OutbreakOn an upcoming episode of CBS’ Under the Dome, the trapped domizens (who are now in season 2 of being cut off from the world due to, well, a dome over their town) are going to face a medical emergency: Someone will need a blood transfusion. The problem is there’s no way to determine blood types when you’re cut off from the world by, well, a dome.

Unless, as it turns out … you have lima beans. And likewise, unless you have a trained medical doctor in charge of writing your show. And Under the Dome does: Showrunner Neal Baer.

Dr. Baer has never practiced pediatrics, but he’s a fully-licensed physician who was in the midst of his residency whey ER executive producer John Wells tapped him to ensure ER was written accurately back in the 1990s, then moved on to write for and run Law & Order: SVU. Dome may not make full use of his doctorial expertise, but when necessary he’s the guy who will ensures that what appears on camera is possible and accurate.

“There aren’t too many medical shows on now that did the job ER did,” he tells me. “I wanted it to be accurate, John Wells wanted it to be accurate, and it set a standard. That’s the gold standard for shows now. A lot of writers go into [writing for television] thinking they’re just doing entertainment, so why bother [being accurate] - but the issue is people really do take it as real. You can’t walk both sides of the street: ‘Oh, it’s just entertainment but I’m going to make it look real with sets and costumes and equipment.’ What message are you sending?”

er460Before ER, medical shows rarely had anyone who actually knew medicine writing for their series. They’d rely on consultants to add medicine like spices after an episode was developed, and those consultants were not in the writers’ room to provide an organic medical entry point for a story.

“John wanted to draw on our lives as physicians to demonstrate and inform the show and not do it as an afterthought with a few words here and there,” says Baer. “It all came from us at the very beginning.”

Yet keeping things accurate and real on medical shows is more than about being fussy. Studies point to how television shows inform untrained audiences about how medicine works, from big procedures to CPR administration and all the way down to the semantics of whether a patient in a vegetative state is getting (or not) “food and water” or “nutrition.” Semantics and visuals matter, because what we see today might influence how we behave tomorrow.

That’s where a group like Hollywood, Health and Society comes in. HH&S, which is part of USC Annenberg’s Norman Lear Center, holds invitation-only panel discussions on various health topics with entertainment writers, in the hopes of sharing updated medical information and best practice procedures - and getting that information into the shows themselves. I attended one session in the 1990s, and on the one hand it was eye opening - that semantic debate, for example, has stuck with me - and on the other it seemed perfectly natural. Writers can’t be experts on every topic, so why not get the details from the experts?

Baer is a fan of what the group does. “People had been getting inaccurate information; they were seeing that CPR works too well,” he says, as an example. In fact, CPR does not work very well at all in most cases. Duke University researchers did a study of medical TV shows portraying CPR administration bringing about a revived patient in 75 percent of cases; a 2012 study revealed that depending on the circumstance, in real life only between 2 and 18 percent of individuals who receive CPR actually pull through.

But when you see that CPR succeeds so much on television, you start to believe it will in real life. “It’s important to portray medicine accurately,” says Baer. “People see it as modeling behavior - and the way we model behavior influences people.”

That said, with the medical elements arranged correctly, perhaps writers worry less about portraying portray doctors and nurses the way they might be in real life. After all, the drama has to come from somewhere, so writers tend to make the lives of the medicos somewhat hyper-real. Marc Zaffran is a fiction writer and cultural critic who also practiced medicine in France for 25 years, and he’s actually okay with that.

“What I’m most interested in is how the medical dilemmas or conflicts of interest between doctors and patients are dealt with, narratively speaking,” he says. “Doctors and nurses are much more peaceful and subtle and unassuming in real life than in TV drama. It’s drama. Real healthcare providers’ everyday life is just too busy to have sex in closets as often as their onscreen alter egos.”

Masters of Sex

Grand Rounds: Five Medical Dramas that Get it Right

Zaffran may not be writing a TV series right now, but in his role as a cultural critic with a medical degree, he knows which shows get a clean bill of health when it comes to accuracy. Here are his favorites from the past and present:

  • Masters of Sex
    It’s currently the best medical drama on the air, period. And that’s because its fantastic writing is both sensible, and thoughtful, and imaginative and clever and based on fact ; and it is also a social/historical commentary on many other things than medicine that are still relevant today.
  • ER
    ER will always be the most realistic medical drama of all time. To my knowledge it’s the only medical drama created by a physician-writer (Michael Crichton); this might be one reason. And its obstination in depicting factually true situations is amazing. 
  • House, MD
    Not at all realistic, but it is the greatest philosophical medical drama. It’s always about dilemmas and what is best for the patient.
  • Scrubs
    This was the best show describing how difficult it is to become a doctor, while becoming an adult, while learning to be a partner/lover, etc. And how much fantasy that creates among trainees!
  • Gideon’s Crossing
    This show was medically very accurate. There are great episodes about medical mistakes and errors, but it didn’t last. Its main character was much too perfect and boring which was bad both from a narrative and medical point of view. No Doctor is that perfect. No Doctor is as imperfect as House, but House is much more interesting.

What’s your favorite medical drama? Do you care if they get the medicine right? Let me know what you think over here.