I presented on Harlequin medical romances at the PCA meeting. Here’s the paper in Gifs. Don’t hit the jump unless you don’t mind gifs, have a fast connection, and are prepared to wait for all the gifs to load.
Bioethicists have gotten interested in all kinds of narratives, including fictional ones. But genre fiction tends to be overlooked in favor of an emerging canon of Literary Novels of Bioethical Significance.
Some bioethicists look at commercial fictional narratives to show how they misinform their uneducated lay readership…
…or stoke anxieties that trained bioethicists can allay with public health education…
Those are all important aims, but I think it’s possible to view commercial fiction as actually participating, however indirectly, in bioethical conversation. If movies like Contagion tells us about the anxieties of the age, maybe medical romances tell us something about its ideals. It can offer a snapshot of socially salient views of medicine that, despite being “niche” (the group that reads medical romances in the UK and the US is demographically narrow, as far as I can tell), interacts in interesting ways with more widely disseminated images.
My paper focuses on the sixteen books in the Penhally Bay series. I make some broader claims, but the main thesis is limited to those sixteen books.
The Penhally Bay series was written in the first decade of the 21st century, a time when organized medicine was having a lot of internal debates about what “professionalism” means. Organized medicine perceives a number of threats to medical professionalism, among them commercialism, third party interference, conflicts of interest, loss of trust, less autonomy, and inappropriate dancing:
In response, organized medicine, represented by a wide array of global partners, including national medical organizations, specialty groups, accrediting bodies, and private companies, launched a coordinated and comprehensive professionalism project.
The professionalism project emphasizes old fashioned values of altruism, compassion, and integrity. It focuses on individuals, and on maintaining continuity with a perceived tradition of medical professionalism dating back 200 years. Medical sociologists, identifying a number of competing accounts of medical professionalism, identify this as “nostalgic professionalism”.
I think that the Penhally Bay series presents a version of medical professionalism closely aligned with nostalgic professionalism in several ways:
1. Technical mastery; medicine as possessing a discrete, highly specialized body of social knowledge that occupies a uniquely important social position. Doctors restore health and save lives.
2. Altruism: Doctors are not in it for the prestige or money. They are supremely hard working, always on behalf of patients.
3. Doctors have an integrity that helps them withstand threats to professionalism. They don’t sweat pesky lawsuits, third party payers, commercialism, Dr. Google, or any of that stuff:
4. If there are injustices in society, medicine is positioned outside of them. Medicine is not implicated in these: it can help. I imagine this would be the reaction of the doctors in Penhally Bay if someone actually named organized medicine as part of the problem:
5. The technical mastery medicine requires is nothing without emotional intelligence. These doctors are caring, compassionate, and empathetic. When their patients suffer, they suffer.
The medical romance series, at least as much as, but probably more than most other subgenres of romance, presents protagonists who are really good people. Since medical romances are workplace romances, it helps to have the hero and heroine work in a profession that requires excellent people skills, a high level of emotional intelligence, and that maintains a fairly high level of social status and approval. A number of the qualities that make for good doctors in the Penhally Bay series also make good romantic partners.
Although other scholars have written that medical romances are basically propaganda for the NHS, I detected some critique of the NHS, and also of medicine more broadly. I describe this critique as a counternarrative, or at least a minor counterpoint to the main narrative of nostalgic professionalism. Here are three of the counterpoint narratives I detected in the texts:
6. The texts go to great lengths to portray the doctors are hard working, not just because they want to, but because they have to. They are always understaffed and underfunded. Why? If they are so effective in their work, and so badly needed by their community, why aren’t they being funded properly?
7. Organized medicine is a hierarchy with the more specialized doctors at the top and general practitioners at the bottom. They are paid more, have more power when it comes to individual patients and hospital policy, and demand, and get, more social esteem. Not in Penhally Bay, where the skills of the GP reign supreme.
(That gif doesn’t fit. I just wanted to use it.)
8. Nostalgic professionalism focuses primarily on individual integrity to solve the professionalism crisis, tending to underemphasize the importance of the medical and social environment. Penhally Bay, set in a close knit rural community, is almost another character. The books emphasize the role of community in good doctoring. Our environment, natural, built, and social, partly makes us who we are:
9. This is the reaction I was hoping for from the audience:
10. Instead I got this:
11. And this from one lady in the back:
12. Seriously, nobody made fun of romance, although I was ready:
The conference was fun and educational, as always. Chicago is great. The people attending the con were great, as always. And now I’m back home and back to life.
Thanks for reading. Gif free blogging to come later this week.