TV Drama Medical Advisers: Accuracy, Plot, and Artistic Licence

Dr Rob Hicks MBBS DRCOG MRCGP

Disclosures

September 27, 2018

Like them or loathe them TV medical dramas have been around for almost as long as the NHS. Consistently pulling in millions of viewers, they reliably contribute to chatter in cafes and pubs, magazine and newspaper gossip columns, and trigger shouts of 'rubbish' in doctors' messes and GP practice staff rooms around the country. 

   

Dr Rob Hicks

But what if you're someone with a foot in both camps – a TV drama medical adviser? How can you make sure that what the viewer sees is an accurate portrayal of what they can expect as a patient? How can you try and help achieve the level of entertainment that keeps them coming back for more? In healthcare we talk a lot about achieving an acceptable work-life balance. In TV medical dramas the challenge is to achieve an acceptable entertainment-reality balance.

Getting Involved

I've been a medical adviser to the BBC1 general practice based medical drama Doctors for nearly 20 years. It was a case of a 'friend of a friend', who was the programme's researcher, getting in touch with me and asking if I was interested in being their medical adviser. 

For me it was a chance opportunity, as it was for Dr Dan O'Carroll, emergency medicine consultant at Walsall Manor Hospital, and a medical adviser for BBC1's Casualty. "It was a spur of the moment decision", he says, "I happened upon a post on doctors.net website asking for expressions of interest. I put my name forward and went down and met the production team and thought that I'd give it a go".

Dr Martin Scurr, medical consultant to ITV's Doc Martin programme was approached by the original writer to see if he'd be interested in getting involved. "My contribution was to give him [the writer] a series of anecdotes describing occasional events in my practice – choosing hilarious or unexpected or amusing consultations", says Dr Scurr.
 

Lessons Learned

For TV drama medical advisers there's a common theme. Producers want the unusual, not the mundane everyday stuff.

"The [production] team is always seeking a crisis of one sort or another, or a clever wizard diagnosis that Doc Martin can make", says Dr Scurr. The team, he says, loves these high drama interventions.

And viewer figures, and the longevity of medical dramas, confirms that the public does too.

At my initial meeting with the Doctors series producer and researcher I was asked about the sort of medical problems I saw in general practice. As I enthusiastically told them about sore throats, blocked ears, irritating rashes, and the like, I saw the will to live drain from their faces. Clearly I had no understanding about what makes good TV viewing.

So my first lesson was – what's common in real-life – a patient with a viral URTI, for example, is uncommon on TV, and vice versa. My second lesson, if it can happen in real-life – a woman giving birth in a lift, or anywhere outside of her own home or the labour ward, for instance - then it's certainly going to happen, and quite often, on TV.

Dr Martin Scurr agrees: "Doc Martin never really sees any of the mundane routine episodes of general practice which, anyway, will hardly make good television."
 

Unrealistic Expectations

"Sometimes writers have unrealistic expectations of what we can do in terms of the medical storyline to facilitate the character's journeys", Dr O'Carroll points out, adding, "this can result in being in medical scenarios that don't always reflect modern emergency medicine".

As time passed I learned and understood more about how TV worked, what was needed, and how to accommodate the needs of a programme without misinforming the public. I rapidly learned that saying "No, that can't happen", and instead saying, "No, that can't happen, but this can", thereby offering up a solution, meant everyone was happy, at least, usually. For example, take the popular TV notion that a patient with a non-urgent problem is seen by their GP at 10am, referred, seen, investigated (often with scans, various dye-tests, and even laparoscopy), and diagnosed, by a hospital consultant at lunchtime, and returns to see their GP before 2pm to inform them of their recently acquired diagnosis and get treatment. Solution - change the story a little so the patient is seeing their GP because they are not entirely clear what is meant in the letter they've received from the consultant. The end point is the same – desired entertainment achieved whilst remaining true to real life – everyone happy, and for me a better chance of a good night's sleep.

It's not unlike treating a patient really – you want them to lose weight to try and avoid future ill health. They may want to lose weight for their own personal non-health related reasons. So you find some common ground, agree on a process, and hopefully it's win-win.
 

Standing Firm

However, there are times when as a medical adviser you have to stand your ground. "Another difficulty is when the director wants a particular scene conducted in a particular way and yet it looks unrealistic", says Dr Scurr. "I have to persuade him to make it look realistic."

I know from my own experience that some things have an irritating habit of repeatedly cropping up – getting results of investigations in land-speed record breaking time, rare as hen's teeth diagnoses being made with only a few answers from a patient and without a physical examination, any investigations, or a specialist opinion, home visits to "drop off a patient information leaflet", and doctors who overnight become qualified in an additional specialty, as a psychotherapist or forensic medical expert, for instance. Hence the 'super-doc' role – criticised by fellow healthcare professionals, and expected by the public. 

When these situations raise their ugly heads the answer is to stand firm, but once again to come to a mutually acceptable solution – so in the case of the 'information leaflet drop' rather than this be a specific trip, let the GP be on their way somewhere, to a CCG meeting, on their way home, or to the pub!

"I do feel that medical dramas can give people unrealistic expectation of what we can achieve in medicine", says Dr O'Carroll. He cites cardiac arrests, commenting how "TV doesn't capture how infrequently we have successful outcomes".

But as Dr O'Carroll points out, "Ultimately, it [Casualty] is a TV show, not a documentary". Although every effort is made to make it realistic, he says he's happy for artistic licence to be used to ensure the programme remains a top rated show.
 

Not Public Information Films

Dr Scurr highlights that his programme, Doc Martin, "is a light evening comedy, not a YouTube video for teaching junior doctors".

Medical dramas are not public information programmes, though responsibly produced they can fulfil this role too.

"Everything that happens has to be realistic and realistically enacted, because there is evidence that the public draw on what they see", says Dr Scurr. That's been my own experience with Doctors too. For example, having watched one of our episodes a patient with a 'smoker's cough' asked about – and was subsequently diagnosed with – COPD. Charities often report an increased number of calls to their helplines after a medical drama has featured their area of support.
 

Why Do It?

"It's an interesting sideline", comments Dr O'Carroll, "and has given me the opportunity to mix and meet with exceptionally talented people that are completely detached from my day job".

For Dr Scurr it's the enjoyment of "thinking of the endless scenarios, and eventually seeing them translated into a film, and working with a team of top professionals".

Dr O'Carroll emphasises "With ever increasing pressure within the NHS, development of side interests/portfolio career options is growing increasingly important".

For me it's an opportunity to do something I had never thought about doing. It helps keep me up to date, and I hope has helped me better understand my patients' needs and to communicate more effectively with them. It's also a constant reminder that it's not only doctors who work hard. It's great fun too! 
 

Comments

3090D553-9492-4563-8681-AD288FA52ACE
Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.
Post as:

processing....