- Trisha Greenhalgh, professor of primary health care, University College London
If you search “medicine” on Google Images, you get a hundred million photographs. The most common image is a stethoscope. The next is a bottle of pills (or, sometimes, red and black capsules). The next is a surgeon, masked and gowned, slicing skin with a scalpel. Try “patient” and you will find lots of people in stripy pyjamas, lying obediently in bed, often with a spotty rash or a leg strung up in an orthopaedic hoist. Access a professional image site and you will get pictures of higher technical quality and cost—but the same outdated themes.
Nursing stereotypes are even worse. Excluding images of breast feeding (for which the US term is “nursing”), your hits will comprise little more than young, slim Anglo-Saxon women in starched uniforms, frilly hats, and—you’ve guessed it—black stockings. Outside the saucy websites they are usually either giving injections or doing thermometer rounds on Nightingale wards.
I once personally sorted through 10 000 images for one to illustrate a brochure for a masters course in primary health care. No hospitals, please, and something multidisciplinary, patient centred, and power neutral, if possible. I found one perfect picture—but that was three years ago, and I’m now looking for another for the new brochure. Hen’s teeth.
Yet it is 13 years since Richard Smith wrote an editorial in this journal (BMJ 1997;314:1495, www.bmj.com/cgi/content/full/314/7093/1495) heralding the imminent demise of “industrial age medicine,” in which our hospital focused healthcare system made people into patients and infantilised, overinvestigated, and overtreated them. He predicted a new era of “information age health care” in which citizens—masters and mistresses of their own bodies and experts in their own illnesses—would use internet based sources to manage their chronic conditions themselves in the community, drawing eclectically and judiciously on the expertise in disease of nurses and doctors.
I have recently worked my way through half a dozen policy documents that were cleverly illustrated with pictures of accessible, flexible, patient centred clinicians (without white coats, stethoscopes, scalpels, or syringes). In the foreground were empowered patients managing themselves, usually of mixed ethnicity, with whom the clinicians were sharing decision making.
I want to know where the Department of Health gets these images. More fundamentally, has the revolution in roles and relationships in clinical care actually happened? If so, why has it so completely eluded the people who make a living from depicting our work visually?
Cite this as: BMJ 2010;340:c1524