Accuracy, Shmaccuracy”
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PAGE 23 / JANUARY 10, 2007 SCRIPTDOCTOR: MEDICINE IN THE MEDIA “Accuracy, Shmaccuracy” By Andrew Holtz, MPH rior was completely re-painted before Andrew Holtz, MPH, is a former CNN Medical Correspondent filming began, but then the crew went s any fiction writer will tell and the author of “The Medical Science of House, M.D.” This through all the rooms and corridors you, the story comes first. column examines mass media programs, particularly kicking and scuffing, so that the set And so it is with TV shows entertainment TV, for insight into popular perceptions, so that would have the look of a worn and A that use medical backdrops for rather than merely wincing at distortions or struggling community hospital. their teleplays. When writers meet to oversimplifications in the portrayals of medicine on these At least one network executive had begin sketching out a new plot, the shows, health care professionals can learn something from a very different vision for the series: a first order of business is determining media professionals about the way that medical and health standard sitcom four-camera studio fundamental mileposts of the story. topics are presented. shot in front of a live audience, with a What is the theme: loss, discovery, Send questions to him about how the media treat medical laugh track added in post-production. attachment? What do the key charac- “My boss was like, ‘No way, I topics or suggestions for future columns about a particular ters experience: career advancement, a don’t want it to be a silly medical show show or topic to discuss to [email protected] new love, a death? What are the emo- where they are in the OR and some- tional notes of dramatic score: joy, sor- thing drops on the floor and they pick it row, anger? up and put it back in.’ That’s the kind Then, as ER writer Lisa Zwerling are going to do that.” sugar-coat reality. That’s one reason the of wacky humor you would have in a notes, “We will brainstorm to come up Defending himself against cranky show has real doctors on the writing sitcom,” says Scrubs Supervising Pro- with a good medical story that meets clinicians isn’t the only reason Kaplow staff,” Dr. Zwerling says. “Sometimes ducer Janae Bakken. our dramatic needs.” Yet she and other keeps a case report or two in his back the non-doctor writers will say, ‘Gosh, So although the show is definitely writers at medical shows are emphatic pocket to prove that the weird things would you really say that to a patient? funny, the shooting style is much like that they care about the accuracy of he writes about do happen. Having to Would you really say, ‘If this isn’t treat- that of medical dramas, with a single their scripts. write his way around rocks of reality ed, you will die?’’ And the answer is yes. camera following the actors, allowing Why? These shows are fiction, not sharpen the storytelling and distinguish “We try to have the doctors on the for close-ups and editing that let the documentaries or news reports. But many medical shows from sci-fi or show relate to patients the way we visual pacing support the emotional part of the contract with viewers is that other fantasy genres. would relate to patients if we were trajectory of the story. there will be enough realism to make “Yes, we have to be much more working in the hospital. You want to be the story believable. Maybe it’s ex- rigorous,” Kaplow says. “It’s easy to as compassionate and caring and sup- tremely unlikely, but perhaps, just cheat and say, ‘Oh, yeah, this could portive, and be as hopeful as you can in maybe, the key events could happen. happen,’ and just make it up.” a realistic way.” “We try to be real when we Of course, characters are often Physician-writers naturally want to think about how doctors composites, time is compressed, and be true to the craft they worked so hard really talk about this to “We try to have the doctors many medical details are left out. to master—and they have to face the Otherwise, plots would be cluttered critiques of their colleagues. In addi- patients, which is: you on the show relate to and confusing; and their pace would tion, all the writers see letters from slow to a mind-numbing crawl. viewers who are personally affected by don’t try to sugar-coat patients the way we Still, writers see limits to dramatic what they wrote. reality. That’s one reason would relate to patients license. Kaplow recalls one episode that “There are a lot of people who have referred to a real side effect of a real these actual illnesses. When they watch the show has real doctors if we were working in the drug. He says they were asked whether the show and they hear about these ill- they could substitute a made-up drug nesses, they are grateful, because they on the writing staff. hospital. You want to be name. After all, who would know the understand and they can identify with Sometimes the non-doctor as compassionate and difference? But Kaplow says making up the symptoms. They say, ‘That hap- a fake drug would corrode the viewers’ pened to me,’” says House’s Kaplow. writers will say, ‘Gosh, caring and supportive, trust. “When I wrote a [childhood] can- “Then the show’s a joke. Then we cer episode, I got a number of letters would you really say that and be as hopeful as you have no credibility. Forget about the from people who had buried grandchil- doctors who work on the show, there’s dren, just horrible, horrible stuff; but to a patient? Would you can in a realistic way.” the concept of the show: this is a med- they were thanking us for portraying it ical show. Might as well be a space in a realistic way, that what the girl had really say, ‘If this isn’t travel show, set in outer space where I gone through, not physically, but emo- treated, you will die? “Absolutely. Otherwise you be- just take a zap gun and fix your liver. tionally, was accurate.” come a fantasy. Sure, we take liberties, The drama goes away,” Kaplow says. And the answer is yes.” but those liberties are still factually As he notes, doctors not only Comedy Shows? based,” says House writer Lawrence advise writers of medical shows, they Kaplow. often are the writers. ER writer Lisa OK, so TV dramas benefit from a mea- Like her counterparts at medical “This show lives in the world of the Zwerling is also pediatrician Lisa sure of realism, but surely this concern dramas, Bakken says the comedy writ- weird,” he admits. “Our show is about Zwerling, MD. In her fourth year with about accuracy doesn’t extend to come- ers and producers at Scrubs want to be the one-in-a-million. Frequently, when ER, she now practices part time. Her dy shows. realistic, to an extent, out of respect for doctors push back and say, ‘This would clinical work is both a source of inspira- Well, don’t tell that to the staff at their audience, including doctors who never happen.’ I say, ‘Well, this would tion and a reality check for her writing. Scrubs. Now in it’s sixth season, the provide inspiration for storylines. never happen in your clinical practice, For example, the choice of words a show centers on the trials and tribula- “We talk to these doctors and we because you are dealing with the 99 physician will use to deliver bad news tions of young doctors. Scrubs episodes want to be true to them and the stories percent of people. House deals with the to a patient. are shot in a real hospital building that they’ve told us and let us use. And why one percent, the abnormal presenta- “We try to be real when we think once housed the North Hollywood not be real?” Bakken says. “We’re not tions of abnormal illnesses. And any- about how doctors really talk about this Medical Center. As part of the real-but- going to say that someone has liver dis- time we can take a unique direction we to patients, which is: you don’t try to not-real world of TV, the hospital inte- (continued on page 24) PAGE 24 / JANUARY 10, 2007 Technology to Improve Colonoscopy Recognized by American College of Gastroenterology Award By Paul Watson during a colonoscopy “Basically we wrote a whole series study that facilitated the cre- “There are some people who may be afraid of such a of algorithms that look at different ation of new software that can tool. They worry about having somebody continuously aspects of what happens during a automatically and objectively colonoscopy,” Dr. de Groen said. A analyze the efficacy of a colon- watching over their shoulder. For the people who More specifically, the software oscopy was one of five abstracts select- automatically extracts five objective ed for the American College of Gastro- do a poor job this may not be a nice tool to have, quality-control algorithms, or metrics, enterology (ACG) Governor’s Award because it’s going to document just that. However, from colonoscopy video files. Each met- for Excellence in Clinical Research. ric analyzes a specific part of the The principal investigator, Piet C. for people who do a good job, this will be a beneficial colonoscopy procedure: de Groen, MD, Professor of Medicine at I Metric 1 measures the overall the Mayo Clinic, presented his findings tool to have access to; they will be able to document duration of the insertion phase, termed during the President’s Plenary Session the quality of their work.” the insertion time.