The Doctor (1991) and Laryngeal Cancer

Jack MacKee is a brilliant, armoured heart surgeon who teaches his residents that caring about patients gets in the way. He develops a persistent cough, then coughs blood. A tumour is found on his larynx, the voice box in his throat.

He becomes a patient in his own hospital: the forms, the waiting rooms, the gown, the doctor who talks past him. The film has been used in medical education for decades, and the reason is simple. The way he has spoken to patients for twenty years becomes unbearable when it is aimed at him.

Spoilers throughout. Jack's diagnosis and what it does to him are both discussed here.

The larynx is the voice box, so a change in the voice is one of the signs NCI lists for laryngeal cancer.

NCI lists a change or hoarseness in the voice among the signs of laryngeal cancer. If your voice change or hoarseness does not go away, see a doctor rather than waiting it out.

The trap is that a rough voice is easy to live with. People blame shouting, a cold, or getting older. It can feel like an annoyance, not an alarm, and that is how a symptom gets ignored.

NCI names these signs of laryngeal cancer, any of which can also be caused by something harmless:

• A sore throat or a cough that does not go away.
• Trouble or pain when swallowing.
• Ear pain.
• A lump in the neck or throat.
• A change or hoarseness in the voice.

Ear pain may be a surprising item on the list. If you have ear pain that does not go away, tell your doctor about it.

NCI says that using tobacco products and drinking too much alcohol can affect the risk of laryngeal cancer. It also says that smoking and drinking make treatment less effective, and that patients who keep doing both are less likely to be cured and more likely to develop a second tumour.

If you smoke or drink heavily, talk with your care team about help to quit.

The CDC page we checked says screening tests can find breast, cervical, colorectal and lung cancers early. It does not list laryngeal cancer. If you notice a sign, do not wait for a screening test. See a doctor.

Jack's route from symptom to diagnosis is fast and frictionless. He is a senior surgeon in his own hospital. He knows who to call, and he is somebody people call back.

The film is interested in his emotional education, not in that advantage, so it never names it. Most people do not have it. Most people go through a receptionist, a general practitioner, a referral, and a wait.

That gap is worth naming out loud, because it changes what you should do. If your voice has been hoarse and it is not going away, say so explicitly, say how long, and ask what the next step is.

The film shows almost nothing of treatment. NCI says laryngeal cancer treatment can affect speech, swallowing and breathing, depending on the surgery and where the cancer is. None of that is on screen.

His transformation is also faster and tidier than most people's. The humiliations he experiences are real. The clean moral arc that follows them is a screenplay.

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The Doctor is a good film about how doctors talk to people, and a thin one about cancer. It is worth watching for the first thing and not the second.

The medicine underneath it is unusually clear-cut. The CDC does not list a screening test for laryngeal cancer. NCI does list a change or hoarseness in the voice as a sign. A voice change that does not go away is a reason to see a doctor.

• https://www.cancer.gov/types/head-and-neck/patient/adult/laryngeal-treatment-pdq
• https://www.cdc.gov/cancer/prevention/screening.html

This page discusses The Doctor for education. It is not medical advice, and nothing here is a judgement of anyone's real medical care. Spotted an error? Please email corrections@cancerexplained.org.