Have TV soaps lost the plot?

Television schedules are packed with hospital dramas and medical storylines. But why do they keep getting it so wrong?

Ben Goldacre
Tuesday February 10, 2004
The Guardian

Ronny has been stabbed. He is rushed to hospital, where the doctors realise he has lost a kidney: his only kidney, in fact. Gasp! He urgently needs an emergency kidney transplant, and only his family can help. “He needs the transplant now!” “Ronny is stable, all he’s gotta do is stay that way until we have the tests…”

I’m biting my nails. But only because I’m worried about just how dodgy EastEnders’ medical advisers can be. Real-life donors are a moral and emotional minefield, so let’s just calm things down a bit. Emergency kidney transplants don’t happen. There is a fantastic machine called a haemofilter, invented a few decades ago, which makes rather a lot of money for Baxter Healthcare. They are available on most intensive therapy units and they mean you can potter along for years with no kidneys at all.

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So what sort of a doctor would make a patient go through a major transplant operation, followed by life-threatening doses of immunosuppressant drugs to stop them rejecting the organ, just after they had been stabbed, when there is a perfectly good way of keeping them alive and well until they are ready for an operation and a donor can be found, gently and appropriately?

Maybe I’m just being picky: after all, it’s hardly the first time television doctors have cocked up, and I am surprised the corridors of Holby City, Casualty, Doctors, and EastEnders aren’t crawling with medical negligence lawyers. I have lost count of the number of times I have seen a baby being waved around in the cold and rushed into neonatal resus before they even bother to dry it off with a towel. Nice try, shame about the hypothermia. Or there was that great life insurance advert, where some old guy is being told there is nothing wrong with his chest x-ray; apart from the large and clearly visible pair of woman’s breasts, which might set off alarm bells in your mind, when looking at a man’s chest film. Or how about that Neighbours episode where they smear electrode jelly on to the defibrillator paddles while charging up, and then rub them together to make sure the stuff is nicely spread around (stand well clear if I were you), before shocking the patient back to life with her oxygen face mask still on.

Intubated patients on intensive care cheerfully holding conversations; surgeons heroically running cardiac arrests while the anaesthetist stands there looking worried (I don’t think so); and I’m sure I saw that Robert Winston get into an MRI scanner once, wearing his glasses (anything made of metal would fly across the room and kill someone).

It is so prevalent that there is even a medics’ drinking game called “Casualty” where you all sit around the telly on a Saturday night, and when some good-looking young doctor sticks up an x-ray the wrong way round, everyone has to stand up and shout “Bollocks!”, and the last one to do it has to down a pint of urine. OK, I made the last bit up.

But is it really so bad? Yes. Kidney transplants, especially from live donors, are a difficult moral and emotional area, and even the BBC has recognised that, running a campaign through Holby City to get more people on the NHS organ donor register. “It’s Tariq’s duty to find out if he can act as a kidney donor…” doesn’t really cover the issues appropriately.

I can understand that they might have needed a clumsy plot device to break the story that Tariq is Ronny’s half brother; but imagine you have been worrying and waiting months and years for a live donor kidney transplant, going through the colossal hassle of being haemofiltered, and then you watch EastEnders. What are you going to think? Here I am waiting patiently, and it must be all these emergency kidney transplants that are bumping me down the list? What are these doctors waiting for? If only I’d been stabbed…

It is hardly an isolated incident. A classic paper in the British Medical Journal gave the first quantitative estimate of the size of the pinch of salt that should be taken when watching soap operas. In an analysis of the deaths in four soap operas over 12 years, they found that the most dangerous job in Britain was not, as previously suspected, a bomb disposal expert, steeplejack, or racing car driver; but being a character in a soap opera. A character in EastEnders was twice as likely to die during an episode as a similar character in Coronation Street, and deaths in soap operas were almost three times as likely to be from violent causes than would be expected from a character’s age and sex. Characters tended to die young, and from a variety of obscure and often violent causes: ranging from the mystery virus in Brookside, which killed three, to a plane crash in Emmerdale, which killed four. The authors recommended protective clothing, and regular counselling for the psychological impact of living in an environment not dissimilar to a war zone.

People have a weird enough view of risk already, and hospitals are scary places. But television even manages to give a distorted view of birth, as well as death. Sarah Clement at Guy’s and St Thomas’s hospital analysed the 92 televised births in one year of television: out of just 92, four babies and one mother died, and another five babies and four mothers experienced life-threatening complications. Labour was portrayed as a quick and unpredictable process, resulting in an unexpected event, such as giving birth in an strange place without a professional in attendance, or without the intended companion present, in a third of the fictional births shown. Most worrying were the low levels of analgesia used during labour: gas and air, opiates, and epidurals were used in just 7%, 3%, and 5% of the births respectively.

I know it is only pretend, but childbirth is scary enough; and there is a plethora of studies showing that television and the media affect people’s perceptions of their own health, and risk, and healthcare, and worse , can change their behaviour. The least we could do is make sure the horror stories are accurate.