Do the classic specialty stereotypes still hold true for today’s doctors?
Authors: Kathy Oxtoby
Publication date: 17 Dez 2013
For years doctors have joked about the stereotypical general practitioner, surgeon, or radiologist. Kathy Oxtoby looks at whether these stereotypes still hold true for today’s doctors and if they affect how doctors choose careers and work together
He’s a big, bold, beer swilling rugby fan, and when it comes to clinical practice he prefers to cut and run, rather than communicate with patients. She’s cute and fluffy, with a permanent smile and a small koala attached to her stethoscope. He’s paternalistic, kindly, with a penchant for corduroy jackets and elbow patches.
These stereotypes of the surgeon, paediatrician, and general practitioner (GP) are the stuff of professional banter, along with those for doctors in all the other specialties. But does the persistence of stereotypes in the profession’s consciousness affect how doctors select which specialty to go into and how they interact with one another? Do these stereotypes still apply to today’s doctors, or are new stereotypes developing?
To try and address these questions, it is worth considering why people use stereotypes. Mark Salter, a consultant in adult general psychiatry in London, says stereotypes are “illusions we create in order to make sense of a messy world.” He warns, though, that “we can’t simply categorise people. It’s important to remember that stereotypes exist only as abstracts and approximations.”
Mind and body
The nature of the medical profession may make doctors more inclined than patients to pigeonhole other doctors into particular types. “Doctors cling more strongly to stereotypical myths than the public does,” says Salter.
Keith Hopcroft, a GP in Essex, believes this inclination to stereotype stems from the way the profession divides itself into different groups. “Doctors can be quite tribal and it makes them feel better about themselves and what they do to define what they are—such as the surgeon who views himself as decisive and other specialties as woolly,” he says.
Salter suggests thinking of the specialty stereotypes on a spectrum, with “the mind” at one end and “the body” at the other. “At the mind end of the specialty stereotype spectrum are general practitioners and psychiatrists specialising exclusively in kindness,” he says. “At the other end of the spectrum are the technicians—pathologists and microbiologists—where the stereotype is that they are removed from patients so therefore have no need to be sensitive,” he says.
In between these specialty extremes of mind and body are a wealth of other specialty stereotypes that have evolved over the years (box 1). These include the psychiatrist with long hair and a beard, who is a deep thinker and a mixture of Sigmund Freud and a geography teacher; the radiologist, who can be hard to spot as he or she will usually be hiding in a dark room; and the the emergency department doctor, who is ex-forces and charges round the hospital barking orders with the same urgency as he may have done on the battlefield.
The stereotypes that persist in medical humour and banter are also fuelled by the media. The 1950s Doctor film series featured Lancelot Spratt, who strode down hospital corridors with a team of frightened trainees behind him and who, in the public consciousness, displayed the traits not only of the classic surgeon but also the typical consultant. In the 1960s, Dr Finlay’s Casebook portrayed the GP as a paternalist caring chap for whom nothing was too much trouble for his patients.
These characters are long gone from the small screen, but a new generation of characterisations have emerged: the drug addicted, unconventional, misanthropic genius depicted by Hugh Laurie in the American series House; the dashing, heroic physician Doug Ross portrayed by George Clooney in ER; and Doc Martin, the brilliant vascular surgeon played by Martin Clunes, who develops haemophobia and is forced to become a GP in a Cornish village.
Specialty stereotypes may be a source of entertainment on the small screen and of humour on the wards, but there is a more serious side to these perceptions of medical disciplines. In particular, stereotypes that portray specialties in a negative light can deter aspiring clinicians from working in these areas, causing recruitment shortages.
Studies have found that badmouthing within medical schools influences career choice and that this often occurs in the earlier years. Misinformation and misperceptions about psychiatry and pathology have deterred people from entering the specialties (box 2). In 2001, only 3.9% and 1.3%, respectively, of new doctors intended to pursue a career in these specialties.
Gender stereotyping within specialties can also discourage a balanced workforce. For example, University of Exeter research carried out this year in collaboration with the Women in Surgery group and the Royal College of Surgeons showed that only 9% of surgeons are women.
The study showed that the decision not to pursue a career in surgery is not because of a lack of ambition or unwillingness to work long hours and sacrifice family life. The research showed that it is more likely to be because women direct their ambition towards careers in which they perceive they are likely to succeed. Women see surgery as a stereotypically masculine career and are likely to think of a surgical consultant as a man. The researchers found that this perception is often reinforced by encounters with surgical consultants, who are predominantly male.
Although specialty stereotypes may deter doctors from working in a particular area, they may also be part of the reason they are attracted to it. For example, Sarah Burnett, a radiologist in independent practice in London, found radiology particularly appealing because one of her hobbies is photography, so that, rather than deterring her, the stereotype of spending time working in a dark room appealed to her.
Doctors may also be attracted to certain specialties because they believe their personalities will fit a particular stereotype. Mike Dixon, a GP in Cullompton, says that on the whole, “individuals go into general practice because they are interested in people and in working with families, while people go into surgery if they’re interested in blood and gore.”
Dixon believes trainees choosing specialties that reflect their interests—even if they are associated with stereotypes—makes sense, particularly at interview. “If a surgeon went for an interview with a GP hat on or vice versa it would probably be counterproductive.” Often these interviews are more of an initiation process to see if the candidate is “right for the tribe,” he says.
Nature or nurture
Doctors may also take on the qualities associated with their specialty. In the nature versus nurture debate on medical disciplines, Hopcroft believes nurture is 99% responsible for how doctors develop their careers.
“I believe that when people go through medical school and become doctors, the majority of them have the potential to be anything they want,” he says. “There may be a few individuals who fit a stereotype, such as the macho surgeon and the anti-social anaesthetist, but they are the exception not the rule.”
For Andrew Rowland, a consultant in paediatric emergency medicine in the north west of England, the reason doctors are attracted to particular specialties is because of different personality traits. “We all have different traits that mean certain specialties appeal to us,” he says. “For example, those of us who like doing practical skills and enjoy working in a fast paced environment are drawn to emergency medicine and surgery.”
Rowland also believes that, although doctors retain their essential personality traits as they develop their careers, “We are likely to mould ourselves into what our specialties require from us.”
Beryl De Souza, honorary clinical lecturer in classic surgery at Imperial College London, says doctors “grow into their specialties.” She cautions against becoming overly socialised into a specialty. “It can be dangerous as you can end up changing your personality just to suit your specialty, which won’t make you happy,” she says.
Personality traits and a sense of being socialised into a specialty may both play a part in doctors’ choices of careers and the doctors they become, but role models also have an important influence on clinicians and their views of different disciplines.
“Role models are crucial in how we develop as doctors; in fact I think we learn more from our role models and take on their habits than anything that’s written in a text book,” says Dixon.
A positive role model will inspire and help you to become a better doctor, he suggests. “One of my early role models was a physician—an inspiring man with strong values, pizzazz, and charisma. He was the sort who would kneel by the patient’s hospital bed and talk to them as equals.
“Another role model was a psychiatrist I worked with who, if he saw I was troubled about being unable to help a patient, would say: ‘Don’t worry, when you’re completely at a loss as how to treat someone just remember to be kind’.”
For Salter, the doctors he looked up to were “clever, witty, devoted students of human nature.” He says, “They gave me a thirst for understanding people’s histories, hopes, and dreams for the future.”
Role models played a crucial part in the choice of specialty made by Suzy Lishman, a consultant histopathologist at Peterborough Hospitals NHS Trust. But she says her role models didn’t match the stereotype of the individual locked in a laboratory who prefers to look through microscopes rather than talk to patients.
“I was fortunate enough to be taught by some inspirational pathologists at all stages of my training,” she says. “For me the fact that there were many women in pathology was encouraging; I could see that they could work full time but still have a better work-life balance than I’d seen in other specialties.
“My role models definitely didn’t fit into any of the stereotypes—they were passionate about their subjects, excellent communicators who passed on their knowledge to the students,” she recalls.
Dixon says that, while positive role models are “worth their weight in gold” in helping to enhance patient care, “unfortunately bad role models tend to create ongoing negative stereotypes and bad practice.” He believes doctors of today are less likely to perpetuate negative specialty stereotypes because the profession is, like the rest of society, becoming “less stereotypical and more individual.”
Burnett agrees, pointing out that stereotypes are less prevalent because the stereotypical doctor “who is white and middle class,” no longer dominates the profession. “Thank goodness today medicine is largely more representative of the population as a whole and includes people from different social backgrounds,” she says.
The gender mix of the profession has also changed. Today, 60% of medical students are women, so medicine is becoming “an increasingly feminised workforce,” in contrast to the traditional stereotype of clinicians being predominantly male, says Amanda Howe, vice chair of the Royal College of General Practitioners.
Another reason that specialty stereotypes might be on the wane is because doctors are now less likely to think they have to stay in one discipline for their whole working lives. De Souza says, “Clinicians are learning to adapt to working in different specialties rather than a single one during the course of their career, and it is not unusual for a surgeon to move into public health or a general practitioner to decide to become a psychiatrist.”
She thinks that, with more clinicians transferring between specialties, different disciplines are now less defined by specific personality traits and are becoming a mixture of different types of doctors’ characteristics.
Closer working between clinicians is also helping to break down barriers and stereotypes, Sue Bailey, president of the Royal College of Psychiatrists and vice president of the Academy of Medical Royal Colleges, believes. “At the academy, for example, physicians, surgeons, GPs, psychiatrists, and paediatricians will meet up and pull together to see how we can improve care for patients. We have our spats now and again, but we all have common ground, which is to help patients,” she says.
Specialties change with time
Specialties have also changed over the years. Dixon recalls how 40 years ago general practitioners were under pressure from their managers and peers to conform to a rigid image of what a family doctor should be.
“You had to be heterosexual, and you had to have a wife—who would be informally interviewed at cocktail parties to make sure she fitted the bill of being a GP’s partner. And, yes, there was a lot of wearing of tweeds and leather patches on jackets.” He believes GPs are no longer under pressure to conform to the family Dr Finlay stereotype and that doctors’ freedom to express their individuality “can only be a good thing.”
Another change to the GP specialty stereotype is that it is now no longer predominantly paternalistic and nearly half of registered GPs are women. Richard Vautrey, deputy chair of the BMA’s General Practitioners Committee, says, “This is to do with the degree of flexibility that general practice offers practitioners, allowing them to maintain a balance between their home life and professional life and to work part time, which has been a feature of the specialty over the last 20 years.”
Howe points out that, while the paternalistic GP may still exist, there is also a generation of young, dynamic, entrepreneurial GPs emerging in the specialty and that general practice is made up of a “really mixed bunch of people.”
Dixon says another reason for the changing GP stereotype is because GPs now have more biomedical expertise than their forebears, and they focus more on health promotion—“helping patients to be active partners in their care, rather than relying on our judgments.”
He adds that, in surgery, the “hectoring image of Sir Lancelot Spratt who never listened to other doctors or patients has thankfully disappeared.” One of the reasons for the disappearance of the surgeon cast in the Spratt mould is that trainee surgeons, in common with all doctors, now learn the value of good communication skills from medical school onwards. De Souza says, “These days, from the start of their training doctors are taught that they don’t need to be didactic to support patients, and that communicating with them is a two way street.”
Durka Dougall, a former surgical trainee who is now a fourth year public health specialist trainee in London, believes specialty stereotypes in surgery are gradually becoming redundant. “The classic surgery stereotype is male, tall, and strong enough to lift a limb. I’m a petite, short lady, but with so many devices available to assist me when I was working in surgery, the physical aspect of the job was never an issue.”
Having moved to public health, Dougall says neither she nor her colleagues fit the traditional stereotype of the public health doctor. “Public health is thought to be a specialty where those drawn to it are women who are not particularly ambitious and that it’s a ‘fluffy’ career option. None of those characteristics fit my personality. And all the men and women I’ve met working in public health are individuals who want to inspire and make a difference,” she says.
For Rowland, the stereotype of the consultant working in paediatric emergency medicine, dashing frantically round a hospital performing dramatic deeds as depicted by George Clooney in ER, has little relevance to the work he and his colleagues do. “More would happen in one episode than would happen in a year where I work now,” he says.
Psychiatry, a specialty that used to conjure up images of patients draped on couches undergoing psychoanalysis from bearded, cigar smoking individuals, is far removed from the stereotype, asserts Bailey. “With psychiatrists now working in the community and involved with neuroscience and social science, we are a specialty that’s difficult to stereotype,” says Bailey.
Although the image of the stereotypical surgeon is gradually changing, many doctors still associate it with being an unfriendly, and non-family-friendly, specialty. Dougall says that is one of the reasons why women may still be put off from working in this area. This is despite her experiences to the contrary when she was working in surgical training and “found surgeons a most welcoming group.”
Even if specialty stereotypes do not fit the profession as a whole as well as they used to, they still hold sway over some doctors’ perceptions. For instance, Vautrey believes there is a certain amount of stereotyping between GPs and hospital doctors. He suggests this is because in the last 10 years there has been less joint learning between primary and secondary care clinicians, fewer joint educational events, and a general “disconnect between hospital and general practice where there isn’t direct contact between consultants and GPs.”
Pathology is still subject to derogatory comments and misconceptions about what the specialty involves, Lishman says. When she canvassed pathologists’ opinions, the responses she received highlighted the stereotypical images about what colleagues thought it entailed. One doctor told her: “There’s definitely a stereotype of pathologists and scientists having no social skills and spending all day in underground mortuaries and laboratories, cut off from real life. There are occasional people like that in all specialties, but you wouldn’t get very far in pathology if you couldn’t work with other people as part of a team.”
Other comments on pathology Lishman gathered included: “When I tell people I want to work in pathology, they automatically think I want to cut up dead people,” and “I’ve been told I’m just a lab rat, not a real doctor.”
Lishman says that, these days, stereotypes are more likely to exist in specialties to which students have little exposure during their training. “There’s a concern that pathology is becoming one of these specialties as many universities have dropped the traditional block pathology course in their curriculums in favour of integrated teaching—resulting in students not being sure who a pathologist is or what they do all day. If students work in or are taught about a specialty, I think they’re more likely to be influenced by the role models they meet during that experience,” she says.
Discourage negative stereotyping
To address negative specialty stereotypes, medical schools should be proactive in providing information, career advice, and positive role models as part of undergraduate education. Research suggests that this may counteract negative propaganda and encourage career choice in tune with both the students’ earlier feelings and with patients’ needs.
Howe says that trusts and GP surgeries should have robust policies on recruitment and training that actively discourage negative specialty stereotyping to help ensure as diverse a mix of applicants as possible.
Professional organisations such as the BMA, the Medical Women’s Federation, and the British Association of Physicians of Indian Origin (BAPIO) are also working to tackle specialty stereotypes so that all doctors feel able to apply for and work in posts without fear of prejudice, and without they themselves being prejudiced against a discipline.
More work will need to be done to address negative stereotypes in medicine, however, as new ones are emerging, fuelled by the media. Vautrey says one of the latest is the “fat cat GP who doesn’t do out of hours and doesn’t know his patients. These stereotypes are very powerful and chip away at the profession.”
As the types of doctors in different specialties continue to develop, Lishman envisages an increasingly diverse doctor workforce, with more women practitioners and more clinicians from overseas working in the UK.
She also believes that the way medicine is delivered will change, with more generalists and fewer specialists. “The population is changing, with more older people, more chronic diseases, and multiple comorbidities.
“Healthcare will need to change to meet the needs of these patients, and doctors will need to have broader experiences and be more generalist, so this may blur the distinctions between specialties,” Lishman says. “It will be interesting to see if new stereotypes emerge as a result.”
Howe predicts GPs can expect more change during the course of their careers, which could involve taking on different roles such as teaching, research, management, commissioning leadership, and special interests. For GPs, this changing world of technology, targets, and the need to encourage patients to be partners in their care is far removed from the paternalistic Dr Finlay stereotype—a fact some regret.
“There’s a slight sweat shop feeling to general practice these days,” says Dixon. “Consultation rates have doubled in the past 20 years, we’ve less time to spend with patients, and it’s hard for us to treat the whole person and to really get behind their symptoms to the heart of their problems. Our role is becoming too far removed from the stereotype of the caring, compassionate clinician, and I miss that stereotype.”
Although the classic doctor specialty stereotypes are changing as the clinical workforce becomes more diverse, human nature and the nature of the profession make it likely that they will continue to exist in some way or another, even if only in the form of medical banter. As Burnett says, “Stereotypes are a means for likeminded doctors to bond. And like animals, we doctors enjoy running in packs.”
Box 1: Classic specialty stereotypes
Anaesthetist—Seems to have inhaled too much gas and spends a lot of time doing crosswords and sudokus
Emergency department doctor—Ex-forces and likes to charge around the hospital barking orders
General practitioner—Paternalistic, kindly, with a penchant for corduroy jackets and elbow patches. The 1960s Dr Finlay’s Casebook TV series typifies the traditional GP stereotype
Neurologist—An armchair intellectual who spends most of his or her time filling in forms
Paediatrician—Cute and fluffy, with a permanent smile and a small koala attached to a stethoscope at all times
Pathologist—Has a morbid fascination with death, and prefers being in a laboratory to communicating with patients
Psychiatrist—Sports long hair and a beard, is a deep thinker and a mixture of Freud and a geography teacher
Radiologist—Hard to spot as usually hiding in a dark room
Surgeon—Big, bold, bullish, and a beer swilling rugby fan. Prefers to cut and run, rather than communicate with patients. Typified by Lancelot Spratt from the 1950s Doctor film series.
Box 2: “Too bright” for psychiatry
Jude Harrison is a core trainee 2 in psychiatry in London and secretary of the Royal College of Psychiatrists’ trainees’ committee. She says specialty stereotypes can be damaging for doctors and for the image of different disciplines.
“Two years ago, as an F2 [foundation year 2], I attended a course among a dozen other foundation trainees. We were all enhancing our CVs for core training applications. In the morning coffee break, the subject of career choices came up in conversation. Around the table were an aspiring surgeon, a respiratory physician, an emergency medicine doctor, and an anaesthetist. Eyebrows were raised when I said that I was going to be a psychiatrist.
“‘Why do you want to do that?’ one asked. I described the brain as the last frontier in medicine, and psychiatry as comprising some of the most prevalent and debilitating conditions. My enthusiasm seemed to neutralise their antipathy. They did not ask me any more questions. No one else felt the need to explain their career choice, we finished our coffees, and the course resumed.
“A seminar and a role play took us to lunchtime. I returned to my seat with my sandwiches to find a post-it note on the desk with a message, which read: ‘For the brain: Neurosurgeons: know a little, do a lot. Neurologists: know a lot, do a little. Psychiatrists: do nothing, know nothing!’ The note added in brackets: ‘It’s not my personal view—just thought I’d share the joke.’ When everyone was seated I asked who had left the note. No one owned up.
“This wasn’t the first time I was on the receiving end of the negative stereotyping of my chosen specialty. As a medical student I was told by my supervisor that I was ‘too bright’ for psychiatry, and other colleagues have told me of similar experiences.
“Of course, psychiatry is not the only specialty associated with negative stereotypes. Orthopaedic surgeons are stereotyped as not being particularly bright and as poor communicators, which does not apply to any of the orthopaedic surgeons I know. But all these stereotypes can be damaging for specialties, harming recruitment and the image of the specialty. I know of doctors who have been put off becoming a psychiatrist purely because of the stereotype and have chosen to become general practitioners instead.
“When doctors joke about each other’s specialties and use negative stereotypes, we need to consider what the impact will be on the individual clinician who is the butt of these jokes and comments, and also the wider impact on the specialty concerned. Stereotypes can deter people from choosing a specialty they might potentially love. Why would we wish to do that?”
Competing interests: I have read and understood the BMJ Group policy on declaration of interests and have no relevant interests to declare.
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Kathy Oxtoby freelance journalist