The Drama of Medicine: How Shows Like “ER” Influence and Are Influenced by Public Health

By Christine |

The 15-year run of  “ER” ended last week, sparking a number of reflections and retrospectives.

Since I cover health, I especially appreciated this analysis of the NBC series’ influence on the representation of health care in television programming.

It was back in 1996 when The New England Journal of Medicine first took “ER” and other medical shows to task for performing CPR much more frequently — and with much greater success — than doctors do off-screen.

Within a year, the show’s writers, which then included an emergency room physician and a pediatrician who was the show’s co-producer, crafted a scene in which Dr. John Carter (Noah Wyle) broke an elderly man’s rib while performing CPR.

Two of the great female characters on "ER"

Two great female characters, Dr. Kerry Weaver and Dr. Susan Lewis, on the "ER" finale

How off were the numbers? A 2006 New Yorker article noted that in reality one in 100 patients undergo CPR or some other resuscitation procedure. Just 15 percent, at most, are successful. On television shows, the success rate is closer to two-thirds.

“ER” has also been the medium for messages about HIV transmission, breast cancer, adoption, domestic violence, elder abuse and drug use. One of the final episode story lines revolved around a teenager who drank too much vodka at a friends’ home, providing Dr. Tony Gates (John Stamos) the opportunity to lecture that only 6 ounces of alcohol can be dangerous.

Adding another layer of real-life complication, the drinking was sanctioned by the friends’ parents. That now translates to “call the police.”

Writing in the Times, Pam Belluck describes the show’s powerful legacy as “a give-and-take between the world of entertainment and the world of medicine that has become stronger and more deeply intertwined with each year that ‘ER’ has been on the air, carrying over to other medical shows.”

One of the first hospital dramas to take its medicine seriously — as the engine rather than the backdrop for its scripts — “ER” caught the attention of the medical establishment as a source of health information for millions of Americans. A 2002 study by the Kaiser Family Foundation found that viewers’ knowledge of emergency contraception and the human papilloma virus increased after watching episodes that mentioned those subjects; a third of them said the show helped them make health care choices. One in five doctors in a 2001 survey said patients asked about diseases or treatments they saw on shows like “ER.”

Today, a small industry has grown up to influence writers and producers. A program called Hollywood, Health and Society gets money from health organizations and federal agencies like the Centers for Disease Control and Prevention to arrange meetings where doctors urge medical-show writers to highlight certain diseases or issues.

“We coach our experts in telling writers real stories of real people,” said Sandra de Castro Buffington, director of the program, part of the Norman Lear Center at the University of Southern California’s Annenberg School of Communication.

Interestingly, the Gates Foundation, best known for funding global health projects, has also helped shape story lines on “ER,” among other shows. Issues include HIV prevention, surgical safety and the spread of infectious diseases.

Look! Fake blood!
Look, ma! Fake blood!

What I also find interesting about the “ER” postmortem is the shift in attitudes toward doctors. During the days of “Marcus Welby, M.D.,” physicians were revered for their medical skill and bedside manner. The American Medical Association even gave its approval to some shows, but the approval had less to do with medical accuracy and more with how the doctors were portrayed.

[A side note: For a terrific discussion about how "Marcus Welby, M.D." reflected its time period, read this article by Joseph Turow at the Museum of Broadcast Communications. Turow recounts how it addressed medical topics, such as sexually transmitted infections, that up until then TV censors didn't allow. The show was memorable in other ways: Gay rights activists, in one of their first organized protests against a TV show, criticized an episode about about the rape of a teenager by a male teacher. And women's rights activists complained that "Marcus Welby's control over the lives of his patients (many of whom were women) represented the worst aspects of male physician' paternalistic attitudes."]

“These were sort of adoring doctor dramas,” John D. Lantos, a bioethicist at the University of Chicago, told the Times. “My sense is that the medicine was irrelevant and unsophisticated — someone’s lying in a room that looks like your living room and there’s an IV running, the universal symbol that something medical is going on.”

That certainly wouldn’t fly today, when story lines can be fact-checked instantly and the accuracy of medical jargon and physical details is as important as character development.

Speaking of character development, “ER” was one of the few shows that featured strong, complex female characters almost every season. Most everyone I know stopped watching “ER” years ago, but I faithfully TiVo’d each week. I’ll miss the familiar characters, as well as the  newer ones, including Dr. Cate Banfield (Angela Bassett, who deserved more air time), and the ones we’ll never get to know, like Dr. Julia Wise (Alexis Bledel); I know, I know — I can’t believe either actress didn’t join sooner.

In recent years my favorite was Dr. Neela Rasgotra (Parminder Nagra). Least favorite: Nurse Samantha Taggart (Linda Cardellini — who had much better scenes as highschooler Lindsay Weir).

But mostly I’ll miss a show that indulged my health curiosity (and anxieties) and made the often arcane and intimidating world of medicine accessible, chiefly by showing that in the end, the characters that compose that world are as human as we are.

Plus: If you’re suffering from “ER” withdrawal, you may want to check out “Doctor’s Diaries.” The NOVA program, which broadcasts on PBS, has been following seven former Harvard medical school students for more than two decades. Pauline Chen has more. (Or you can try to convince me to watch “Grey’s Anatomy.”)

cross-posted at PopPolitics.com

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12 Comments

  1. Judith Lienhard says:

    On the downside, I do not remember seeing a normal birth on ER-no drama in that. I had stopped watching years ago, saw the last episode and reflected on how scary it must have been to every pregnant woman to see the scenes where the woman gave birth to twins and subsequently dies. I work in maternity and as soon as a pregnant woman arrives in the ER, even if it is with a serious medical problem, she gets shipped off to OB-so very unrealistic to see time and again, women giving birth in the ER on the show. Seeing all that blood and all the complications with moms and babies- out of proportion as well with the real world where still there are too many C/S. It is fear mongering from my perspective-I was upset at every birth related clip in every TV show.

  2. Christine C. says:

    Judith, you’re so right. I can’t imagine watching if I were pregnant. (I had a spontaneous pneumothorax once, and I instinctively winced every time the word “pneumothorax” was mentioned.) There’s probably a fine line between drama (that is, the kind of “drama” ER trafficked in) and fear-mongering. But reflecting on the the pregnancy scenes, I’d wager midwives and doulas were never part of the consulting process.

  3. Sandra de Castro Buffington says:

    Hollywood, Health & Society (HH&S), a program of the USC Annenberg Norman Lear Center, is the CDC’s entertainment education program. In our 8th year of funding from CDC, we also receive funds from the Bill & Melinda Gates Foundation, the California Endowment, and HRSA’s Dept of Organ Transplantation and Poison Control Program. HH&S works to increase the accuracy and frequency of timely public health portrayals in TV storylines. We take health experts, including midwives, patients, researchers, residents and physicians, to meet with Hollywood’s writers and producers to provide real stories of real people, case studies and facts. We never tell writers what to write! We simply serve as an on demand resource of health information on a wide range of topics.

  4. mrs spock says:

    Sandra, are nurses included in that list? As a nurse, I often find that although nurses are the heart and soul of hospitals, we are rarely portrayed on TV with accuracy.

    With the exception of the ER and the OR, nurses are the first to notice and respond to a Code Blue, giving compressions, pushing drugs, and leading the team until the attending physician arrives.

  5. Sandra de Castro Buffington says:

    Greetings Mrs. Spock,

    We do have nurses in our subject matter expert database and have had nurses conduct briefings with writers. HH&S has no power over the final story or the accuracy of health portrayals. We simply serve as a free resource to writers. We don’t tell them what to write. We do provide expert consultations, tip sheets with health facts and key messages about health issues, a Real to Reel quarterly newsletter that captures news headlines, case studies, real stories of real people and more. Some of the shows ask us for expert consultations on the roles of various types of healthcare providers including nurses, nurse practitioners, midwives, medical residents, and physician’s assistants among others.

    One question I ask our experts, and I’ll ask you now, is if you could reach up to 20 million people in one hour with 3 key messages about nurses, what would those messages be?

    Thank you, Sandra

  6. mrs spock says:

    Hmmmm…great question.

    1. We spend as much time thinking as we do the listening and caring we are more well known for. When we walk into a room, we are sizing up everything and everyone that we see, kind of like on CSI, making an instant priority list in our head, and acting on that. We have to have a good understanding of the usual disease processes and treatments we see in our specialty, because a doctor may breeze in and out, rapidly explaining something to a shell-shocked family, and we will have to spend the next 8-12 hours explaining and re-explaining that to a psychologically overwhelmed person. There is a lot of active learning, discussing research relevant to the field, and excitement for the medicine and science that goes on behind the scenes.

    2. That we might not be writing the orders, but we save many a life with our hawk-like watchfulness, quick thinking, advocacy, and gut instincts.

    3. That we work, and work hard. We go without bathroom breaks and lunches most days, even when pregnant. That we don’t get any snow days. That we don’t get our vacations because of short-staffing, and are frowned upon when calling in sick. That we miss every other holiday and every other weekend with our families. That we get yelled at by physicians who are having bad days. And then yelled at by families who are scared and overwhelmed. That we don’t ignore the call-light because we don’t care or are lazy, but because we have been forced to take on too many patients. And the minute we sit down at the nurses station to shove a granola bar in our mouth and catch up on charting, someone comes over, shoves an empty pitcher at us, and says, “While you were here chit-chatting, I’ve been waiting for a fresh pitcher of water for 15 minutes!”

  7. Judith Lienhard says:

    I came across a British TV show that shows the life of a midwife with all its ups and downs, shows the conflicts she encounters, interesting issues and nice births, hospital, home and birth center births and it shows clearly the conflicts between medicine and midwifery. Plus is a fun show about the romance between this midwife and an undertaker. When I was expressing my dismay about American TV shows and how they portray pregnancy and birth, one of my neighbors said, you will really like this British show called William and Mary, available on Netflix. I have started watching it and am in love! Please spread the word!

  8. ERKerryWeaverLuvu says:

    ER is my FAVOuRITE SHOW EVAAaaaa! I have all the box sets and my little sister and I are obsessed!?! Our favourite character is Kerry Weaver- shes such a complex female character and Laura Innes does a great job playing her!!!!! GO KERRY! Woooooo :D