Streetwalking to Welltopia
Dr. Ken on whether nurses are more like prostitutes or work spouses
October 9, 2015 -- In tonight's episode of the new ABC sitcom Dr. Ken, the arrogant lead physician character learned that "his nurse" Clark was also his "friend" and should be treated better. Unfortunately, the plotline also suggested that nurses are low-skilled servants looking for a physician to possess them. In particular, viewers were told that (1) Clark, formerly a "nurse" or "doctor's assistant," had just become a registered nurse by taking his "boards," after studying in an RN program "since last summer"; (2) this transition was like a "streetwalker" becoming an "escort," ha ha, but it would not result in a pay raise; (3) nurses are subordinate work spouses of physicians who essentially belong to the physicians, rather than serving patients under their own practice model; (4) physician abuse of nurses is unfortunate but also kinda funny; and (5) men in nursing do not embody traditional notions of masculinity. The show has yet to suggest that nurses have actual health skills--in contrast to Dr. Ken, who offers a few passing indications of health expertise in each episode. This adds up to toxic stew of nursing stereotypes: the unskilled handmaiden, the angel, the weak male, and even the naughty nurse. In fact, nurses receive at least three years of college-level science education and they use their advanced skills to save lives, often with little or no involvement by physicians. The episode, written by Mary Fitzgerald, loses more points because lead actor and show creator Ken Jeong actually is a physician. We realize the show mocks most of its characters. But please join us in urging Dr. Ken's producers to make amends and to avoid nursing stereotypes, which harm real nurses--and their patients.
An early scene takes place at the "Welltopia Medical Group," the HMO where Ken and Clark practice. We see the goofy young physician Julie Mintz and her streetwise colleague Damona (job undefined) present Clark with a cake saying "Congratulations Clark" and then cheer his achievement. Julie pins some kind of name tag on Clark, presumably designating him an RN.
Julie (gleefully): Now it's official, you're not just a nurse, you're a registered nurse!
Clark (smiling): I know, it's like going from streetwalker to escort!
Clark smiles after this joke has landed, but he is clearly proud of his RN advancement. Then the HMO administrator Pat, who is cheerful but mean and penny-pinching, enters.
Pat (to Clark): Now, you're aware that this promotion doesn't come with a pay increase.
Clark: Oh yeah, it's not about the money for me.
Pat (laughing): I hope not, you don't make enough for it to be about the money.
Clark immediately turns away with the piece of celebratory cake he was about to give Pat; he has that much dignity, at least. Clark tells Julie that he "cannot wait to tell Dr. Ken about this, he is gonna be so excited." Even Julie isn't naïve enough to be confident of that.
Clark: OK, look, I know our relationship can seem a little bit one-sided, but at the end of the day, he is still my husband. . . . Oh, have you never heard that term, "work husband"?
Julie: You didn't say "work". . .
Clark: I'm sure I said "work". . . That's weird! Anyway, Dr. Ken is a man of medicine, so this is the kind of thing that matters to him. But, more importantly, he is my friend. He's gonna be really proud of me.
Ken enters, giddy about his new step-counting watch.
Clark: Hey Dr. Ken, I passed my boards, I'm a registered nurse now.
Ken: Amazing! (Pointing at his watch.) It knew when I stopped!
So, obviously Ken was paying no attention.
Later, Pat arrives with the "delightful news" that because Ken has just received a third patient complaint ("three strikes"), he will have to attend "physician sensitivity training." Ken is dismayed at having to take what he calls the "bedside manner seminar," which is like "traffic school for doctors." Unsurprisingly, Ken does not like or do well at the first session of this seminar. The next day, he is furious at having suffered through it. Clark eventually confesses to Ken that he filed the complaint. Ken is shocked. Clark says he thought Ken could use some help with how he treats people. Ken assures Clark that he knows how to deal with patients.
Clark: I'm not talking about your bedside manner, I'm talking about your friend-side manner. And I did not know that you were gonna have to go to some seminar or about the whole four strikes thing.
Ken: It's three strikes!
Clark: I'm not a baseball guy!
Ken: It's three strikes, you don't have to be a baseball guy!
Clark: I was home-schooled.
Ken: Where, outer space?
Clark: No, Cooperstown, New York.
Yes, home of the Baseball Hall of Fame. Ken says Clark should have talked to him rather than filing a complaint. Clark says he tried to do that, he always tries, but Ken never listens, he doesn't care, "even when it's something as important as me becoming a registered nurse."
Ken: So I didn't throw you a parade. As a doctor, I have a lot on my plate. I may not pay attention to every little thing you say, but one thing I would never do. . . is sell out a friend. Damona, I want a new nurse. Preferably one who's not a rat.
Clark: Well, that works out great for me, because I want a new doctor, preferably one who treats his nurse like a human being!
They stalk off. Later, we see two white-coated male physicians are lined up across from two scrubs-clad male nurses. Damona introduces them, unenthusiastically.
Damona: Dr. Ken, this is your nurse Rick, Dr. Sawyer, this is your nurse Clark, have fun.
The nurse-physician pairs shake hands, then hug, then kiss, with Clark and Ken goading each other to ever more intimate expressions of affection for their new partners. Later, Julie pressures Damona to get Ken and Clark back together. So Damona gives Clark a sheet of paper, reminding him of when he "asked Dr. Ken to write you a recommendation for the RN program."
Clark (reading the sheet out loud): "Clark Beavers is not only the best doctor's assistant I've ever worked with, he's also one of the finest people I've ever known. Knowledgeable and eager to learn, he will be a shining asset to your program and a magnificent registered nurse."
Clark leaves in tears. Julie can't believe Dr. Ken wrote "all those beautiful words."
Damona says: "He didn't, I wrote it, he signed it."
Later, Ken's wife Allison and their kids are having dinner with Ken's stone-faced parents, while Ken remains in the sensitivity training. Allison has long felt that Ken's parents don't really like her, and now she finally loses it and confronts them. She suggests that maybe
they think she's not good enough for Ken, the golden boy, the successful physician. Ken's parents assure Allison that sometimes they doubt Ken is good enough for her. His mom says Ken is "very arrogant about being doctor," and his dad notes that he starts many sentences
with, "As a doctor. . . "
Back in sensitivity training, Ken is playing the role of a nurse, as a female physician examines a pretend patient, who is also role-played by a physician. The physician-physician says, gently: "OK, patient, you're going to feel a little pressure as I remove the tube." Then she screams at Ken: "Nurse, get me a cold compress!" Ken: "OK, you don't have to yell." The female physician turns to the instructor: "OK, why is he talking? He's just a nurse." Instructor: "Well, nurses have feelings too." The physician laughs, as do others in the room. But Ken stays in role: "Hey, I've been by your side for 8 years, I'm more than just your nurse, I'm your. . . friend. [Having a revelation.] Clark Beavers is my friend." Ken turns to go, and when the instructor asks where, Ken says: "To be a better man." The instructor announces: "And there it is!"--meaning his work with Ken has been successful. People clap. This suggests that the scenario was designed to help Ken empathize with a disrespected nurse; maybe everyone in the room knows this is the wrong way to treat nurses. But the other two physicians look confused, suggesting they were not in on this plan--they were acting naturally and really do have no respect for nurses.
Ken goes to Clark.
Ken: I know your middle name is Leslie. I know your birthday is February 29, so you like telling people that you're 10. I know you've been studying for your nursing boards since last summer. I know you were always picked last for kickball. And most of all, I know and appreciate all you do for me.
Clark: Dr. Ken, make me the happiest man alive. Reinstate me as your nurse.
Julie blurts, "Say yes!"
Ken does, and he and Clark hug. Just then, Clark's replacement nurse Rick enters. Rick informs "Dr. Park" that "your patient in exam room B is bleeding from the--"
Clark: "Dr. Ken already has a nurse. Good day."
Rick: "But he's bleeding--"
Clark: "I said good day, sir!"
The other nurse leaves, baffled. Clark asks Ken whether Damona told Ken all those things Ken just said about him. Damona says "not the kickball thing"; Ken admits that just felt like a pretty safe guess. Clark admits that he is not athletic. Ken agrees he is not.
Everyone is happy. Ken and Clark leave the room together, and only then remember the patient in exam room B, which they run toward.
The world and his work husband
This episode has many problems, but let's start with the good parts. Highlighting physician mistreatment of nurses is helpful, since that is a major factor in nursing burnout and turnover, and it endangers patients, who cannot get their best advocacy or other care from an abused nurse. Nurses should get respect from physicians, and the episode does suggest that at least to some extent in showing Ken that he should treat Clark as his "friend."
But nurses are not just physicians' "friends," or emotionally dependent work spouses, or faithful dogs. This episode's basic problem is the huge disrespect for nursing as a skilled, autonomous profession. With regard to skills, the terms "nurse" and "medical assistant" are not interchangeable. Was Clark supposed to be "medical assistant," or a licensed practical nurse (LPN)? Does the show know or care what the difference is? Medical assistants have roughly six-twelve weeks of health training, and LPNs about a year. It takes at least three years of college-level training to become an RN, and we doubt any RN in the United States would accept the same compensation as a medical assistant or LPN after all that additional work. In addition, a nurse's pride in becoming an RN should not depend on whether a physician approves. Nor would a physician be the most obvious choice for a recommendation for an RN "program"; instead, that would be Clark's nursing supervisor. As far as nurses' clinical practice, it does not consist of gawking at physicians as they work, fetching things, and reporting obvious external bleeding without actually doing something about it.
With regard to nursing autonomy, the episode clearly suggests that nurses depend on and belong to physicians. Clark is essentially an appendage and/or subordinate work spouse to Ken, if not something like Ken's dog. Consider Clark's slip about Ken being his "husband," Clark's request to be reinstated that is meant to echo a marriage proposal, Clark's worship of and obsession with Ken, Clark's willingness to endure emotional neglect at least up to a point, and the show's repeated references to "my nurse" and "your nurse," as if physicians own nurses and nurses work for them, not patients. Ken asks Damona to arrange the initial personnel change, but it seems clear that Ken has ultimate authority over nurse staffing. As the ABC website helpfully notes, Clark is Ken's "faithful nurse" and one of his "support staff." Of course, being faithful is a good quality in general, but in this context it fits perfectly with the unskilled angel stereotype of nursing, in which nurses are more notable for their spiritual merit than their skill or knowledge. Yes, there is that recommendation letter, but its statement about Clark being a knowledgeable "medical assistant" doesn't mean much when we never see him display any health knowledge.
The sensitivity training scene also sends some unhelpful messages about nursing autonomy and physician abuse, although it is ambiguous. On the surface, we are being urged to laugh at the role-playing female physician abusing the "nurse," as well as her apparent views that nurses are not allowed to speak and that they lack feelings. This interaction does bring out empathy for nurses in Ken, who realizes Clark is his "friend" and rushes off to reconcile with him. When the instructor claims credit for Ken's reaction, it seems that perhaps the whole thing was simply designed to achieve that goal, and maybe no one else in the room really agrees with the views the show has just asked viewers to laugh at. However, the other physicians seem baffled at Ken's reactions, as if they really did hold the anti-nurse views on display. And perhaps that's why they are in physician sensitivity training. But suggesting that such abusive conduct is funny--when in the real world it causes so much harm to nurses and patients alike--is troubling. The show calls Ken on his arrogance generally and his insensitivity to Clark in particular. But that doesn't show that nurses are autonomous professionals; treating them with respect seems to be a matter of physician discretion. Note that Clark had to submit his complaint by pretending to be a patient; maybe it matters how physicians treat patients, but nurses, whatevs.
There are also troubling gender and sexual issues. (We discuss this in greater detail in Chapter 6 of Saving Lives: Why the Media's Portrayal of Nursing Puts Us All at Risk). The prostitution comparison is a problem, although again it is ambiguous. Of course it's not great to compare nurses to sex workers. That's not just because most of the public does not view prostitution as a moral, skilled, or important profession--it's not legal in most places--but also because of the naughty nurse stereotype. Clark is obviously being ironic, no one thinks he's a sex worker, and he does not fit the standard naughty nurse image. In fact, he may well be suggesting that nurses are oppressed and marginalized in somewhat the same way sex workers are, in part based on gender stereotyping. But it seems unlikely many viewers are going to get that far into it; they'll just note the casual comparison of nurses to sex workers and move on. Yet serious comparisons have been made between nursing and prostitution, for example by Dame Helen Mirren in a 2010 talk show appearance; indeed, nurses in some nations are reportedly seen as doing work akin to sex work and they suffer greatly as a result, even in their personal lives.
Clark's own gender presentation is also a problem. His apparent sexual orientation and the fact that he does not fit traditional models of masculinity (being unathletic and so on) are stereotypes about men in nursing, and Clark's full name is apparently "Clark Leslie Beavers," a bit of homophobic smirking that reminds us of the "Gaylord 'Greg' Focker" character in Meet the Parents. However, those elements would not be major issues if Clark's clinical conduct was different. Greg Focker was, despite his misadventures, a strong, skilled nurse who eventually gained a position of clinical authority. But Clark seems needy, dependent, and submissive in his professional work, and particularly in his relations with Ken. The Clark character suggests that men in nursing are weak pleaders looking for a male physician to possess and dominate them.
Please join us in asking the producers of Dr. Ken to do better with Clark. Of course the character couldn't be helpful to nursing without drastic changes, but short of that, the show could still avoid suggesting that nurses are unskilled handmaidens who each belong to a special physician. That matters because research shows that popular media portrayals have a real effect on how decision-makers and members of the public view nurses. And a profession that gets as little respect as nursing does in this episode will have a hard time competing for scarce health resources. The result is an underempowered profession unable to save lives it otherwise could.