The Hollywood Medical Reporter – Artistic Licenseby Daliah Leslie | August 26, 2014
What is more important, for a show to be compelling or medically accurate? The answer is not simple.
I certainly believe that absurd inaccuracies in medical dramas, as I discussed in last week’s post on House M.D, have helped produce a public that is tragically and dangerously misinformed. However, I know we must not lose sight of the true purpose these entertainments have. House does not purport to be a factual medical source. It is meant to entertain. Nevertheless, regardless of the shows intention, it must be held responsible for any negative effect it has.
That said, the medical inaccuracies in House were not my big problem with the show. Rather, it was the laughably formulaic structure and overall poor screenwriting choices. It is not the inaccuracies themselves that I took issue with, it was how they were used.
One of the most notable inaccuracies the public has absorbed from television relates to cardiopulmonary resuscitation (CPR). Many studies have shown that television shows drastically sway the public’s understanding on how effective CPR is.
For example, a 2008-2009 study monitored four weekly television shows including: Casualty, Holby City and Grey’s Anatomy. A total of 76 cardio-respiratory arrests and 70 resuscitation attempts were displayed in the reviewed shows. Of the 70 attempts, 46% had an immediate survival rate. In reality, while immediate survival rates are around 40-47%, only 10-21% survive past hospital discharge. These and most all other television shows rarely bother to give screen time to show whether or not a patient made it past CPR.
Now, does this mean I believe that every portrayal of CPR on television must be absolutely realistic? Obviously not. Complete accuracy in television or film should not be suggested if only for the fact that it is impossible to attain.
However, correct and responsible use of CPR (and other things of the like) within a given narrative is what makes any story effective and displays an understanding of their medium’s power to influence. No film or television show can play ignorant to the demonstrable fact that they play a significant role in increasing society’s inaccurate understandings and conceptions that can and do lead to dangerous choices.
Facts that lie at the center and give support to the narrative as a whole must come from a truthful place.
However… On the other hand, if some facts are incidentally used as a plot device to make note of a character trait, or help move the story along without lending much focus to the fact itself, then medical accuracy can legitimately take a backseat to artistic license.
Take Showtime’s Nurse Jackie. Created by Liz Brixius, Linda Wallem and Evan Dunsky, the show stars Edie Falco. Like Dr. House, Jackie has a fondness for narcotic painkillers. Other than also being set in a hospital, I believe the similarities stop there.
In episode two, season one, we see Nurse Jackie step out of the hospital. She sees a recently released patient in a wheelchair failing to get a taxi. Jackie goes over to a taxi she sees, barely ten feet away. She bangs on the window as she yells: “What the f***? Are you gonna pretend you didn’t see her sitting there? It’s your goddamn job.”
Jackie sees that the taxi driver is struggling for air and clearly in need of medical attention. Upon seeing this she begrudgingly pulls the driver out and administers CPR on him. With even more irritation, she begrudgingly gives him her last pill of the day (which she was saving for herself) in order to help with the pain she knows he must be having.
In this example, CPR has no focal point to the story. It is used solely as a mechanism to reveal information about the main character – which, while always important, is even more crucial here, as this is only the second episode – and to move the story forward as well as provide some comic relief. The viewer pays little, if any attention to the CPR itself. Rather, what stands out to us is the fact that this character, when presented with a man in need of her help, her first reaction – which she did not care to hide – was that of annoyance. We are being told this character has the capacity to do the right thing, but really does not want to. As such, the long-term result of the CPR is irrelevant. Its role is no more significant that that of the non-recurring EMT actor who wheels in a sick boy at the beginning of the episode.
Now let us examine an episode of House M.D that uses CPR. In the season finale of season three, House treats Marina, a young woman who fell ill after escaping from Cuba. Well into the story, House orders a cardiac catheterization because Marina’s PET scan revealed a blood clot, and any clot ultimately relates back to the heart. During the catheterization, Marina’s heart rate shoots up, then quickly flat-lines. House administers CPR on Marina, then places her on a cardiopulmonary bypass machine (the same point of CPR, this pump takes over the heart’s pumping action) which they keep her on for the next 3 hours. House takes her off the machine. Marina instantly and miraculously shows a normal healthy heart rhythm.
In this example, CPR was essential to the plot itself, and not simply a device. The CPR was employed as an element of the narrative to show what House’s decisions were for the case and how he ended up saving the patient. If it were not for this remarkable and ridiculously unethical and incorrect use of CPR we would not be so amazed at House’s genius and relieved at his client’s survival. Because the culmination of the entire episode is that House’s medical efforts succeed and the patient lives to walk out of the hospital, the effectiveness of the CPR is highlighted to the viewer. This absurd and irresponsible portrayal of CPR impresses upon the average viewer’s understanding of CPR.
Going back to my opening question – whether a show should be medically accurate or compelling – I would think it foolish to argue one is more important than the other. Instead, we should ask ourselves why each is important.
More and more reputable scientific/academic studies constantly reveal the growing power the media has on viewer’s understanding and subsequent actions. As such, their screenwriting and production choices carry great weight. For example, the choice to use gritty medical details in both dialogue and cinematic techniques draws attention to the medical facts themselves (regardless if they are accurate or not) and maks these “facts” a crucial element that the entire narrative relies upon. These choices are meant specifically to gain trust from the viewer which can be used to decieve.
An issue so complex, impactful and significant as health care, must demand responsible handling even when portrayed through a creative lens.
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