The world continues to have a passion for movies. Moviegoers worldwide spent $20.3 billion and purchased 8.6 billion admission tickets to see films in 2003.¹ 2002 was a record breaking year at the UK box office, with 176 million cinema admissions, £755 million in total box office receipts, and 369 films released.² In the USA in 2003, there were 1.6 billion cinema admissions, $9.5 billion in box office receipts, 473 films released, and home entertainment sales to dealers of 1.1 billion DVDs and 294 million video cassettes.³

Movies have a powerful influence on popular culture, due to their international popularity, easy accessibility, and profitability as an industry. Cinematic depictions of doctors thus have the potential to affect public expectations and the doctor-patient relationship. In a 2002 paper, I conducted an in-depth analysis of the portrayal of doctors in the movies, reviewing 131 films from nine countries spanning eight decades.⁴ Key findings from this research included: (1) compassion and idealism were common in early doctor movie portrayals but have become increasingly scarce in recent decades; (2) since the 1960s, positive doctor portrayals declined while negative portrayals increased; (3) doctors frequently are depicted as greedy, egotistical, uncaring, and unethical, especially in recent films; (4) a recurrent theme is the “mad scientist”, the doctor-researcher who values research more than patients’ welfare; (5) because negative portrayals of doctors are on the rise, patients’ expectation and the doctor-patient relationship may be adversely affected; and (6) films about doctors can serve as useful gauges of public opinion and tools for medical education. The aim of this paper is to use this extensive database, supplemented by several more recent films, to explore selected key themes about the portrayal of doctors in the movies. In contrast to the prior paper, however, this paper will also focus on humour in doctor films (both intentional and unintentional), and examine the few movies that have portrayed paediatricians.

MAJOR THEMES IN DOCTOR MOVIES

Money and materialism

Materialism and a love of money have pervaded cinematic portrayals of doctors dating back to the 1920s, and continue to be prominent in recent movies. In Doctor at Sea (1956), Dr Simon Sparrow (Dirk Bogarde) states, “A Rolls Royce is the ambition of almost every newly qualified doctor. And preferably a Harley Street address to go with it.” In Carry on Again Doctor (1969), Dr Jim Nookey (Kenneth Williams) confides to a colleague: “Specialise, that’s what I’d like to do! The whole Harley Street bit with bags of lovely filthy rich women patients.” In Doctor at Large (1957), the doctor in charge of a Harley Street practice advises Dr Sparrow, “You know, it’s a chastening thought, but good clothes are more important to a GP than a good stethoscope.”

Indeed, it shocks and bewilders other characters when movie doctors do not display adequate wealth. In Playing God (1996), an FBI agent visits the home of the surgeon Dr Eugene Sands (David Duchovny) to arrest him for the death of a patient due to operating while addicted to drugs, and the agent says, “This is not how a doctor lives. No, this is squalor. I mean, you did go to medical school, right?” Dr Sands replies, “What, are you going to arrest me for failing to live up to my potential?”.

Money is not infrequently portrayed as the prime motivation for becoming a doctor and choosing a medical specialty. In Not As a Stranger (1955), medical school classmates discuss their career options:

“Personally, I’m for surgery. I just got a look at Dr Dietrich’s car. You know what he drives? A Bentley. $17,000 bucks.”“That guy doesn’t take out a splinter for less than $1000.”“I’ll still take ear, nose, and throat. The common cold is still the doctor’s best friend.”“Call it a virus. You make more dough that way.”“Look, if you kiddies are all through, your old man here will really wise you up. It’s not what you practice, it’s where.”“What do you mean?”“I’ve done a little research on this problem. The average doctor’s income is 11 Gs. In the southwest, west, and more...”“Pebble Beach, Colorado Springs, Beverly Hills, that’s where the rich are crackin’ up fast.”

Movie doctors even base treatment decisions on patients’ ability to pay. In Critical Care (1997), Dr Werner Ernst (James Spader), in the intensive care unit (ICU), asks “ICU Chairman Emeritus” Dr Butz (Albert Brooks) why a comatose patient with a poor prognosis needs a procedure:

“If there’s no reasonable prospect of cure, why should we proceed?”“Where have you been all your life: It’s called revenue! He’s got catastrophic health insurance. Long term health care. The works!”“What difference does his insurance make?”“What? It’s cash money. Not one of those ‘try and collect from the estate’ deals. And you want to yank his tubes!”

Paediatricians

The medical specialty of movie doctors most often is surgery (33%), psychiatry (26%), or family/general practice (18%), with paediatrics accounting for only 2%.⁴ It is informative to examine movies with a paediatrician as the main character. Every Girl Should be Married (1948) was released with fanfare as RKO’s big Christmas offering, and was a financial success.⁵ Anabel Sims (Betsy Drake), a romantic woman determined to find the perfect husband, meets and falls in love with handsome paediatrician Dr Madison Brown (Cary Grant) when they both reach for a copy of “Better Babies” at a luncheonette. He resists her obvious advances, and she uses every trick and trap, including a fake romance with her department store boss, to finally land Dr Brown. In real life, Drake and Grant met in 1947 aboard the luxury liner Queen Mary travelling from England to the USA, and were married one year after the film’s release (Drake was Grant’s third wife and the marriage lasted almost 13 years, the longest of Grant’s five marriages).⁵

Dr Brown is portrayed as a compassionate, dedicated paediatrician who sometimes does not even charge for patient visits. Brown playfully scolds a mother of three who happily departs after a clinic visit:

“Now before you bring these youngsters of yours in here again, Norma, make sure there’s something the matter with them so that I can send you a bill.”“You probably will anyway.”“Heh, heh.”“Come along boys, we’ll get no sympathy here.”

Brown twice comments on the long hours he puts in as a paediatrician. After putting in a particularly long day, he says to his nurse, “Oh my, why didn’t I become a night watchman or a flagpole sitter or somebody with regular hours instead of a baby doctor.” After Brown’s cocktails with Anabel are interrupted by a call from a concerned mother, he says, “I’m sorry, Annabel, but that’s what it’s like being a doctor, no time for anything else”, to which she replies, “but I think being a doctor is the most wonderful thing in the world a man can be!” Brown delivers a lecture to mothers entitled, “The Parent’s Responsibility to the Child. A Lecture by the Eminent Pediatrician Madison W Brown, MD”. His concluding remark is impressive for revealing an insight privy to the experienced paediatrician: “However, there is an instinctive wisdom in most mothers which transcends all the science of doctors.”

In Caught (1949), Leonora Eames (Barbara Bel Geddes) fulfils her dream by marrying millionaire Smith Ohlrig (Robert Ryan), but the marriage is a disaster, so she goes to work in the office of paediatrician Larry Quinada (James Mason), who has devoted his life to serving impoverished children in New York City (fig 1). They fall in love, but Eames is pregnant with Ohlrig’s child, which she finally miscarries, and then Eames and Quinada live happily ever after. The portrayal of Dr Quinada is noteworthy for his commitment to the under-served and lack of interest in materialism. Eames’s interview with Quinada proceeds as follows:

“You know what the job is, Miss Eames?”“Receptionist.”“Yes, for Dr Hoffman and me. He’s an obstetrician, I’m a paediatrician.”“He brings children into the world, I try to keep them here.”“I’m sure you succeed, doctor.”“Well, I don’t always. It’s easier to write prescriptions than to pay for them.”

Later, when Eames has become Quinada’s receptionist and lover, she comments on his attitude to money:

“That’s because you don’t care about money.”“Everyone’s got to care about money to a certain extent—how else can I take you out to dinner when I want to. But I care more about other things like doing the kind of work that interests me.”“Is that why you work on the East Side?”“Sure. I can learn more there in one day than I can learn anywhere else in one month.”

After this brief burst of paediatrician movies, little attention has been paid to paediatricians as main characters. In Sunchaser (1996), which does not feature a paediatrician, a 16 year old with a retroperitoneal sarcoma who is imprisoned for murdering his stepfather is referred to adult oncologist Michael Reynolds (Woody Harrelson), whom he later kidnaps. Angered that a paediatrician will not treat the patient because he is a murderer, Reynolds says, “Paediatrics can’t just dump their overload on us. Tell them to cut down on their lunchtime and tennis. Maybe they’ll have more time to practice medicine.” The Wedding Planner (2001) features Dr Steve Edison (Matthew McConaughey) as a paediatrician who is engaged to another woman but eventually calls off the marriage because he has fallen in love with his wedding planner, Mary Fiore (Jennifer Lopez). This maudlin, forgettable film is noteworthy for Edison inexplicably hospitalising the adult Fiore on a paediatric ward and using a paediatric cervical collar after Fiore suffers a concussion and loss of consciousness, and for Edison mentioning that he had to attend a diverticulitis seminar, a conference of doubtful utility to a paediatrician.

Bureaucracy and healthcare systems

Movie doctors frequently face the frustrations and follies of having to confront inefficient bureaucracies and healthcare systems that hinder patient care. In Article 99 (1991), Dr Sturgiss (Ray Liotta) explains to an intern why open-heart surgery is being performed on a patient admitted for prostate surgery: “Here’s the problem: this patient needs open-heart surgery. The administration of this hospital will only authorise a prostate procedure. Now what good is fixing his prostate if he has a heart attack every time he tries to use it?” In Extreme Measures (1996), a hospital administrator confronts resident Dr Guy Luthan (Hugh Grant) about the costs of multiple lab tests on a patient who died mysteriously:

“Who the hell is Claude Menkins?”“It’s ‘was.’ I’m afraid he died.”“Tell me he had insurance.”“No. That’s not at all likely.”“This is $2600 worth of lab work.”“Right. Could I…” [Reaches for printout].[Snatches back printout]. “I had two people tied up for eight hours.”“Well, you know, Gene, what you do in the privacy of your own home is really your business.”“O.K. Let’s get it into your head. This is not England. This is not the National Royal Shakespeare taxpayers pick up the tab health care system. O.K. Somebody has to pay for this s---!”

Humour: intended and unintended

In Body Parts (1991), psychologist Bill Chrushank (Jeff Fahey) loses his arm in a car accident, but receives an “arm transplant” by Dr Agatha Webb (Lindsay Duncan), who is transplanting body parts harvested from convicted killers. After Chrushank recovers, he finds that his “killer’s arm” has a life of its own, forcing him to strike his wife and murder the surgeon and anaesthesiologist who performed his operation. Chrushank sets out to discover other recipients of transplants from the donor, who it turns out was a serial killer. The serial killer’s head is transplanted onto someone else’s body, and the killer starts slaughtering each transplant recipient to get back his body parts. Chrushank eventually kills the resurrected serial killer. Perhaps the most humorous segment of the film is when Chrushank asks Dr Webb to detach his rogue arm transplant:

“Do you realise what I and my team have accomplished with that arm of yours? Don’t you realise that if a gun were put to my head I wouldn’t jeopardise the accomplishments that your surgery represents?”“Can’t you see this arm is killing me!”“I’m sorry to put this so bluntly, Bill, but the pain you’re in just isn’t that important when I balance it against the significance of the experiment.”“You won’t perform the operation to remove the arm?”“No. And I’ll see you put in a mental institution before I let you undo what I’ve done.”

When you need a doctor who “really kicks butt”, R Wesley McLaren, PhD, MD (Steven Seagal) is your man (fig 2). In The Patriot (1998), McLaren heads up the Montana Wellness Center, specialising in family practice and holistic therapy. In addition, he is a Native American cowboy, single father, and former world famous government immunologist. When a paramilitary extremist releases a “highly contagious viral agent” called NAM 37 that has “10 times the potency of anthrax”, McLaren must develop a “cure” and fight extremists in hand-to-hand combat and with firearms. Among the more unintentionally humorous segments are McLaren diagnosing a patient with “severe oedema of the abdomen and liver” before palpating the patient’s abdomen, using a light microscope to examine the virus, developing a treatment for the virus in an evening’s work which almost instantly cures patients, and McLaren killing the paramilitary chief with the stem of a wineglass, then doing a flip through a plate glass window, holding his rescued daughter wrapped in a blanket. The “cure” is derived from a traditional Native American herbal therapy, and consists of a tea or injection of a red flower distillate. A whole army troop is shown collecting red flowers in biohazard gear, and the entire community is saved when US Army helicopters shower the town with red flower petals, which inhabitants are instructed to use to treat themselves with cups of tea.

In Change of Habit (1969), Elvis Presley plays Dr John Carpenter, a musically talented general practitioner who runs a free clinic in a tough section of New York City (fig 3). Dr Carpenter is in the middle of a jam session with community youths when he is called away:

“Hey Doc! You left us hanging in the middle of our thing, man.”“Just fake it for about 32 bars. I’ll be right back.”“You’re the doctor?”“You don’t look like a doctor.”“Well, man doesn’t live by bread alone. Especially the kind of bread you make working at the free clinic. John Carpenter, MD. Just like the sign says.”

Three nuns who also are healthcare professionals covertly are assigned as laypersons to Carpenter’s clinic on a religious mission, including Sister Michelle (Mary Tyler Moore), a social worker and speech therapist. Michelle falls in love with Carpenter, but does not allow the relationship to start, and returns to her convent conflicted. She attends a community church where Carpenter is leading a musical mass, and the movie ends with Michelle trying to decide between God and the god-like musician-doctor Elvis Presley, a difficult choice indeed.

COMMENT

Doctor movies continue to fascinate because they can be humorous, thought provoking, informative of the public’s perception of doctors, and they never cease to entertain. Movie doctors provide insightful and realistic portraits of the challenges, rewards, and excitement of being a doctor, whether it’s Ingrid Bergman playing a psychiatrist in Alfred Hitchcock’s Spellbound (1945), Sidney Poitier as a prison psychiatrist forced to treat a racist psychopath in Pressure Point (1962), Peter Sellers as the wacky psychiatrist in What’s New Pussycat (1965), or Robin Williams as the physician-clown Patch Adams (1998) (fig 4). For the aficionado, I provide a series of annotated “top-ten lists” of doctor movies I consider to be the best, most humorous, and most useful in medical education (table 1).