Feature Christmas 2012: Lives of Doctors

Doctors on television: analysis of doctors’ experiences during filming of a documentary in the workplace

BMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e8220 (Published 19 December 2012) Cite this as: BMJ 2012;345:e8220
  1. Shelby Webster, fellow in medical education1,
  2. Kevin Shotliff, director of multiprofessional education1,
  3. Urvashi Sharma, research associate23,
  4. Derek Bell, professor of acute medicine23
  1. 1Department of Postgraduate Medical Education, Chelsea and Westminster Hospital NHS Foundation Trust, London SW10 9NH, UK
  2. 2NIHR Collaboration for Leadership in Applied Health Research and Care, Chelsea and Westminster Hospital
  3. 3Imperial College London, Chelsea and Westminster Hospital
  1. Correspondence to: S Webster shelbywebster{at}doctors.org.uk
  • Accepted 6 November 2012

Shelby Webster and colleagues explore the effects of working under the eye of the camera

Fly on the wall medical documentaries are increasingly popular in the UK. Our hospital was the base for the second series of Junior Doctors: Your Life in Their Hands, a BBC documentary series following the lives of National Health Service junior doctors (foundation trainees) at work and at home. The series has prompted strong opinions and concerns among clinicians, medical educators, and the wider public about issues in medical training and the impact of filming junior doctors at work on the profession and public perception.1 2 Indeed, the complexity of starting a new job, in a new hospital with new colleagues is challenging in itself without the added complication of film crews and subsequent public broadcast. We evaluate and explore doctors’ experiences during filming of the BBC series.

Ground rules

The interaction between the medical profession and the media is becoming increasingly complex. Guidance relating to how medical professionals interact with different forms of media is increasingly available as traditional boundaries blur and healthcare professionals become more accessible to patients and the public.3 4 The ethical and legal framework to support patient confidentiality during filming in a healthcare setting is now well established; however, the ethical considerations for clinician involvement in reality based documentaries is less well described.5 6 7 8

During filming of Junior Doctors, the hospital followed robust procedures to assure legal and ethical consent processes for patients and staff. A steering group was established, and roadshows, grand rounds, and poster campaigns were used to highlight the filming. Recruitment of foundation doctors was voluntary, and information was provided to them by production staff and previous contributors. The BBC offered all featured doctors the support of an independent psychologist.

We sent an initial survey to hospital staff in September 2011, one month after filming started, to collect their views on how the filming might affect doctors, teams, and patient care. The survey highlighted staff perception that the filming was likely to be stressful and time consuming for the doctors taking part. We used these findings as themes for semistructured interviews with staff after the filming.

Examining staff reactions

We conducted individual face to face interviews lasting 20-80 minutes with eight featured trainees, seven clinical supervisors, six trainees working in filmed departments, three trainees working in departments not filmed, and a consultant on the trust’s board. The interviewer had no involvement with the filming processes. All interviews were audio recorded and transcribed verbatim, and the interviewer also made reflexive notes throughout the interview period.

Transcripts were entered on to NVIVO9 data analysis software and coded for themes using a constant comparison approach. Data were triangulated with survey results, reflexive notes, and trainees’ learning portfolios to provide further validity. The table shows the main themes and results.

Summary of findings by main themes, subthemes, and descriptors

View this table:

Effects on the wider clinical team

Some of the clinical teams involved in filming felt underprepared and “thrown into” filming. This resulted in increased anxiety and stress. However, staff seemed to have an overwhelming desire to maintain “normality” wherever possible. The need for some clinical teams to have privacy to focus on patient problems affected the footage allowed to be filmed. In turn, the film crews tried to “encourage” team members to cooperate with filming, which made some feel guilty for withholding their consent to be filmed. One consultant reported: “They asked, ‘Would you do one final interview?’ and I said, ‘Do you know what, I can’t. I really cannot go through that. It’s actually quite traumatic.’”

Featured trainees and other foundation trainees felt that filming may have affected the distribution of work and the time spent by the featured doctors on everyday tasks. More “interesting” clinical activities may have been allocated to filmed trainees. This was considered annoying but not insurmountable and, in general, there was a sense of collaboration and cohesiveness among the trainees and clinical teams.

Individual doctors

Foundation year 1 trainees who were being filmed generally felt the most stress. Lack of experience and confidence contributed to anxiety about being judged by many potential patients, colleagues, and friends. Professional support structures, although present, were underused. The principle of new graduates taking part in such documentaries was considered “brave” rather than foolish. Trainees were motivated to take part by a sense of curiosity and a desire to engage the public in the challenges of a career in medicine. Trainees not working in filmed departments did not describe the same level and intensity of stress. Trainees and members of staff working in other departments were not significantly affected by the filming.

Filming consumed large amounts of time for those featuring. In general, new graduates were less able to cope with the added time pressure, resulting in stress. Time was taken up doing interviews and retakes. One featured trainee said: “It was like having a part time job really on top of doing medicine.” Privacy and personal time were reduced as filming occurred during social hours too. This, in turn, affected work-life balance and feelings of general wellbeing. Other doctors working near the filming also felt added time pressure—for example, when asked to give commentary or interviews to the film crew.

Participating trainees described how formal training opportunities and levels of supervision and support were at least as good as expected and often better during the filming period. Increased exposure to procedures, frequent reflection, prompting of feedback from seniors, meticulous attention to detail, interview practice, and feeling comfortable being watched were all reported advantages to being involved with the filming. As one consultant explained, filming “was a pressure which was making them go to theatre, but, in fact, the opportunity to go to theatre is there to all; it’s just that some don’t bother.” Analysis of trainees’ portfolios showed filming did not have a detrimental effect on training and development during this period.

Television agenda or medical agenda?

Doctors seemed generally satisfied that procedures for patient consent were satisfactory. No interviewees were aware of complaints from patients about filming. The consent process for filming of emergency or cardiac arrest situations was not widely understood by non-featuring clinical staff, and this occasionally led to feelings of uncertainty about the appropriateness of filming. The timing of interviews with medical staff during emotive or sensitive medical events was difficult for a few of the featured doctors. Doctors working alongside the filming reported having to be strict with crews about personal consent.

The use of editing to create storylines was more acceptable to some doctors than others. Stereotyping of personalities and junior doctors in general was described, and some thought it reduced the credibility of the programme as an educational tool. Some trainees felt disappointed at the choice of footage used to portray them and thought that it was a not a true reflection of their ability or character. Discussions between “characters” were sometimes prompted by the crew. Music and voice over provided interpretation of events that were considered rather sensationalist.

Discussion

Our findings show some of the complexities of introducing film crews into professional workspaces, the potential effect on staff, and the perceptions that can be given to public audiences. Clinical teams are increasingly multidisciplinary and multiprofessional, and junior doctors do not practise independently. The clinical team and supporting systems for junior doctors need to be involved throughout. The image of the lone house officer, fresh out of medical school and prowling the wards at night is inaccurate and creates public concern.

Junior trainees being filmed are likely to need strong senior direction and support to minimise disruption to clinical teams, especially when established routines may be unfamiliar. Leaders of clinical teams should understand the opinions of all team members about the process and potential effect of filming. Some people are more comfortable in front of camera than others, and this is independent of grade or level of experience. Foundation trainees work closely alongside other healthcare professionals, and the filmed content will depend heavily on their cooperation and willingness to be filmed. Time and logistical constraints meant that we were able to interview only doctors close to the filming, but interviews with other professional groups may provide additional insight into the effect on the wider clinical team.

Most of the doctors who volunteered for filming underestimated the stress and time pressures it would cause. Consultant educational supervisors were mostly not aware of the pressures that junior doctors were experiencing during filming. The pastoral role of educational supervisors conflicts with the teaching and assessing role, and some of the doctors might have benefited from a mentor or personal support tutor.9 10 Doctors who described the highest level of stress during filming attributed it to the constant pressure to be filmed doing something interesting or exciting, combined with the high pressure of a new demanding job. As a result, time to become familiar with the working environment, colleagues, and clinical routines would be helpful before starting filming.

Another factor that increased stress for some doctors was the editing and stereotyping of characters. Professionals should be aware of the editing style and targeted audience of the programme for which they volunteer. Equally, broadcasting organisations must be frank and open when informing professionals of expected filming duties including retakes, interviews, and reactions to clinical events. In addition, film makers, must be culturally sensitive and responsible when filming in professional workspaces.11 12 13 14

The perceived benefit to training in our study was surprising. Some featured trainees had fewer patient encounters than their non-filmed colleagues, but overall, this was felt to be overcome by intense reflection, increased exposure to training opportunities, and more frequent senior feedback. Reflection and feedback are well known strategies in medical education for recognising strengths and weaknesses.15 16 17 The potential value of edited broadcasts as a stimulus for learning at trainee or institutional level needs further evaluation. 5 The doctors in our study believed that learning opportunities from the broadcast programmes were limited because of editing and were not comparable to video feedback used in formal medical education settings.18

The ability of the media to shift public perception of healthcare matters is well recognised.19 20 As a result, conflicting broadcasting and medical agendas can be the source of strong discontent among medical staff.21 Factors that helped to ease tension at our hospital were the setting of ground rules, the agreement of consent processes, and the respected reputation of the broadcasting agency. Thousands of hours of footage were filmed for each hour of broadcast, suggesting producers have considerable choice and control over scene selection.

At a time when professionalism and medical training are open to public and political scrutiny, this lens into junior doctors’ lives must be interpreted carefully and with appropriate understanding of the processes around it. We hope that our analysis will help patients, medical educators, medical managers, clinicians, and politicians to put issues portrayed in medical documentaries in context and help support our workforce in ever demanding work environments.

Notes

Cite this as: BMJ 2012;345:e8220

Footnotes

  • Competing interest statement: All authors have completed the ICMJE unified disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years, no other relationships or activities that could appear to have influenced the submitted work.

  • Contributors: SW, KS, and DB conceived and planned the work for the article. SW and US analysed and interpreted interview data. SW drafted the original article with substantial contributions from all authors. All authors approved the final article. SW and KS are guarantors.

  • Provenance and peer review: Not commissioned; externally peer reviewed.

References