The Problem with Medical Dramas
Apr. 27th, 2007 11:51 am![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
ivyficSince I did not see Supernatural last night and my fracking internet was out this morning so I don't know when I'll be able to download it, I'm going to meta about something else.
The Problem with Medical Dramas
I watched a season of ER a month or two ago and just finished two seasons of Grey's Anatomy and I've come to the conclusion that medical dramas in the television format have insurmountable problems that will make me hate them after a season or two. (I'm not counting House in this analysis because House isn't actually a medical drama—it's a police procedural that happens in a hospital. It plays by its own rules.)
I have to start this by saying I hate hospitals. I've never wanted to be a doctor, possibly because my dad's a doctor and my mom's a nurse. Aside from the whole squeamish thing and the whole not ever wanting to see a dead body thing, I just never want to be in a position where my off day costs someone their life. Medicine is such a weird profession—if you ascend to the top, like my uncle, who is one of the country's best neonatal cardiac surgeons, how can you ever call your life your own again? If you become the best, then it becomes your responsibility to save lives that other people can't. If you go golfing, a baby might die because you weren't around to save it and the second best surgeon wasn't good enough. And what if you're not the best and you know it? Then you'd have to know that your patients are going to experience more pain and complications than if they had a better doctor. I'm oversimplifying here, but I don't want that responsibility. I'm just as happy to let other people bear the burden of being the last resort. So watching a medical drama I can't help thinking that the jobs the characters have are a special type of hell. So obviously I'm less inclined to like a medical show right off the bat.
But beyond my personal dislike for the genre, watching a lot of medical dramas in a row I can't help but noticing certain inherent flaws.
1) There are only two outcomes to any plot-line: patient lives, patient dies. There are variations on this: patient looks like they're going to live but dies, patient almost dies but lives, patient lives but will die soon…
It is almost impossible for writers to resist being ironic with this. The patient's friend, who appears to be fine and is mouthing off at the doctor drops dead because no one bothered to check her, making everyone feel guilty. The person with only minor injuries is a general asshole and the doctors think it's unfair that he's fine and the nice people are at death's door—then the asshole dies and everyone feels guilty. The patient who is resigned to their own death miraculously survives and faces life with a newfound sense of joy.
The problem with this type of story-telling is that it's damn predictable. Patients keep saying pseudo-prophetic and ironic things and I keep knowing whether they will live or die because of this. I know the writers are going to go with the most "profound" conclusion to the story-line, so I'm never surprised by it. Booooring.
2) The patient's cases mirror the on-going story-lines of the main characters. This arises mostly for structural reasons—in a show with twenty cases going on at once, the way to maintain a sense of coherence is to have them relate to the main characters or relate to a general theme (as Grey's Anatomy is so fond of doing). The problem is that by exploring the emotional issues of our main characters through the reactions of patients going through profound life changes that have some relevance, the main characters end up looking wishy-washy. A character decides to keep a baby after a patient on her death-bed laments over giving her own child up for adoption. A character decides to pursue their love interest because a husband gives a heart-wrenching confession about his dying wife. Or, a character decides to break off an affair after a patient comes in suffering from the catastrophic consequences of their own actions in a similar situation.
Though this conceit allows a lot of wallowing self-examination without long monologues from the main characters (in effect, circumventing exposition about possible outcomes by acting out those possible outcomes with the patients), it makes the main characters merely reactive. They don't make decisions themselves; they only react to outside stimuli. And at least on ER, the writers are content to spin this out over whole seasons, having one character first pursue a romance because of a patient's speech, then break it off because of a different patient, then pursue it again. The character therefore has no agency in their own life.
3) The personal lives of the doctors are completely overshadowed by the drama of the patients. Because all of the action on a medical drama happens with a backdrop of a hospital, the on-going romantic story-lines are trivialized by the incidental stories in each episode. Character A is going through a season-long messy break-up. Well, character A is surrounded in every episode by characters that are losing their spouses and children, facing a life permanently changed by terminal illness, experiencing the most profound, heart-breaking, momentous moments in their entire lives. People are dying. Character A's obsessing seems inconsequential in comparison.
If the show is going to do one-shot storylines about having to choose which patient of two will die because they can't save both, or examining a good person who just accidentally killed their own father—these are things that break people's lives, that they'll have to deal with every day. Who slept with who therefore seems stupid, or at least less interesting. Grey's Anatomy once even acknowledged this: "You're comparing your pathetic love life to my record-breaking tumor? Seriously?"
4) Putting the main characters in jeopardy eliminates everything that makes them interesting as characters. Because every episode features storylines about random people that are juicier than the stories about main characters, the writers seem completely unable to resist putting the main characters into life-and-death situations themselves. But by making the doctor the patient, though you can suddenly tap into all of that drama, you've turned an active, interesting character into an unconscious lump on an operating table.
Suddenly the show has turned into the worst sort of hurt/comfort story, where the writers milk the angst by making recovery as long and as agonizing as possible. But while they're doing that, the character is no longer the strong, powerful character we've come to like. They're helpless. And they drift further and further away from their original characterization. Eventually they stop being a strong character going through a moment of weakness and become a weak character.
5) Focusing on the main characters makes their treatment of patients seem cavalier. There's an episode of ER where, as a result of a power-struggle between two surgeons, one surgeon performs a completely unnecessary thoracotomy (cracking open the patient's chest). The story-line resolves when the surgeons work out their differences, completely ignoring the patient whose chest was cut open and, though still alive, is looking at an agonizing and unnecessary six-month-long recovery and life-long repercussions.
Characters do occasionally mention things like this, but for the most part, story-lines resolve happily if the patient survives, completely ignoring long-term consequences. I understand the need for this, but I'm going to stop being sympathetic to doctors who do exploratory abdominal surgery "just to be sure." The show may be trying to say that this character was in the right because they weren't taking risks with their patients' lives, but any sort of surgery has long-term consequences and I have a hard time just writing off the pain and suffering our main character just inflected on someone else because they "had to be sure."
6) You can only tell so many stories about ethical dilemmas. Medical ethics is one of the richest dramatic grounds for a medical drama. But unlike a cop show where the rogue cop who does what's right instead of what's legal remains a hero in the eyes of the audience, the doctor who goes against their ethical rules loses a little something every time they do it.
How many episodes are there out there where the doctor wants to go against a DNR? Seriously. But in the end, as an audience member, I always side with the DNR order and any doctor that violates it becomes a little tainted. Or what about the doctor that does something against a patient's wishes because it's in their "best interest?" Or one that violates the Hippocratic oath for the "greater good?" Almost every doctor on every medical show does one of these things. The longer the show runs, the more ethical violations for every character, and the more extreme they get.
Because we know it's a TV show, we know that these characters won't experience the consequences they should. They won't be stripped of their medical license, they won't be fired, if they're suspended it won't be for very long, because as soon as they're no longer doing their job, they no longer have a place on the show. Consequently, all of the doctors are accumulating these ethical violations to the point where I'm horrified every time they treat a patient.
Because of all of these problems, over time the doctors on a medical show turn into indecisive immoral fuckwads that I no longer want to watch. I don't identify with them, I don't admire them, and I stop seeing them as heroes.
Even though you would think that a medical show would have an infinite mine of angsty story-lines that would be right up my alley, I find that they lose their sheen much quicker than other types of shows do. I just can't watch that many episodes before I have to switch to something else.
The Problem with Medical Dramas
I watched a season of ER a month or two ago and just finished two seasons of Grey's Anatomy and I've come to the conclusion that medical dramas in the television format have insurmountable problems that will make me hate them after a season or two. (I'm not counting House in this analysis because House isn't actually a medical drama—it's a police procedural that happens in a hospital. It plays by its own rules.)
I have to start this by saying I hate hospitals. I've never wanted to be a doctor, possibly because my dad's a doctor and my mom's a nurse. Aside from the whole squeamish thing and the whole not ever wanting to see a dead body thing, I just never want to be in a position where my off day costs someone their life. Medicine is such a weird profession—if you ascend to the top, like my uncle, who is one of the country's best neonatal cardiac surgeons, how can you ever call your life your own again? If you become the best, then it becomes your responsibility to save lives that other people can't. If you go golfing, a baby might die because you weren't around to save it and the second best surgeon wasn't good enough. And what if you're not the best and you know it? Then you'd have to know that your patients are going to experience more pain and complications than if they had a better doctor. I'm oversimplifying here, but I don't want that responsibility. I'm just as happy to let other people bear the burden of being the last resort. So watching a medical drama I can't help thinking that the jobs the characters have are a special type of hell. So obviously I'm less inclined to like a medical show right off the bat.
But beyond my personal dislike for the genre, watching a lot of medical dramas in a row I can't help but noticing certain inherent flaws.
1) There are only two outcomes to any plot-line: patient lives, patient dies. There are variations on this: patient looks like they're going to live but dies, patient almost dies but lives, patient lives but will die soon…
It is almost impossible for writers to resist being ironic with this. The patient's friend, who appears to be fine and is mouthing off at the doctor drops dead because no one bothered to check her, making everyone feel guilty. The person with only minor injuries is a general asshole and the doctors think it's unfair that he's fine and the nice people are at death's door—then the asshole dies and everyone feels guilty. The patient who is resigned to their own death miraculously survives and faces life with a newfound sense of joy.
The problem with this type of story-telling is that it's damn predictable. Patients keep saying pseudo-prophetic and ironic things and I keep knowing whether they will live or die because of this. I know the writers are going to go with the most "profound" conclusion to the story-line, so I'm never surprised by it. Booooring.
2) The patient's cases mirror the on-going story-lines of the main characters. This arises mostly for structural reasons—in a show with twenty cases going on at once, the way to maintain a sense of coherence is to have them relate to the main characters or relate to a general theme (as Grey's Anatomy is so fond of doing). The problem is that by exploring the emotional issues of our main characters through the reactions of patients going through profound life changes that have some relevance, the main characters end up looking wishy-washy. A character decides to keep a baby after a patient on her death-bed laments over giving her own child up for adoption. A character decides to pursue their love interest because a husband gives a heart-wrenching confession about his dying wife. Or, a character decides to break off an affair after a patient comes in suffering from the catastrophic consequences of their own actions in a similar situation.
Though this conceit allows a lot of wallowing self-examination without long monologues from the main characters (in effect, circumventing exposition about possible outcomes by acting out those possible outcomes with the patients), it makes the main characters merely reactive. They don't make decisions themselves; they only react to outside stimuli. And at least on ER, the writers are content to spin this out over whole seasons, having one character first pursue a romance because of a patient's speech, then break it off because of a different patient, then pursue it again. The character therefore has no agency in their own life.
3) The personal lives of the doctors are completely overshadowed by the drama of the patients. Because all of the action on a medical drama happens with a backdrop of a hospital, the on-going romantic story-lines are trivialized by the incidental stories in each episode. Character A is going through a season-long messy break-up. Well, character A is surrounded in every episode by characters that are losing their spouses and children, facing a life permanently changed by terminal illness, experiencing the most profound, heart-breaking, momentous moments in their entire lives. People are dying. Character A's obsessing seems inconsequential in comparison.
If the show is going to do one-shot storylines about having to choose which patient of two will die because they can't save both, or examining a good person who just accidentally killed their own father—these are things that break people's lives, that they'll have to deal with every day. Who slept with who therefore seems stupid, or at least less interesting. Grey's Anatomy once even acknowledged this: "You're comparing your pathetic love life to my record-breaking tumor? Seriously?"
4) Putting the main characters in jeopardy eliminates everything that makes them interesting as characters. Because every episode features storylines about random people that are juicier than the stories about main characters, the writers seem completely unable to resist putting the main characters into life-and-death situations themselves. But by making the doctor the patient, though you can suddenly tap into all of that drama, you've turned an active, interesting character into an unconscious lump on an operating table.
Suddenly the show has turned into the worst sort of hurt/comfort story, where the writers milk the angst by making recovery as long and as agonizing as possible. But while they're doing that, the character is no longer the strong, powerful character we've come to like. They're helpless. And they drift further and further away from their original characterization. Eventually they stop being a strong character going through a moment of weakness and become a weak character.
5) Focusing on the main characters makes their treatment of patients seem cavalier. There's an episode of ER where, as a result of a power-struggle between two surgeons, one surgeon performs a completely unnecessary thoracotomy (cracking open the patient's chest). The story-line resolves when the surgeons work out their differences, completely ignoring the patient whose chest was cut open and, though still alive, is looking at an agonizing and unnecessary six-month-long recovery and life-long repercussions.
Characters do occasionally mention things like this, but for the most part, story-lines resolve happily if the patient survives, completely ignoring long-term consequences. I understand the need for this, but I'm going to stop being sympathetic to doctors who do exploratory abdominal surgery "just to be sure." The show may be trying to say that this character was in the right because they weren't taking risks with their patients' lives, but any sort of surgery has long-term consequences and I have a hard time just writing off the pain and suffering our main character just inflected on someone else because they "had to be sure."
6) You can only tell so many stories about ethical dilemmas. Medical ethics is one of the richest dramatic grounds for a medical drama. But unlike a cop show where the rogue cop who does what's right instead of what's legal remains a hero in the eyes of the audience, the doctor who goes against their ethical rules loses a little something every time they do it.
How many episodes are there out there where the doctor wants to go against a DNR? Seriously. But in the end, as an audience member, I always side with the DNR order and any doctor that violates it becomes a little tainted. Or what about the doctor that does something against a patient's wishes because it's in their "best interest?" Or one that violates the Hippocratic oath for the "greater good?" Almost every doctor on every medical show does one of these things. The longer the show runs, the more ethical violations for every character, and the more extreme they get.
Because we know it's a TV show, we know that these characters won't experience the consequences they should. They won't be stripped of their medical license, they won't be fired, if they're suspended it won't be for very long, because as soon as they're no longer doing their job, they no longer have a place on the show. Consequently, all of the doctors are accumulating these ethical violations to the point where I'm horrified every time they treat a patient.
Because of all of these problems, over time the doctors on a medical show turn into indecisive immoral fuckwads that I no longer want to watch. I don't identify with them, I don't admire them, and I stop seeing them as heroes.
Even though you would think that a medical show would have an infinite mine of angsty story-lines that would be right up my alley, I find that they lose their sheen much quicker than other types of shows do. I just can't watch that many episodes before I have to switch to something else.
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no subject
Date: 2007-04-27 04:21 pm (UTC)I'm not sure I follow this one. I had my lymph node biopsied because the doctor wanted to be sure--he was pretty sure from the CAT scan that is wasn't cancerous, but the potential consequences outweighed the riskes of checking. It's not a cracked thorax, but it seems like the same thing you're talking about.
no subject
Date: 2007-04-27 04:34 pm (UTC)I recognize that a doctor is not always going to be right, nor can they be expected to be, but I have a hard time seeing a doctor as heroic when they disregard that their choices do have consequences for their patients; consequences the patient may not understand. The narrative frames the doctor's decision as acceptable risk, and it sort of bothers me when the consequences are oversimplified just to make our heroes look good.
no subject
Date: 2007-04-27 04:34 pm (UTC)no subject
Date: 2007-04-27 04:36 pm (UTC)But yeah,there's not so much you can do regarding outcomes with medical shows, but it would be nice to see more consideration given the outcomes which are not "Hey, you're dead/alive!" Things like long-term care, debilitating disease conditions lingering on. There's just no time to devote to that when you have to kick off the patient-of-the-week in favor of your mainstays, alas.
no subject
Date: 2007-04-27 04:44 pm (UTC)I was thinking about this some more--in the types of shows I usually watch, your Supernaturals and X-Files and Buffys and Law and Orders, your standard episode is hero is presented with a problem/challenge, hero solves it, whether that's a MotW or a mystery. This means that most of the episodes your heroes are just being heroic because they are doing their job competently and solving the dilemma.
On a medical show, doing their job competently would mean watching the surgeons do tons of succesful routine surgeries. Yay! Except--no. Boring. The drama only comes when they fuck up/make bad decisions. Which means that you are always having them doing things that undermine what we are supposed to believe their character to be.
In a show like Buffy, she kicks ass most of the time so that the one or two times a season she doesn't, it's a gut punch and incredibly angsty. In a show like Grey's Anatomy, the doctors are constantly doing the wrong thing so you stop believing that they actually are amazing doctors.
Medical shows just tell different types of stories.
House, on the other hand, follows the format of a Law and Order. The drama every week is the patient's case, and House and co. solve it like a mystery. It's not always about them personally.
But on ER, the characters are emotionally raked across the coals every episode and I just don't think doctors would last very long reacting like that.
no subject
Date: 2007-04-27 04:56 pm (UTC)It's interesting to think of this in terms of shows like X-Files and Buffy which, though they definitely do the monster-of-the-week stuff, I usually consider to be arcing series more than procedurals like I'd say ER or L&O are. There are the similarities, but the differences make Buffy more interesting, say, than ER for the fact that she messes up because she's human whereas, as a non-doctor, I have the need to believe doctors are little bit above us norms (because otherwise I will worry about that when I need to trust them to be medical machines instead of flawed people).
I guess it's less fun to think of people who are responsible for saving lives as being fallible than it is to see weakness elsewhere. ::shrug::
no subject
Date: 2007-04-27 05:10 pm (UTC)no subject
Date: 2007-04-27 05:11 pm (UTC)no subject
Date: 2007-04-27 05:25 pm (UTC)Plus, that doesn't solve my problem that we are told the characters are one way (best doctors in the world) but are shown them acting in a completely different way (killing patients accidentally, letting murderers die deliberately, ignoring patients' wishes...). I have a hard time continuing to believe they are great doctors when they never act like them. Just like I'd have a hard time believing a character was a stoic silent type if they cried and spilled their guts in every episode, or I'd have a hard time believing Scully was a good cop if she could kidnapped every episode, which the X-Files came perilously close to doing.
So some of it is the quality of the writing, but some of it I think is just a flaw of the genre.
no subject
Date: 2007-04-27 06:25 pm (UTC)no subject
Date: 2007-04-27 05:31 pm (UTC)no subject
Date: 2007-04-27 06:22 pm (UTC)