doctor." The show's website is at
abc.go.com/shows/greys-anatomy

Private Practice

The Grey's spin-off Private Practice, starting its sixth and possibly last season, focuses on an L.A. outpatient practice and features nine major physician characters, led by star OB/GYN Addison Montgomery. During its first three seasons, the show did have a minor regular nurse character, the receptionist / nurse-midwife Dell Parker. Dell began the show with little more apparent skill than a lay person and the show initially mocked midwifery, though as time went on there were minor plotlines in which he actually showed some aptitude for patient care and some limited autonomy. But Dell died in the last episode of the third season, and the producers also could not resist amping up the drama by having him display elation at having been admitted to medical school just before his death, reinforcing the wannabe-physician stereotype.

Since Dell's departure, the few nurses who appear on Private Practice play the same blank, subservient role as virtually all of the nurses on Grey's do. And although the show's original premise involved surgeon Addison's adventures with the more diverse "wellness clinic" crew in LA, the show has moved closer to the standard Hollywood hospital show model, with more flawed but brilliant surgical characters. By the end of the last season, four of the nine physician characters were at least sometimes acting as surgeons, and the plotlines seemed to spend more time on how awesome and consequential their work really is. The show's website is abc.go.com/shows/private-practice

Body of Proof

The hero in ABC's Body of Proof, which is starting its third season, is neurosurgeon Megan Hunt, who became a medical examiner after losing sensation in her hands following a car crash. Her boss is physician Kate Murphy--the first female chief medical examiner in Philadelphia! The show includes two other recurring physician characters, but no nurses. And although the show apparently lost its three police characters prior to the third season, their replacements will evidently be more police. Body of Proof is a girl-power detective drama, with Hunt as a sort of female Greg House, using her observational and deductive brilliance to solve murders while the men under and around her go slack-jawed. Body of Proof spends virtually no time in clinical health settings, and not all that much time in the morgue--Hunt is often in the field showing homicide detectives what's what--but the show still sends the message that physicians are the masters of health, by virtue of their expert knowledge of how and why death occurs. In particular, the show does not seem to tire of reminding us of Hunt's clinical awesomeness, often setting it against her sometimes abrasive manner and troubled personal life. Anyway, despite the increasing role of forensic nurses in real life, nurses have virtually no role in this show. The show's website is abc.go.com/shows/body-of-proof

Hart of Dixie

This CW comedy-drama about young New York physician Zoe Hart, who "inherits a local medical practice" in a small Southern town, returns for a second season. There are clinical scenes, but the show focuses on the personal relationships between the lead character and the locals. No other major characters work in health care, and there have been no significant nurse characters, though there is one nurse named Addy who acts as a kind of knowledgeable assistant/advisor at the star physician's practice. Addy asserted herself initially, noting how long she had been part of the practice, but as the season went on she seemed to appear only once in a while, briefly, to offer social advice to Hart. The show generally confirms to the standard Hollywood convention that physicians provide all meaningful care. The show's website is at www.cwtv.com/shows/hart-of-dixie

Nurse Jackie

Showtime's veteran nurse-focused "dark comedy" will return for a fifth season in 2013, probably in the spring. This past year's fourth season was more focused on personal relations and workplace politics, and less on the clinical skill of Jackie Peyton, her protégé Zoey Barkow, or the other nurses. But when there are clinical scenes, the show continues to present Jackie at least as essentially a peer of the physicians in most respects, as she handles patients collaboratively with them and provides expert holistic care. Indeed, in the final two episodes of the fourth season, Jackie essentially took over the ER in the midst of a staffing crisis, running it expertly and showing what things could be like if she were running the show--before she was fired by the CEO-physician. And that brings us to the show's main recent problem--its tendency to suggest that physicians direct nurse staffing and nursing care, particularly since that same CEO-physician demoted the quasi-nurse manager Gloria Akalitus to direct care nurse. Now, the show seems to have no real nurse managers. Still, it does continues to feature sustained, credible, compelling interactions among nurses, and between nurses and physicians, both in clinical and social contexts, amicable and hostile, serious and comic—showing that nurses are three-dimensional, sentient beings.

Conclusion

We're pleased about the appearance of the limited run drama Call the Midwife on PBS and that Showtime's Nurse Jackie has lasted this long (maybe those two shows can arrange some kind of crossover thing, since Jackie would probably be a great fit for Nonnatus House). But of course, it would take many years and many shows to counter the hundreds of hours of powerful disinformation conveyed by shows like Grey's and the rest. And while two of the three 2009 nurse shows are now gone, the new physician shows just keep coming, every year. Still, we'll keep saving hope!