Dissecting the Sensation

November 13th, 2007

The anatomy of a medical drama

By Mike Berlin

The ABC online plot synopsis of a “Grey’s Anatomy” episode, entitled “It’s the End of the World,” reads: “A trauma victim is brought in by a paramedic with her hand still stuck inside him to stop the bleeding. As Alex soon discovers though, her hand isn’t the only thing inside of him — after trying to make a homemade bazooka, he’s also got a piece of unexploded munitions inside of him,”

“Far-fetched!” you cry? Get this — a Wikipedia recap of a “House” episode entitled “Cane and Abel” reads: “House’s new case is 7-year-old Clancy, a product of in vitro fertilization, who’s been admitted to the hospital with rectal bleeding and proclamations of being tortured by aliens.”

Honestly, I am not cherry picking these plots, nor am I exaggerating the ridiculousness that has befallen current medical dramas. Today’s television doctor is not the wise-with-age, practical, Hippocratic Oath-spewing practitioner of yore, but instead a sexy single trying to find themselves, and love, amidst a treacherous and fast-paced work environment of medical disaster.

Through a television producer’s lens, hospitals manifest some of the most classic elements of drama — environments where life and death are always concerns. But some screenwriters may have run amok, or — as “South Park” coined in a recent episode — “hijacked our imaginations.”
But medical dramas weren’t always like this. Since the 1960s they have been ingrained in our pop culture consciousness and have undergone significant transformations to become the medical spectaculars of today.

1960s: Idyllic Foundations

Many of today’s heroic medical dramas, especially the dominant quartet — “ER,” “Grey’s Anatomy,” “House,” and “Scrubs” — have television roots as deep as the personal and medical quagmires they set out to solve.

Before McSteamy and McDreamy, there were rivals “Dr. Kildare” (NBC) and “Ben Casey” (ABC) from the early 1960s. As pioneers of the genre, both doctors represented idealism amidst the sterile, by-the-book hospital establishments they were practicing in. But both shows also held true to the formulaic inclusion of a mentor, a character placed to ground both characters in the reality of their hardscrabble professions.

Much like Zach Braff’s character on “Scrubs,” Dr. Kildare enters the series as a bright-eyed intern, concerned with making a difference in others’ lives, a common characterization that surfaces throughout many medical dramas. Kevin Goodman writes in the American Medical Association Journal of Ethics, “By far, most medical dramas are set in teaching hospitals, allowing the writers to exploit the rich dramatic potential in the often-difficult transmission of professional knowledge, wisdom and authority between doctors and students, or between senior and junior doctors.”

Kildare’s mentor, Dr. Leonard Gillespie, states in the debut episodes of the series, “Our job is to keep people alive, not to tell them how to live.”
Resentful of this philosophy, Kildare’s attitude sets the stage for many plot conflicts concerning his personal relationships with patients in contrast to the practicality in his own mentor.

Conversely, Ben Casey, a slightly older, brusque surgeon, is presented as shrewd and thorough, displeased by the state of the medical establishment — a self-serving system in his view. This type of characterization echoes in the gruff Dr. Perry Cox from “Scrubs,” whose interactions with his superiors and the hospital board illustrate the bureaucratic aspects of medical practice.

“Ben Casey,” in its time, also generally functioned on a larger level of moral obligation as this analysis from an archive entry on The Museum of Broadcast Communications Web site shows:

“The hospital functioned as a microcosm of the larger society it served… Racial tension, drug addiction, the plight of immigrants, child abuse and euthanasia were a few of the issues treated in [the show].”

Unsurprisingly, these same pressing themes still have their place in many modern medical dramas, especially ones like “Grey’s Anatomy” that portray growing multiculturalism through their racially diverse casting. Shows like “Scrubs” go a step further, even giving significant voice to the plight of nurses and janitors — the unsung heroes of hospital drudgery.

Tragically, as ratings for “Ben Casey” fell in the last season, so did some of the integrity of its plot elements, even incorporating Dr. Casey’s love affair with a woman who had waken up from a coma of 13 years. The show also strayed away from its original format of self-contained episodes to serialized storylines within the last season.

(It should be noted that “General Hospital,” currently the longest-running serial produced in Hollywood, debuted in 1963, possibly contributing to the merge between episodic medical dramas and action packed, love-stricken sagas.)

1970s: A Doctor With Many Hats!

Moving into the mid-1970s, “Quincy, M.E.” gives us the ever-talented doctor/detective. Extremely formulaic, Quincy, as he is known on the show, examines someone who has died, suspects foul play, and investigates — much to the chagrin of his superiors. Quincy appears to be a mere coroner but is mainly preoccupied by the investigative quality of his job, and is able to prove the ever-skeptical police wrong every time.

In the dichotomy of television, “Quincy, M.E.” belongs to a larger family of “procedural” programs. Championed by another major category of drama — police or crime dramas — the procedural television show seeks to identify a mysterious problem and solve it within the span of an episode. Though the formula is loose, there is no lack of inspirational content.

As Quincy pulls out his stethoscope, he also pulls out his magnifying lens, assuring the viewer that the murder mystery will be solved within the span of the episode. This plot structure can also be found in “House,” which focuses on more of the technical aspects of pathology and unorthodox treatments; Dr. Gregory House acts as a crippled, curmudgeonly Sherlock Holmes of weird diseases.

In the aforementioned “House” case of 7-year-old Clancy, his rectal bleeding and alien delusions stem from, well, I’ll let the synopsis do the talking: “House tells the parents that Clancy has chimerism, where there are two sets of DNA in one body — in effect Clancy’s twin brother had merged with him in the womb.”

See! Chimerism is a rare disease, and makes the case that procedural medical shows will never run short of malady material. Take, for instance, the “ripped from the headlines” mantra of shows like “Law & Order” and “CSI.” These programs’ longevity has been made possible by an abundance of real life crime. Similarly, medical dramas treat bulking diagnostic manuals like crime dramas treat newspapers; exotic, deadly diseases are “ripped from the pathology textbooks.”

1980s & 1990s: Realism and Accuracy Go Overboard

In the early 1980s “St. Elsewhere” brought us a new kind of serialized medical drama, as described on The Museum of Broadcast Communications Web site:

“Set in a decaying urban institution, St. Elsewhere… presented a large ensemble cast, a ‘realistic’ visual style, a profusion of interlocking stories and an aggressive tendency to break traditional generic rules. While earlier medical dramas like Dr. Kildare, Ben Casey and Marcus Welby, M.D. featured godlike doctors healing grateful patients, the staff of Boston’s St. Eligius Hospital exhibited a variety of personal problems and their patients often failed to recover.”

By also involving some of the more controversial topics of the times (i.e. becoming the first prime-time series to feature an AIDS patient), “St. Elsewhere” set standards to be outdone. Many name this successful television drama as the predecessor to “ER,” a claim only furthered by its over-the-top final episode in which it turns out that the five-and-a-half year series was all just the imagination of an autistic child. (“Farfetched! Farfetched!” We’re getting there…)

The mid-1990s came with scalpels and doctoral jargon a-blazing in “ER,” a flagship turning point of the modern medical drama. With a strong ensemble cast, “ER” — created by Michael Crichton (“Jurassic Park”) — focused on medical accuracy, utilizing several specialists, doctors and medical consultants in the writing process. The fast-paced, sometimes handheld camerawork contributes to “ER’s” sense of urgency, as the viewer is many times power-walking with Dr. So-And-So — the cast has gone through many revisions in the shows ongoing 13-year run — to reach the ICU in time.

But, true to form with television history, “ER” has undoubtedly jumped the shark, a disease that no decade-long serialized drama is immune to. A recent example that comes to mind from a 10th season episode entitled “Free Fall” (TV.com Web site): “A helicopter crashes on the roof, falling into the ambulance bay where it lands on Romano and causes a huge explosion,” In. The. Hospital.

(“Farfetched, farfetched!”)

Today: “I need 20 CC’s of explosives and condoms — STAT!”

While each individual medical drama may have its tendencies toward certain aspects of characterization — the quirky romantic-comedy of “Scrubs” and the smoldering sexual tension of Grey’s contrasted with the helicopter explosions of “ER” contrasted with the detective work on “House” — each also seems to defy the laws of, well, medical practice in their own little way.

It’s hard to blame these shows for trying to pack as much drama as possible amidst a modern television culture saturated with increasingly graphic renderings of violence and sex. But one can see the evolution of medical dramas taking a more sensationalist approach, especially today. Despite the wealth of pathological content available, shows’ plot twists are still explosive, but more in a physical sense now.

Additionally, some shows, like “Grey’s Anatomy” and its fledgling spin-off series “Private Practice,” verge on soap opera, making sure to feature each characters’ emotional confessions to the soft backing vocals of whatever popular acoustic indie band is in vogue. Another TV.com summary of the “Private Practice” episode “In Which Sam Gets Taken for a Ride,” illustrates this point: “While Sam answers a dangerous house call, love or at least sex is in the air at Oceanside Wellness, as Pete and Addison decide to take their relationship to the next level.”

“Oceanside Wellness”…doesn’t that just radiate daytime television?

Flowery names aside, is there any harm in embellishing the personal lives of today’s practitioners, or peppering their day-to-day work with more of the same blood and gore that we get from shows like “24”? Does this actually affect the way we perceive the medical world or how professionals in this field conduct themselves?

Goodman argues that medical students who watch these programs are able to use the dramatized aspects of technically-sound scenarios to learn about textbook cases without falling asleep. But he also argues against taking less desirable examples from the screen:

“Here we encounter a contradiction worth exploring. Medical dramas provide such engaging tutorial cases by virtue of their televisual and cinematic qualities (dramatic urgency, narrative intrigue, emotional depth, aesthetic composition), yet it is precisely these qualities, it seems, which compromise their legitimacy as realistic depictions of medical practice.”
Neal Baer — M.D. and writer (1994-2000) for “ER” — elaborates on this in a 1998 interview with the Journal of the American Medical Association: “I think we make emergency medicine a bit more glamorous; there are many times during the day when there are no traumas and all you see are ear infections and runny noses.”

Shelley Fralic writes in the Vancouver Times about the possible side effects that medical dramas impose upon the general public, who may not be able to discern fact from fiction, like professionals in the medical field can:

“Think, for a moment, of your tendency to self-diagnose, of your impatience at cooling your heels in a crowded waiting room weeks after you made the appointment and were actually sick, of not believing or trusting your doctor when he/she tells you what you don’t want to hear… You do that, frankly, because television has taught you that doctors make mistakes, and that there’s no such thing as a waiting list and that instant medical attention is a patient’s right.”

Of course, it is a television viewer’s responsibility to acknowledge the fictitiousness of the storylines they watch. But given the obvious influence that media has over our culture, it is cloudy as to how much is absorbed into our mindsets as a population.

I would be mindful of plots that scream “ratings!”…like the conclusion to our incredible “Grey’s Anatomy” debacle:

“Burke and Meredith successfully remove the explosive device from the body and hand it off to Dylan…Meredith goes out to say something to him — anything, maybe just a “thank you” — but she doesn’t have a moment. The device explodes — killing Dylan right in front of Meredith.”

One can’t deny the widespread cultural consumption of violent, edge-of-your-seat thrills like these. But I can’t help wondering if they really belong in a hospital — a setting where the diseases are already deadly and fascinating enough.

Mike Berlin is a senior writing major who needs 20 CC’s of something - STAT! Email him at mberlin2[at]gmail.com.

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