His "Scrubs" Story
A NextGen Free Standing Perspective Article
Countless medical and pre-medical students ask themselves, "What is it like to be a doctor?" They inevitably seek input from as many sources as possible: parents, friends, books, interviews, career counselors, etc. But there is another source to which many will turn that isn't as obvious: television. With a surge of interest in medically related television programs like NBC's "Scrubs," * more and more people are getting their information about the medical profession from mass media. To get a look at what goes into the "medicine behind the show," we spoke with Dr. Jonathan Doris, one of the Medical Advisors for NBC's "Scrubs" and the namesake for the series' main character J.D. (John Dorian, played by Zach Braff).
His Experiences
Dr. Doris (or "real J.D.", as the cast and crew of the show fondly refer to him), an MD from Albany Medical College and currently the assistant director for the Los Angeles Medical Center's Electrophysiology fellowship, is good friends with the show's creator, Bill Lawrence. He recounts how Lawrence came up with the idea for the show: "Bill and I were college buddies, and he would always listen to these crazy stories I would tell him through medical school and residency. Towards the end of my internal medicine residency [at Brown], he contacted me and told me that he'd been keeping all these stories and wanted to make a show about it."
Did Dr. Doris sense the brilliance of the idea? With a hint of amusement, he recalls his early skepticism: "We sat down and went through a bunch of first day jitter stories, and he went off and wrote it, and I just thought the whole time, 'Bill, no one's going to think this is funny, and you're going to scare people away from hospitals!'" Through the filter of Lawrence's head, however, these stories soon became the grounding for one of today's most popular and funniest television shows.
Despite his initial skepticism, today Dr. Doris—along with his wife Dr. Dolly Klock—plays an active role helping to establish medical contexts for the shows' stories: "If the writers have an idea—if they want there to be some ethical concern or some diagnostic dilemma or they want there to be a surgical versus medical dilemma, we then come up with some sort of reasonable medical plotline." Of course, because the show is fundamentally a comedy, medical reality is sometimes tweaked for the purpose of the show: "Everyone expects the comedy to come first. Bill and I always argue, and he ultimately always wins...If something isn't medically accurate, he'll say that 'the fake way is funnier' and ultimately that has to take precedence."
So, while even the most enthusiastic fan probably won't be able to pass any medical licensing exam just by watching the show, Dr. Doris maintains that the show does, in its own quirky way, communicate some of the essential emotional experiences of medical training. "Bill is such a comic genius in that he's able to extract what is universally funny. The show, and especially the pilot, expresses the anxiety that comes with being an intern, the sudden change in expectations from nobody expecting anything from you as a fourth-year medical student on June 30th and everybody suddenly expecting you to know the answer as an intern on July 1st. The show really captures that well and really captures the humor that stems from those situations."
His Colleagues
In addition to detailing the personal jitters of new doctors, the show presents the importance of the personal relationships one makes during medical training. Regarding the genesis of Dr. Cox (played by John C. McGinley), the overbearing mentor-figure, Dr. Doris comments, "I think that the Dr. Cox figure is an amalgamation of many different personalities drawn from my personal experiences and that of many other doctors. I think that through training, we've all had that type of character, that mentor or ball-buster who you love and hate at the same time...who is a great doctor, someone to look up to, who knows the ins-and-outs of the system, and who has a realistic perspective of what goes on."
The relationships between doctors and nurses also features prominently, via characters such as nurse Carla Espinosa (played by Judy Reyes). When asked about these symbiotic relationships, Dr. Doris explains, "When you're an intern on your first day, you'll be looking for someone to give you the answer. Sometimes, these nurses have been there for years and years and have diapered and babied many interns through many tough situations. When push comes to shove, on that first code or that first night of call, you love it when there is a great nurse who knows what to do, and even though it's her job to ask you for advice, she does it in such way that gives you the answer in the question so that you can get through it."
These ad hoc support networks for new doctors are particularly important given the difficult and tumultuous nature of residency. Dr. Doris notes, "it's just a very difficult time, emotionally and physically and mentally, and no matter how many caps you put on or hour limitations you use, it's still a really unique experience that no other profession can really relate to. We had callrooms that were co-ed. I can't think of any other profession which asks a new hire to sleep in the same room with a coworker every third night!" For all of its tweaking of reality in the name of comedy, at its core "Scrubs" still details the relationships and emotions of people tied together during this very difficult time. It's natural, Dr. Doris maintains, for interns and residents to "develop very positive and very negative feelings for fellow interns and residents, for some nurses, for some attendings, and even for some janitorial staff and cafeteria workers. It's a tough time involving a lot of emotions, and I think that Bill and the writers were able to capture a lot of that, which is why I get a lot of feedback from people who say that even though it's a comedy, it's the most realistic show."
His Life Lessons
When asked about his favorite episode, he refers to the first season episode, "My Old Lady." In the episode, the three intern protagonists JD, Turk (played by Donald Faison), and Elliot (played by Sarah Chalke) are faced with three patients, each of whom they develop a close personal tie with. Unfortunately, all three patients die, leaving the protagonists to deal with their deaths. JD's patient is an old, charming woman, who reacts to being confronted with death in a way that completely shocks JD. Dr. Doris relays, "One particular scene that was one of my favorites was the JD character trying to talk his patient into a life-saving therapy, which happened to be hemodialysis [being connected to a kidney machine]. What was absolutely shocking for him was her refusing treatment, her being okay with the idea of her death and with the end of life, and with not doing something. We watched him try to come to terms with that, and this let us touch upon the idea that, as doctors, just because we can do something, doesn't mean that we should do something."
Given Dr. Doris's chance to re-explore his formative years of medical training through his work with the show, we asked him if it gave him any fresh perspectives on medical training or how to improve it. He replies, "There's no better teacher than direct patient care and direct experience, because you never forget patients that you've treated. You might forget their name, or what they look like, but you never forget the diagnoses because you're so personally involved in them. So I think that while the apprenticeship of residency is important and could never be replaced by hands-off learning, the terrible hours that are historically associated with residency and internship are things that can be overcome, and we're working towards that with work hour restrictions, mandatory sleep, and other things like that."
In particular, he speaks about efforts being made by Los Angeles Medical Center, among other major medical center, to implement new technologies as a training aid: "Many centers are developing simulation labs to aid in medical training. The idea is that before a student has ever touched a patient, they have to have demonstrated proficiency in a simulator. It's a nice place for your senior resident or upper-level fellow to show you how to do certain things, to tell you not to do certain things, as opposed to trying to whisper under their breath so that the patient doesn't hear it that he or she is your first one." Other technologies include electronic medical records to reduce errors from resident fatigue due to "a resident thinking of one patient when they were treating another or being completely psychotic because they hadn't slept in 36 hours and just wrote something completely insane."
Of course, Dr. Doris notes, "No matter how technology improves or aids in resident education, there will never be a substitute for patient care, learning how to interact with patients and how to feel comfortable with treating patients...It's those first times that really count and that define and shape someone's medical training—the first time you see someone bleed out from a GI bleed or the first time you see someone code during an MI—those things never leave your brain. They never leave your mind, and there's just no substitute for it."
When asked if he had any advice for the next generation of doctors, Dr. Doris emphasized, "Be confident that your medical school education has prepared you. It's universal that you start that first day thinking 'my medical school let me down, I didn't do enough of central lines, or I didn't do enough lumbar punctures, I'm not ready for this!' But believe me that you are ready, and you are prepared. Of course, don't be afraid to say 'I don't know' and don't be afraid to ask for help, especially of your fellow interns. But most of all, just hold on for the ride of your life!" 
Benjamin Tseng is a writer for the Next Generation and a member of the Harvard Class of 2007.
Jonathan Doris, MD is the assistant director for the Los Angeles Medical Center's Electrophysiology fellowship and a medical advisor for "Scrubs."
Disclaimer
* "Scrubs" and its characters are copyright Touchstone Television and broadcast by NBC.