When you think of the term ‘doctor‘, what picture pops into your head? Images of doctors have changed through the ages, but never have they been more ubiquitous than they are now. They are powerful tools of communication. Do the images cause problems not only in the way patients view doctors but also in the way doctors view themselves?
Learning objectives
1. Google image search your job role/specialism
2. Reflect on whether these images are influencing patients and the profession
3. Consider if as a profession we should be more proactive in conveying realistic images of doctors and healthcare
At the time of writing, the internet search engine Google is the most popular means by which people search the internet. It is often the first point of call for many to find or look something up. Results at the top of a Google search are coveted and there are a multitude of organisations set up to improve the ranking of websites and images in search results. Much of this search engine optimisation (SEO) is to direct traffic for monetary purposes/advertising as individuals are more likely to click on links more prominent in search results.
What I find particularly interesting are the images of doctors that reach the top of image results. Google do outline how their process works stating that ranking is done programmatically based on how useful webpages are. The algorithms apparently analyse hundreds of different factors.
So what does Dr Google look like? Below are the highest ranking google images when I search for the following terms:
“doctor”
“clinician”
“physician”
“surgeon”
“general practitioner”
Google and the Google logo are registered trademarks of Google LLC, used with permission.
The images above are what I found searching in June 2019. One of the fascinating aspects of these algorithms are that the results will change with time and potentially with location. So unlike the images of the past, engraved in stone or printed on paper, we have an adaptive process at our fingertips. So don’t just take my word for it, try it yourself!
Questions
What images do you get when you try the search for the term “doctor”?
How do these images relate to your personal experience of what doctors look like?
If you have a specialism, try looking that up too (e.g. radiologist). Is it what you expected?
What do you think about the demographics of the people in the images?
Try approaching the issue from another perspective. What do you think about the images displayed when you search for the term “patient”?
“patient”
Google and the Google logo are registered trademarks of Google LLC, used with permission.
Although there appear to be few statistics on who still wears a white coat to work, there is some information about the demographic background of doctors. In the UK, the General Medical Council try to collect information about doctors which is available here. Bear in mind, however, that completion rates for doctor demographic information is poor when compared to some other healthcare professions.
Age
Research demonstrates that doctors in the UK seem to retire from medicine younger than some people expect. This appears to go against societal trends. The reasons why doctors leave the profession early are multifaceted and influenced by specialty.
Graph adapted from GMC register data: https://data.gmc-uk.org/gmcdata/home/#/reports/The%20Register/Stats/report
Sex
In 2018 NHS digital reported that 45% of UK doctors were female. Yet men dominate senior positions and earn more. In the NHS, 2 in 3 consultants are men and men earn £1.17 for every £1 earned by women. There are also significant differences within individual specialties (e.g. 27% of surgeons are women).
Ethnicity
A BMJ editorial in 2019 highlighted that about 1 in 3 doctors working in the NHS identify as being from an ethnic minority background, against a UK ethnic minority population of 14%. These doctors face a disproportionate number of official complaints and disciplinary actions as well as earning 4.9% less than their white consultant counterparts.
Contains public sector information licensed under the Open Government Licence v3.0.
Image from https://www.ethnicity-facts-figures.service.gov.uk/workforce-and-business/workforce-diversity/nhs-workforce/latest#nhs-workforce-by-ethnicity-and-type-of-role
Comparing this factual demographic data against the top ranking images on a google image search reveals a disparity. For those individuals who have little contact with healthcare services, they may have developed an expectation of what a doctor should look like based on such images. These types of images are not confined to google, they are pervasive throughout our society, whether it is online, on television or in advertising.
Questions
Do you think such images influence patient expectation?
Are these images beneficial to the doctor-patient relationship?
I don’t know if a mismatch between expectation and reality is more likely to make someone disappointed when they encounter a real doctor. What is clear however is that the demographic background of a doctor is an important factor in whether they receive a complaint. The General Medical Council has recognised there there is an overrepresentation of BME doctors that have been complained about. Expectations of doctors based on images facilitate the problem.
But it would be naive to imagine that the influence of such images is confined to patients; doctors are not be immune. Evidence demonstrates that some doctors judged female surgeons with bad patient outcomes more harshly than male surgeons and that this also affected subsequent referrals to women in the same speciality. This pattern of thinking is odd considering that female surgeons have a small but statistically significant decrease in 30 day mortality compared with those treated by male surgeons.
Of course, none of this may have anything to do with the images of doctors we and our patients are exposed to. What do you think?
Questions
How might your behaviour be affected by medical imagery?
Some examples are applying to a particular speciality, taking up particular hobbies or wearing particular types of clothes to work or leisure activities. Looking like an all round ‘proper’ doctor. Don’t forget your nosocomial white coat.
The dissemination of this stereotype may be self fulfilling. What images will potential medical students be exposed to in their journey to become doctors? Will they somehow imitate what they see and conform to what the internet thinks doctors should look like? Will some of them not bother applying at all?
Questions
Do you think images of these type will influence potential medical school applicants?
What can we do as established doctors to encourage a diverse intake of medical students?
Doctors originate from a pool of highly capable, talented individuals. They were often the students at the top of their class at school. They are also usually determined to excel in extracurricular activities. It would not be unreasonable to postulate that some doctors in training may indeed be enthused by the challenge of fighting established stereotypes. Yet, the image of a stereotypical doctor remains firmly embedded in our cultural consciousness evidenced by the images at the top of our most popular internet search engine.
“He who fights with monsters should look to it that he himself does not become a monster. And when you gaze long into an abyss the abyss also gazes into you.”
Beyond Good and Evil, Friedrich Nietzsche
Doctors are starting to understand that unlike the past, the profession is no longer in tight control over the image portrayed to the wider population. The image of a doctor has changed with time depending on how society approaches the issue of illness.
Questions
Are you comfortable with what the current doctor image is?
What image(s) would you be comfortable with?
Even if we could (how?), should we try to promote a particular image of a doctor?
Summary
Patients look online when investigating their own health issues. The images they encounter may create an impression of what a doctor should look like. When this expectation is challenged it may lead to adverse outcomes not just for the patient but for the doctor. Like patients, doctors must also understand the power of medical imagery in not just how we look but how we act. An algorithmic process that reinforces stereotypical images based on clicks, monetisation and perceived norms now may threaten to narrow an already small field of potential medical applicants. The influence of such images may continue into our careers when deciding on specialism and the relationships we have with our patients.
Further resources
Medical Women’s Federation: facts & figures
http://www.medicalwomensfederation.org.uk/about-us/facts-figures
Comparison of postoperative outcomes among patients treated by male and female surgeons: a population based matched cohort study
https://www.bmj.com/content/359/bmj.j4366
Interpreting Signals in the Labor Market: Evidence from Medical Referrals
https://scholar.harvard.edu/sarsons/publications/interpreting-signals-evidence-medical-referrals
The Racial and Ethnic Composition and Distribution of Primary Care Physicians
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5871929/
UNEXAMINED MEDICINE 
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