What TV medical shows get right – and wrong

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In the translation to television, Kay has surely had to make concessions that depart from a truly realistic depiction of an NHS hospital in the present day – or at least, his own experience. Unlike the book, which is written in fragmentary diary entries spanning many months, Kay’s experiences are woven together into episode-long arcs. The anecdote-and-punchline style of the book is gone, and therefore different patients are glued into single people. Notably, too, some of the book’s sharpest doctor-humour has been toned down for mainstream television. Not much – it’s still very rude – but a little.

Missing nihilism

Kay is of course not the only doctor who has adapted their medical experience for the screen. I asked the screenwriter Dan Sefton, a still-practising doctor, how he translates what he knows about medicine into fiction. He doesn’t write memoir like Kay, but as a TV writer and co-founder of the production company Seven Seas, he has occasionally weaved his lived experience into various UK medical dramas, including The Good Karma Hospital, Trust Me, and episodes of Casualty, Doctors and Holby City.

What does he think is missing from hospital drama? His answer surprised me, because it had little to do with issues like medical accuracy or professionalism.

“The experiences that have stuck with me most profoundly as a doctor is the sheer nihilistic pointlessness and unfairness of it. That there is no reason, no meaning, for why somebody gets sick and dies,” he explains. “If you tried to portray the reality of it, the cold reality, nobody would want to see it.”

Most medical dramas, he continues, offer an antidote to that bleakness of real life. “They’re trying to make even death seem meaningful. The ones that are successful, or at least, the emotionally warm ones, are about making sense of these painful experiences and trying to build them into a narrative.

Daniela Lamas, a doctor and screenwriter, reached similar conclusions when she wrote for the US series The Resident.At first I worried that I made the televised version misleading,” she recalled in the New York Times. “But the authentic core of uncertainty – how we balance risk and benefit and the great complexity in making decisions about allocating a limited resource – is still there. And I like believing in an alternate reality where my patient might have lived. This was the world we had hoped for. And in the writer’s room we were able to make that world come to life.

“Television finds a way to offer enough reality to teach and to provoke, but also offers a balance. Viewers can come close to the fire but they are not scorched.”

Sefton also points out that audiences come to mainstream medical dramas with certain expectations of doctors, which can influence the characters that writers choose to create or not. For example, it’s rarer to see a fictional doctor or nurse who is not seeking to heal. Even House, for all his anti-hero flaws, was trying to save people’s lives. “The idea that your doctor is not a selfless sort of saint, who’s got your best interest at heart all the time and who goes home worrying about you…that’s quite disturbing,” says Sefton. “I think people find the idea of doctors not being perfect really very threatening.”

Despite this, Sefton wonders whether, post-Covid, there may now be space for more nuanced depictions of hospital life, like This is Going To Hurt. The pandemic, he suggests, has also opened a lot of people’s eyes to the pressures on health systems like the NHS. “The truth about the NHS is that it is a poorly-funded adequate health service, from a global perspective,” he says. It’s neither the best health provision in the world, nor the worst. “The sad truth is somewhere in the middle: extremely good value, kept going by lots of hard work by some dedicated people.”

The pandemic’s impact on US hospitals already seems to be feeding into the plotlines of American medical drama. A recent scientific study of 60 episodes of The Good Doctor, Grey’s Anatomy, Chicago Med, The Resident and New Amsterdam aired between November 2020 and May 2021 found that half (35 episodes) included the pandemic or its consequences in their narratives. “The medical dramas all focus on the psychological effects of the pandemic in health care workers, showing their exhaustion, anxiety, anger, and fear,” writes Irene Cambra-Badii of the University of Vic, Central University of Catalonia and colleagues. While acknowledging that these series contain factual inaccuracies, the researchers conclude that showing such psychological hardship could be helpful for educating medical students and the public about the realities of treating Covid-19 inside US hospitals.

Ultimately what matters to Sefton when he writes medical drama is stories that are emotionally truthful. The question of whether medicine itself is accurately depicted is a distraction.

“If you’re looking for good medical advice from medical shows, then I think you’re delusional,” he says. The best medical drama is authentic in a different way: “They’re all stories about life, death, the risk of it, or love. Very simple profound things. That’s why people watch it. They don’t watch it for health information.”

This is Going to Hurt is available now on BBC iPlayer in the UK and will be premiere in the US on AMC soon.

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