While other medical films often depict physicians with hearts of gold making battle against the system (see Awakenings, Patch Adams, Something the Lord Made), The Doctor alternatively depicts the transformation of a man, once intoxicated by the rarified air of his status, into a humble and empathetic healthcare provider.  Although not as well-known as a Patch Adams, The Doctor was in fact a box-office success upon its release in 1991, and you can’t help but figure that audiences found some catharsis in the taking-down-a-peg of a real life character they knew all too well; the aloof or altogether disconnected clinician.

Immediately we are cued into the wealth and stature of our main character, Dr. Jack McKee, as he zips around the San Francisco streets in his convertible, loudly snarking on a brick sized car-phone.  At the hospital he rounds with medical students, warning them that it’s “dangerous to care” for your patients.  He boots a priest sitting bedside from a patient’s room and begins a set of vitals (the students trip over themselves to offer a stethoscope).  The priest, as a symbol of spiritual and emotional support for the patient, is starkly contrasted by our doctor, who doesn’t even bother to look the patient in the eye, never mind say hello.  In fact, the cadre of hotshot surgeons around Dr. McKee have nothing but contempt for a colleague they’ve nicknamed “The Rabbi”, who sacrifices, their eyes, the hubris requisite in a top surgeon for the dangers of caring.

The first 20 minutes of the film are an exposition of Dr. McKee’s offensive qualities.  Every patient is an opportunity to flaunt his talents, every concern they voice is brushed off with sarcasm, and, what’s probably meant to torture us most, he is handsomely compensated for his efforts.  Despite the palatial house and luxury convertible, it’s clear his snarky callousness and emotional distancing continue on into his home.  That is, if he’s home at all.  He generally interacts with his wife when they cross paths on the road, and when she calls to their son to “say hi to dad” the kid instinctually picks up the phone instead of looking up to see that he is standing right in front of him.

Of course, the bottom falls out when Dr. McKee sees “the best” ENT in his hospital to investigate a persistent cough.  During his exam, the doctor get’s “a taste of his own medicine” (the title of the book by Dr. Edward Rosenbaum that inspired the movie) as Dr. Leslie Abbott employs a similar approach to his own, purely clinician centered.  He is told where to sit and what to do with no effort made to put the patient and clinician on an even plane of exchange.  Fingers, devices, and flashlights are thrust at him without warning, and for the first time we see McKee uncomfortable.  Up to this point he’s been an egotistical loudmouth, yet, when confronted with the prospect of a biopsy, he’s left speechless.  “Everywhere I go I’m getting cut out of the talk!” he complains after a pre-radiation appointment where two specialists make decisions for treatment on his behalf.  “We’ll discuss treatment options with Dr. Abbott” they say.  Considering Dr. McKee’s insistence on surgical excision of the mass, this would have been a situation where shared decision making is crucial.  In fact, their decision to use radiation ultimately fails, wasting precious time.

People can change, and from his diagnosis forward McKee does change, drastically.  He reprimands a student for referring to a patient as “the Terminal.” He befriends a woman with stage 4 brain cancer who teaches him to slow down and enjoy life more in the present moment.  Interestingly he briefly loses the nerve to perform surgery and we wonder for a moment if maybe he was a better surgeon as a callous jerk?  But ultimately, he chooses “the Rabbi” to excise his tumor and is left actually speechless for a period of weeks where he wins back his wife and family and eventually makes a full recovery.

Prior to his illness, his approach to medicine was entirely clinician centered.  I think of a scene where he bursts into the room where a female patient is waiting anxiously, and within about 5 seconds yanks down her gown to inspect stitches on her bare chest.  He makes no eye contact and gives no cue that he has the slightest interest in anything she is saying.  By the end of his recovery, he actually spends some time with a heart transplant patient and their gathered family members, responding to all their concerns thoughtfully and humanely.  As PA students, I imagine it will be easy to fall into some of these traps.  In the clinical stage, we may find ourselves seeing patients more as opportunities to test our knowledge than as vulnerable human beings.  The Doctor reminds us that treatments and methods of care can feel almost as intrusive as the illness itself, and that bringing humanity to our work increases the well-being of all involved.

Dr. McKee caps off his transformation by doing his best to pass on what he’s learned to his medical students.  To help them understand the plight of the patient they are told to trade their slacks, suspenders, and white coats for a patient gown, spending a week living in a simulated hospital environment.  You’d imagine after being subjected to humbling exams and hospital food (rear ends hanging out all the while) that they would learn more of what the patient goes through and ultimately treat these patients better.  I have a feeling this might underestimate just how self-absorbed and impervious to reform some people are.  It took Dr. McKee what seemed like months of being outraged with his treatment before he started to shift perspective.  But assuming they actually did learn something, I would hope that they better realize anybody can become a patient, including themselves, and that a patient should be considered a collaborative participant in their own care.  As McKee says in the film, “every doctor becomes a patient somewhere down the line.” They may even discover the ability to extract useful information from their patients who may have clammed up if they continued to act like total jerks.

Based on the true-life experiences of WWII veteran and surgeon Dr. Edward Rosenbaum, The Doctor shows us that bad habits break hard.  It’s not too hard to see that the paternalistic and borderline macho attitudes common in healthcare to this day stem from a kind of defense mechanism.  Dr. McKee, as he tells us, spent his entire life with his arms out, keeping everyone at a distance, afraid that showing some humanity would only get in the way.  By adding the skills of a patient centered approach, and in his personal life a people centered approach, he discovers that a bit of humanity actually clears the path toward a more meaningful career and a richer life.