Body parts

Drama - Jed Mercurio diagnoses the shortcomings of medical fiction

For more than 40 years, medical drama has occupied the uplands of the television landscape. Emergency Ward 10 (1957-67) was ITV's first soap opera. The BBC answered with Doctor Finlay's Casebook (1962-71). On screen between 1969 and 1991, Richard Gordon's Doctor books were adapted into the sitcom franchise of Doctor in the House, Doctor at Large, Doctor in Charge, Doctor at Sea, Doctor on the Go, Doctor Down Under, Doctor's Daughters and Doctor at the Top. Between them, General Hospital (1972-79), Angels (1976-83) and Casualty (from 1986 and still running) ruled for three decades. And that's before mentioning the US imports, from Doctor Kildare via St Elsewhere to ER and Chicago Hope. Oh, and the Australian imports . . .

Commentators speculate that viewers of medical drama empathise with the plight of patients and relatives. They aspire to the doctors' compassion and professionalism. Like rubbernecking drivers passing a crash scene, they are fascinated by the spectacle of guts and gore. I would argue that, for programme-makers of the so-called precinct (or workplace) dramas, hospitals provide one of the few settings in which, week in and week out, without exceeding credibility, regular characters can be plunged into life-and-death storylines. Furthermore, as they love playing safe, television executives will continue to commission new ones.

For British audiences, I think the doctor who has created the most enduring evocation of medical life is Richard Gordon. Originating in 1952, his series of Doctor books, films and television programmes remained a motif more than 30 years later, when I was applying for a place at medical school. In Doctor in the House, Gordon's debut, entrance to St Swithin's involved an interview in which the dean ensured that the applicant had attended public school, drank beer and played rugby. The obs & gynae course included cycling out into the community to deliver a baby - unsupervised. Wherever he went, the doctor was treated with a respect bordering on servility. Tales from the Gordon era are so far removed from my own experience that I don't know whether I am reading fact or fiction, memoir or satire. I believe that he worked in a golden age now long past, and he probably had a genuinely sunny outlook on the profession: either that, or he considered himself obliged to propagate one. None the less, the timeless appeal of Gordon's work is that it made being a doctor seem fun - so much so, in fact, that I wanted to become one.

When I qualified, I found that working in hospitals is sometimes a great laugh, and practising medicine, when fulfilling, does feel like the best job in the world. But real-life scandals, such as Bristol, Alder Hey, Rodney Ledward, Richard Neale, Beverley Allitt and Harold Shipman, reveal that medicine has its dark side. However, medical fiction, as a rule, chooses not to explore it. The long-running medical series favour an idealised view. Doctors are daring, nurses are caring. They console the bereaved, heal the sick and reanimate the dying. Diagnoses may be difficult, resources may be scarce, but you know they will win through in the end. There have been exceptions. Samuel Shem's 1978 novel The House of God delved into the institutional cynicism of American hospital life, and has been a favourite with doctors ever since. G F Newman's series The Nation's Health (Channel 4, 1983) delivered a bleak dissection of medicine's limitations. The doctor part of me recognises the light and shade of medical life, but the writer in me is more attracted by the darkness, perhaps because it is the road less travelled. My own first-hand experience has taught me that the job breeds cynicism and gallows humour. Some staff become traumatised; others become dysfunctional. A small number of doctors and nurses are incompetent and get away with it for years, while their colleagues turn a blind eye. Some nurses are lazy and stupid.

Paradoxically, I believe that drama can reach a deeper truth than documentary. The uncertainty principle states that, in measuring a quantity, you alter it. Reel after reel of fly-on-the-wall footage from Jimmy's or Children's Hospital shows doctors playing doctor for camera. Through drama, a writer can picture how doctors behave when the cameras aren't rolling, and voice what is uttered when the microphones are switched off. But it is not easy for the lay writer to gain insight into the working life of a doctor. What you observe, you observe as an outsider; what you are told is only what someone has elected to tell you.

With Cardiac Arrest (1994-96), I was given a chance to deliver an authentic insight. Some characters were cynical. Some made mistakes. They fell out with the nurses. They hated the hours and the workload. They got shafted by the management. It became one of the most controversial drama series that the BBC had ever transmitted. Even the then secretary of state for health, Virginia Bottomley, felt moved to pen a critique in the News of the World. Some journalists wrote features accusing me of peddling a harmful fiction. At the time, I was senior house officer at a hospital in the West Midlands, dealing with upwards of 30 emergency admissions a day - heart failures, brain haemorrhages and cancers - yet some people thought they knew more about hospital life from the features desk than I did from the end of a stethoscope.

Part of what motivated my writing was anger. I was angry that the daily misery of doctors, nurses and patients was being trivialised into soap opera. We were made to feel bad because we were not perfect like our television counterparts. We were resentful that our patients did not get better as quickly as they did on telly, or at all. We were resentful that the nurses weren't angels. We were resentful that, when news programmes broke stories of medical calamities, they did not seem interested in how the system had failed, only in which doctor was to blame. When Cardiac Arrest was branded unrealistic, I understood that the TV mythology had usurped the truth.

I think that the general public understands that its own doctors are human, fallible and flawed. It may be that most viewers do not want to see that kind of doctor in Holby City or Always and Everyone; they will choose decent, square-jawed George Clooney over a cynical alter ego. However, I also suspect that television executives, although they might occasionally be prepared to risk portraying a dark view of medicine, feel more comfortable when scheduling hour after hour of the drama of reassurance.

The result reminds me of dystopian works of science fiction such as Fahrenheit 451. The world is a horrible place, but no one worries, because we have all been pacified by anodyne television in which incorruptible cops solve crimes, crusading lawyers keep the innocent out of prison and streetwise social workers rescue children from abuse. Our public services are failing all around us, but don't worry, because on screen next are the doctors, giving us yet another hour of how we would like the world to be.

Jed Mercurio's Bodies is published by Jonathan Cape (£10.99)