Marcus Welby, MD was a popular medical drama airing on ABC from September 1969 through May 1976. In March 1969 a made for TV movie introduced the characters of Marcus Welby MD, played by Robert Young (of “Father Knows Best" fame) and Stephen Kiley MD, portrayed by James Brolin. Welby is a crusty but golden hearted general practitioner forced by a mild coronary (myocardial infarction) to take on a new assistant. Kiley is his long haired, motor cycle riding younger partner.
(ref allmovie)
This series followed the basic pattern of medical drama; the older physician mentor guiding and teaching the younger. But, unlike similar series made at about the same time, the medical action was not necessarily in the hospital, but rather in the doctor’s office. And instead of dealing with acute medical problems, Welby dealt consistently with long-term medical problems that were tied directly to the patient's psyche and interpersonal behavior. Acute episodes of the difficulty often sparked movement toward a cure, but only after Welby or Kiley uncovered the root causes of the behavioral problems.
(ref Turow Museum of Broadcast Communication)
Marcus Welby MD was very popular during its run; acheiving #1 in the Nielsen’s in its second season. It was less popular with some physicians who felt that the fictional Welby raised the expectations of the public to levels unreachable by actual doctors.
So, what's wrong with this picture? (above)
Look at the x-ray Drs Welby and Kiley and are examining?
As you can tell from the direction of the ribs, the film is upside down. If you noticed that the film is upside down, then perhaps you also identified what kind of study this is.
Here is a detail of this same picture; right side up, flipped and enlarged a bit.
Now can you tell what this is?
This is an oral cholecystogram (OCG).
This film shows a well opacified gallbladder with a few radio opaque stones.
The technique of imaging the gallbladder using iodine containing dyes taken up by the liver and excreted into the bile was introduced in 1923. The first cholecystograms used dyes delivered intravenously. Over the next several years different methods of delivering the dye were explored. The rectal route was felt to be less reliable, not to mention uncomfortable. By the late 1920's the oral route was determined to be the preferred method. The method of performing the test remains little changed over the approximately 50 years that this test was used to diagnose gallstones. A day or two before the exam, the patient is instructed to take a number of iodine containing pills. The patient is asked to be NPO on the day of the exam. The examination involves taking one or more abdominal films looking for presence or absence of gallbladder opacification and the the presence or absence of filling defects in the gallbladder. In the days before fiberoptic endoscopy, an UGI with OCG was the usual work-up for patients presenting with RUQ and/or epigastric pain.
How accurate is this test? Here is an excerpt from the 7th edition of Harrison's Principles of Internal Medicine, 1974 -
Although only one in five gallstones contains enough calcium to be visible on plain abdominal films, oral cholecystography identifes 70 percent of all gallstones. In an additional 20-28%, non-visualtization of the gallbladder is presumptive evidence of disease.... The overall accuracy of oral cholescytography, proved in the operating room, is 90-98%. Only 3% of nonfunctioning gallbladders are normal at operation, and less than 2% of gallbladders, normal by cholecystogram, contain stones..... Despite its value in detecting gallbladder disease, oral cholecystography yields little information about the hepatic ductal system.
Not too bad - if all you want to know is whether or not your patient has gallstones. This test is still performed in some places, but it has been largely replaced by ultrasonography
