I was recently watching behind the scenes commentary on Scrubs and was made more aware of the history and context surrounding the character Dr. Doug Murphy. For those unfamiliar, Dr. Murphy was the co-intern in internal medicine of the shows hero’s JD and Elliot who after being made to repeat his third year due to his propensity for killing patients transfers into pathology where he proves himself a peerless coroner. While both in the metanarrative and with the world of the show, this shift was meant to redeem the character and elevate them beyond being a morbid recurrent gag. It made me aware of a running trend in medical television; pathology as a penalty box. The most recent example of this trend I noted impacted another Dr. Murphy, Shaun Murphy the eponymous protagonist of The Good Doctor. In this program our hero finds himself transferred to the pathology department not for any mistakes he has made but rather due to concerns by the new chief of surgery that his autism prevents him from effectively engaging with patients. While not intentionally punitive this forced shift in career is nonetheless punishing for Dr. Murphy for whom surgery has been an anchor in navigating myriad personal struggles and tragedies. Even when Shaun makes a lifesaving diagnosis due to his attentiveness to the patient’s story this only reinforces the perception that pathology is where he belongs. Ultimately it takes the president of the hospital essentially abusing his power in firing the chief of surgery to “save” Dr. Murphy from his fate.
I have not taken the time to explore exactly how prevalent this phenomenon is but even from these select examples I find it to be a troubling one. As already stated with Scrubs, Doug’s transfer was an attempt to preserve a character beloved by the audience but nonetheless, it gives the impression that Pathology is at best a refuge for those who simply cannot hack it in the “real” medical fields of internal medicine or surgery and at worst an escape valve for incompetent physicians to remain within medicine. While played for humor looking back now as a third-year medical student and holder of training in bioethics the minimization of death in Doug’s earlier career is also somewhat problematic as is the possible implication from Doug’s resounding success within the field that this casual perception of patients is commonplace within pathology. Despite these potential issues I can be somewhat lenient on Scrubs as in 2005 when these events occurred pathology was still relatively respected within medicine, these kinds of jokes and stereotypes were more prevalent and the shift was framed in the context of helping a friend find his proper place within medicine. I am far more troubled by The Good Doctor in light of its recency and its more explicit portrayal of pathology as a place of punishment horrifying enough that an otherwise cool-headed and logical hospital president would risk his career and that of one of his best surgeons to save a resident from its jaws. At the same time, this period of the show serves to reinforce a number of stereotypes about pathology such as an overly relaxed approach to their work.
While some may feel I am taking television subplots too seriously it is largely because pathology is already such a misunderstood specialty. Multiple recent studies of medical students show profound misconceptions regarding the actual clinical duties of a pathologist especially and overestimation of the centrality of autopsy within the field. Even those medical students who look favorably upon pathology as a career do so according to recent literature due to “a perceived fit between their personalities and the perception of pathology as a solely scholarly and isolated specialty.” All this may contribute to the year over year decline in American graduates going into pathology despite the import of the field. Given the undeniable lack of proper information even among those within medicine, the diminution in respect the field is currently undergoing and the fact that many students begin to form the concept of our future careers long before medical school proper representation in the media is critical.