Medicine in TV drama: keeping it real

“The safest place to get stabbed?” Chris Peters doesn’t miss a beat. “The buttock, away from the anus.” It’ll bleed copiously, apparently, but shouldn’t cause too much damage.

“Arm and leg wounds are generally speaking pretty safe if you don’t sever a major vessel or hit a major nerve.” Those also bleed a considerable amount, he tells me, though not as much as a head wound. “A minor cut on a scalp can bleed a lot. They really like head injuries on EastEnders, and they really like people being stabbed in the chest.”

Peters, a consultant surgeon at St Mary’s Hospital, Imperial College London, is trying to move EastEnders away from head and chest wounds. They might be the perfect route to sprawling characters on the ground in dramatic pools of blood but as injuries go, he thinks they can get samey. As a medical supervisor on TV drama, creativity is all part of the job.

“If anyone was looking at my email trails it would probably make me look like a psychopath,” jokes Peters. His outbox is full of suggestions for ways to stab people for any desired outcome – death, a quick recovery, a lengthy hospital stay or a down-to-the-wire life-saving operation. It’s not only stabbings. For EastEnders he can devise an illness or addiction that will take a character on a years-long arc, or an ingenious murder-of-the-week method for a detective mystery. One of his Death In Paradise murders is coming up, he tells me, “a clever little trick that works really well.”

For 2018 ITV drama Trauma in which a surgeon was accused by a grieving father of making a surgical error that led to his teenage son’s death, Peters worked with writer Mike Bartlett (Doctor Foster) to design the initial wound and the surgical procedure in which the mistake may or may not have occurred. He also performed the surgery for Trauma’s close-up shots, though they didn’t make the final edit.

Hand-stitching sutures takes surgical trainees around two years to perfect, so while Peters is able to coach an actor on the correct body position, arm movement and hand placement for surgery in approximately half an hour “if they’re really good,” complex surgical close-up shots require the hands of a real surgeon. You can see his currently on Sky One drama Temple standing in for those of Mark Strong, who plays a surgeon operating an illegal underground medical unit.

Medical coaching is one thing required for a realistic-looking surgical scene on screen. The other? Fairy Liquid. When fake blood is being pumped into the cavities of prosthetics such as those created by Millennium FX for Temple, it foams too much to look real. “You stop it foaming by putting a layer of washing-up liquid on top,” explains Peters. “Under the lights, surgical swabs and tools dry out too quickly too, so we use washing-up liquid to give them that moist, wet, shimmering look.”

FX tricks aside, script advising on medical matters is Peters’ real TV work. He finds it a fun intellectual game to play, a question of devising scenarios that are medically correct while being dramatically exciting. It’s all about getting the right balance between realism and peril. If a hospital drama were made solely to reflect real life, “you’d have people standing around for twenty minutes at a time, waiting for the lift. There’s lots of signing letters and monitoring patients. Medicine can be incredibly exciting, but the really exciting things don’t happen as often as they do on TV.”

If they did, it would be disastrous. “Holby City [where his handiwork can also be seen in surgery] is a classic one for this. Every time there’s an operation in Holby, there’s a problem. If we had that level of complication, we’d be shut down as a hospital.”

In the heightened world of thriller Temple, the needs of drama are allowed to trump those of realism, says Peters. Its hyper-real setting underneath a London tube station allows for a bit of leeway when it comes to accuracy. On a soap, it’s a different story. “What happens on EastEnders is playing out in an NHS hospital, therefore it’s branding what happens in our healthcare system. When you get that wrong with eight million viewers, you can really screw things up.”

There have been cases where Peters has refused to advise on storylines if they were to play out in a way he felt would be harmful to the public. There was an episode of EastEnders planned in which Steve McFadden’s character Phil Mitchell, a long-term alcoholic and and former crack cocaine user, was supposed to vomit blood and then go to bed and carry on as normal.

“If you vomit up blood as an alcoholic, that can be fatal,” says Peters. “Were people to see that and vomit blood themselves – it may sound silly – but they could think ‘These things happen, I’ll probably be alright’ whereas in fact the message should be that if you’re vomiting up a proper amount of blood, you need to phone 999.’

Peters was approached about Phil Mitchell’s storyline in 2015. The show’s producers were looking for a chronic illness for the character that would last around a year, from which he would eventually recover and emerge revitalised as a person. “There was a concern that Phil was becoming a bit of a grumpy belligerent and not as interesting in his old days of being a gangland king.”

The idea of liver failure leading to a transplant was devised, a plan Peters describes as the perfect public health storyline. “If it’s done well, you have an important condition – alcoholic liver disease – and can accurately portray how patients are looked after, the issue of organ donation, the lack of organs, and you can show that it can give people their life back.”

In the storyline, the series and Peters were keen to avoid a recurrence in what’s known as “the George Best phenomenon”. When former footballer and alcoholic Best was reported to be drinking again after undergoing a liver transplant in 2002, “there was a notable decrease in people choosing to donate their liver” says Peters. “Therefore if we showed Phil having liver disease, getting a new liver and then drinking again, that would reinforce all of the negative stereotypes to the public – that alcoholics who show no signs of remorse are getting brand new livers.”

The answer was to show the character struggling with alcohol, getting support to stop drinking, and being tested to make sure he was ‘dry’. It was all designed to reflect that fact that giving up drinking is difficult and that the efforts of those trying to do so wouldn’t be belittled. Peters really hopes that some of those watching saw Phil’s storyline and thought about cutting back on their own alcohol intake.

Another EastEnders storyline on which Peters advised involved Lacey Turner’s Stacey Slater, a character who suffers from bipolar disorder and was diagnosed with postpartum psychosis after having her son. “Mental health after having given birth is really, really important. We need people who have a mental health problem after giving birth to seek help. If we portrayed that storyline as Stacey having her baby stolen from her by disclosing her illness, people would not go to seek they help they need.” Instead, they showed the process of treatment and follow-up support available to Stacey, and the storyline was praised for its empathetic treatment of the issue.

When TV shows do get it wrong, the medical community isn’t shy about speaking up. “Doctors absolutely love to pick up silly little errors that are of no consequence. We love doing that,” says Peters. “I bet everyone does. Truck drivers watching a truck driver on a film will say oh, you’d never do that.” A favourite complaint is that the chest X-Ray in the opening titles of NBC comedy Scrubs, is back-to-front, though Peters tells me that was done deliberately as an in-joke.

Incidentally, 2004 Channel 4 comedy Green Wing and Scrubs are the two TV shows Peters really rates in terms of portraying hospital life. “They capture the absurdity of what we do and they capture beautifully the humour and interactions that occur between doctors and nurses. That interaction between the staff is in some ways more realistic in Green Wing and in Scrubs than in Holby, where you have huge long periods of people being ultra-serious with each other and talking really seriously about stuff and being very grown up all the time.”

One recurring on-screen mistake that does “drive everyone nuts” says Peters, is when a patient in asystole (i.e. their heart has completely stopped beating) is revived through defibrillation. That doesn’t happen in real life, but flatlining hearts are shocked back into action all the time on TV and film.

Another more serious TV falsehood is the success rate of cardiopulmonary resuscitation (CPR) on screen. “If you see someone whose heart stops on TV, either on the street or in the hospital, there is an excellent chance that they will be brought back to life via breathing and chest compressions. In reality I’m afraid to say that the success rate of that is really much, much lower.” Medical bodies have complained that the frequency rate of successful CPR on television sets up unrealistic expectations from the public.

Doctors and nurses may be irked by an upside-down surgical instrument or the wrong colour scrubs being worn in theatre, says Peters, but what they care most about is when audiences are being given a message that might stop them seeking help. “We get upset when we see a doctor who’s rude to their cancer patient, and doesn’t explain things properly, or a doctor who is dismissive of someone’s concerns or when a condition isn’t taken seriously enough.”

Or the opposite, and a condition is treated with undue gravity. One storyline in Holby City came under fire by the medical community for depicting a young patient given a stoma (an incision made into the abdomen to bring a section of the bowel outside of the body). It’s an incredibly routine operation had by thousands of patients each week, says Peters, and with it “you can lead a totally normal life. You can swim, you can go out, you can do whatever you want. They don’t smell, they don’t leak, it is not a big deal and yet the way it was portrayed in this scene was that this young person’s life was over.”

Real medicine doesn’t need overegging to create drama, says Peters. “If you stuck a camera in A&E at the weekend at St Mary’s Hospital trauma centre, you would have narratives that if you tracked them back would be every bit as fascinating to the public as an EastEnders storyline.”

That’s exactly what was done by acclaimed BBC documentary series Hospital, the first run of which was filmed at his St Mary’s workplace. As well as the responsible public healthcare messages carried by dramas such as Call The Midwife, factual shows like Hospital and Channel 4’s 24 Hours In A&E are a real boon to the profession says Peters. They showcase the daily reality for NHS workers and the efforts gone to for every patient who comes in the door.

“The number one cause of bankruptcy in America is medical bills. The most amazing thing about the NHS is that it doesn’t matter how rich you are, if you are properly sick, the world is moved to make you better. You’re never going to lose your house because of your medical bills.”

 “The NHS is an amazing institution where everyone is working more hours than they’re ever paid for, are being battered and bruised and really stretched, but what they really want is the best for their patients.”

Chris Peters is on Twitter at @oesophagusuk. Temple is available to stream now on Sky and NOW TV.