I'm a doctor . . . and I played one on TV

Filmed for a cable TV documentary on residency training, this doctor found that the camera is more than a third eye.

By Jamie Saben, MD

"Code Blue: Report to the pulmonary function lab!" As I hurried down the stairwell, I was worried about what I would find. But, luckily, the patient had simply fainted at the sight of the needle for his blood draw.

After I finished evaluating him, it seemed as if someone should yell, "Cut! That's a wrap. Good job, everybody."

But nobody on the camera crew that had been following me said a thing.

When I was first asked to be a subject in a made-for-cable documentary on residency training, I didn't hesitate. After all, this is Los Angeles—doesn't everyone here want to be an actor? And I liked what the show's producer explained about the project. The goal wasn't to produce an "ER" or a "Scrubs," but to shadow residents training in family practice, pediatrics, and surgery through their normal workdays. A sort of reality TV— but no one would get voted out of the hospital. (I appear in the show—"The Residents"—on Nov. 2 on the Discovery Health Channel. The episode is repeated Nov. 8. Check local listings for times.)

As a second-year family practice resident, I felt reasonably confident about being filmed. If I had still been in my first year, I don't think I would have wanted my inexperience on record for present and future patients to view. Of course, I still made mistakes, but much less frequently. Even so, there would be no second chances in front of the camera—only the hope that the editing would be kind.

Before filming I asked the crew— a camera person, a sound person, and someone who obtained consent from the patients to be filmed—"What should I do?" They replied, "Just do what you normally do." "Simple!" I thought. "No lines to memorize, no fake emotions—I just have to 'act' myself."

Easier said than done. There's a principle in physics called the Heisenberg Uncertainty Principle, which basically says that the mere act of observing something alters it. Unexpectedly, I began to see the principle in action on a daily basis.

I discovered the difficulty of ignoring the camera. While talking with a patient, my eyes wandered and ended up staring into the camera lens. Or my gaze was diverted by the microphone boom cast like a fishing line above the patient in order to catch the details of our conversation. Obviously, this wasn't normal, and my interactions with patients started to feel different.

Just as the camera distracted me, I saw my patients acting differently. One normally effusive woman was tamed by the camera. On the other extreme, a semiconscious older woman became vivacious. The lens was filtering the private space normally reserved for our doctor-patient relationship. It was both disruptive and—I realized later—therapeutic.

Although one of the crew was in charge of obtaining consent from patients to be filmed, we quickly realized it was more efficient and effective for me to ask their permission. So I memorized my first line.

After introducing myself, I said, "I have a film crew following me. They're doing a documentary on the training of doctors. Is it okay if they film us?" I found the question put up a barrier between myself and the patient. If she declined, would she wonder if I'd view her differently—as uncooperative and noncompliant?

If she agreed, did she risk exposing her personal problems to television viewers? Or, even worse, would she agree, but then withhold potentially embarrassing medical information?

At first, I didn't expect many patients to consent. Imagine being in the hospital—ill and vulnerable. Why would someone want to expose the details of her medical problems for the world to see? But it turned out that many patients were motivated by the same things I was—a healthy dose of wanting to be on TV and a touch of beneficence to teach others about what young doctors have to go through.

When a patient declined to be filmed, the camera crew was very respectful of our privacy. I was struck by the discrepancy when a patient chose not to expose his story to a group of strangers, yet felt completely comfortable talking with another stranger—me. The only visible difference was my white coat and all it signified. These occasions reminded me of my privileged role as a physician.

Being in the documentary also forced me to think about my work more than I otherwise would have. As the camera rolled, the crew would ask me questions like, "How do you think Mr. X took the news?" and "How long do you think Ms. Y has to live?" These questions were an attempt to learn more about my own feelings.

I found such questions unsettling because my days were so busy that I rarely spent time pondering my feelings. At the end of my day, I liked to eat dinner and relax; often I was too exhausted to reflect back on the day's events and their meaning. But being asked to discuss my feelings forced me to process and vocalize emotions that usually were buried beneath all the paperwork, phone calls, and orders that increasingly define my profession.

Despite the extra work it caused me, the show was worth the experience. Having a camera follow me forced me to realize that I would never make it in "the biz." But it also reminded me why I wanted to be a doctor.

The author has completed his residency in family practice at the Santa Monica-UCLA Medical Center in Santa Monica, CA. He's currently a fellow in primary care sports medicine at the UC Davis/UC Berkeley Sports Medicine program in Sacramento.

 

Jamie Saban. I'm a doctor . . . and I played one on TV. Medical Economics Nov. 7, 2003;80:73.