Newswise — PHILADELPHIA – Salvatore Mangione, M.D., pulmonologist and critical care specialist at Thomas Jefferson University Hospital, does not wear a white coat.
Reason being, the adopted “uniform” of physicians represents only one aspect of what Mangione says a physician is. It represents the scientist, but not the artist. And as the Founding Father of Modern Medicine, Dr. William Osler, pointed out, physicians are artists who use science.
Dr. Mangione, who is also director of the Physical Diagnosis course at Jefferson Medical College of Thomas Jefferson University, is using the question, “what is a physician,” as the premise of a new class being offered to Jefferson medical students starting this fall. Called “Medical Cineforum,” the class will examine the portrayal of physicians in older and modern day films and its subsequent impact on the public’s perception of medical issues, and what physicians are and ought to be.
“At the turn of the 20th century, the Franco-British medical model was shifting away from a compassionate, humanistic, bedside-oriented idea of what a doctor should be, towards the newer and more scientific German model – white-coated, laboratory-oriented, detached, cold, technical and at times even arrogant,” says Dr. Mangione. “Being a physician comes with perfecting technical skills of course, but also with practicing low-tech medicine, which includes giving your time and empathy.”
Empathy is something that Dr. Mangione’s colleague, Mohammadreza Hojat, Ph.D., research professor of Psychiatry and Human Behavior at Jefferson Medical College, has found is lacking among some medical students. As director of the Jefferson Longitudinal Study, Dr. Hojat discovered a trend in his research that showed that third-year medical students have less empathy than when they were first-year medical students. He concluded that this erosion of empathy in medical school creates a need to develop programs and strategies to maintain and improve empathy.
“Empathy is one of the themes of the class,” says Dr. Mangione. “It is the backbone of bedside manners and physician-patient communication. We also examine other themes, such as the patient perspective, compassion versus cold science, the allure of greed, physicians’ egotism and the “God” complex, plus ethnic and gender discrimination in medicine. The purpose of the class is to present and discuss medically related movies to enhance students’ understanding of patients’ concerns and improve their empathic engagement in patient care. It is the Greek model of theater as ‘catharsis by proxy.’”
Dr. Mangione says doctors are among the most portrayed professionals in movies, and that, with the exception of the “mad scientist” of the 1930s, they were overwhelmingly portrayed in a positive light. Then, from the ‘60s onward, public perception changed, with compassion and idealism becoming increasingly scarce attributes of film physicians.
“Movies have a powerful influence on popular culture,” explains Dr. Mangione. “Given the wide audience, cinematic depictions of physicians may affect public expectations and the doctor-patient relationship. They can also provide a useful gauge of public opinion. That is why it’s important that students are exposed to them, since films can foster introspection and create new ways of looking at medical issues.”
Mangione also says that medical inaccuracies are present in one-fourth of physician films, and usually fall into three categories: Unrealistic depictions or views of physicians or their practice; scientifically unsubstantiated therapeutic interventions; and factual errors. They also show very few women (14 percent in the 1990s), which is ironic in times when women make up more than half of the medical school class.
Still, movies remain a powerful medium to teach about medicine. Some examples of the films Dr. Mangione’s students will examine and discuss include: • Gattaca (a Brave New World of rampant genetic selection)• Malice (the “God Complex” in Medicine)• The Hospital (understanding the frustrating impotence of Medicine)• One Flew Over the Cuckoo’s Nest (what happens when the system goes bad)• Dear Diary (why doctors “never listen”)• As Good as it Gets (what the public really wants in a physician)
Different types of physicians are depicted in these films, including surgeons and internists. Their portrayals of course vary depending upon the movie, but Mangione says pediatricians (like the good doctor of “As Good as it Gets”) have been consistently portrayed in a positive light.
“In studies over time, they have been shown to be the most stable, happy and empathetic of us all. Ironically, pediatricians also don’t wear white coats.”
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