Abstract
Photo courtesy: BBC/Neal Street Productions.
A grimy bedroom in East London. A pregnant woman lies gasping for air, her throat constricted by the effects of diphtheria. The nurses in attendance wipe her sweat-drenched face. I enter the room, my doctor’s bag in hand. I assess the situation and conclude that an emergency tracheotomy is required to save the woman and her unborn child. The nurses comfort the patient, as I prepare the scalpel. The woman’s rasps become more desperate. I spread the skin of her throat and press the scalpel to the flesh, ready to slice.
A voice is heard nearby. “And … cut.”
This is thankfully not a command to proceed, but an instruction to cease. My patient’s breathing instantly revives. We are on the set of a TV drama. The voice belongs to my director, and I am an actor portraying a fictional doctor called Patrick Turner.
My name is Stephen McGann. For more than 30 years, I’ve worked as an actor in British film, TV and theatre. Recently, I’ve been privileged to play a GP in the hit BBC period medical drama, Call the Midwife, set in the poor Poplar district of East London during the early years of the NHS. Dr Turner is an overworked but enthusiastic practitioner on the front line of post-war urban health. The series is enormously popular – viewed by more than 10 million people each week, and sold to almost 200 territories worldwide. The medical stories featured are not confined to childbirth but embrace wider social issues such as infectious disease and the health consequences of deprivation.
My fascination with the role is not simply artistic. I love to explore the relationship between medical science and the wider society it serves. While working on Call the Midwife, I completed an MSc in Science Communication at Imperial College London – with a particular interest in narrative representations of science in media. Playing Dr Turner has given me some interesting insights into questions regarding the way popular culture portrays medics and medicine. For instance: how do dramas like Call the Midwife ensure sufficient medical accuracy and authenticity? Are they successful? And by what, or whose, criteria should success be judged?
It might be tempting for professionals to measure effectiveness of medical portrayals purely in terms of a narrow procedural accuracy. Yet I suggest that the real communicative power of drama lies in a wider sense of dramatic truth, or authenticity of portrayal. How the TV medic depicts something is only a part of the story, albeit an essential one. More important is establishing a belief in who this medical character is, and why their actions matter. This is crucial to achieving full engagement with the medical themes, characters and outcomes shown – without which all procedures are meaningless.
To explain, I’ll outline some of the specific methods we use at Call the Midwife to ensure procedural accuracy, before discussing wider ideas of dramatic character and story authenticity.
Issues of medical accuracy in Call the Midwife begin at script development stage, when series writer Heidi Thomas researches possible story lines. The drama was originally based upon the memoirs of a midwife – Jennifer Worth 1 – who practised in East London in the late 1950s. However, the series long since departed from Worth’s accounts – with all plots now created by Thomas and inspired by period documents or living testimony. A particular source of inspiration has been the Wellcome Trust archive of the reports of the Medical Officers for Health in Poplar at that time. 2 These fascinating documents outline not simply the health data and housing conditions of the district but include extensive personal comments by their authors – casting a living light on the neighbourhood and the issues that preoccupied it.
Initially, Heidi undertakes her own medical research, using open-access journals or contemporary sources. Once the first draft is complete, medical details are then checked for accuracy. An early copy is sent to our series clinical advisor, Terri Coates – a practising midwife and midwifery lecturer. Terri oversees all aspects of childbirth and nursing procedure on Call the Midwife. Facts are checked, and any amendments incorporated into subsequent drafts. If the content requires more specialised medical knowledge, then Coates will consult an expert in the respective field.
In addition to individual expertise, our production engages assistance at an organisational level for issues with a significant social impact. For instance, we have featured stories involving cystic fibrosis and neonatal death. These subjects can have strong communities of support, specific vocabularies, conflicting public perceptions or painful social histories. Our production therefore conferred with The Cystic Fibrosis Trust 3 and Sands 4 to ensure their support for our story and to offer valuable expert advice.
By the time a script is ready to be filmed, the text has undergone substantial medical examination. Attention then moves to the embodiment of this medical detail in characters and action. This is where I come in. On the film set, Terri Coates is the actors’ principal medical advisor. Where she doesn’t possess the specific medical skills, she will consult a specialist beforehand or else bring an expert to advise on the set. Terri oversees not just what actors do and say but also the correct use of a dizzying array of period equipment and implements – ranging from a 1950s sphygmomanometer to an entire post-war mobile X-ray vehicle, loaned by the Science Museum for an episode. 5 This equipment can sometimes present amusing challenges. On one occasion, we were very pleased to acquire an antique gas and air machine for use in a birth scene – only to find that nobody knew how to turn the thing on. Hasty calls were made, and instructions conveyed.
One interesting accuracy issue for me is phraseology. Medical language can be notoriously complex, yet as a doctor I must pronounce strange terms not simply with the confidence of a professional but also with the correct stress. Moreover, the same term used by several actors in the story must be used consistently by all, and across many scenes. Filming is sometimes stopped so that a consensus pronunciation of a word or phrase can be verified.
Terri watches the action on a remote monitor and stops the scene if she spots an error. In my case, this is all too common. I’m frequently coached on complex obstetrics – but also on the simplest of procedures, such as taking a pulse. After four years as Dr Turner, I still know practically nothing about medical matters. Yet this is of little concern to me. The background work that an actor does rarely involves the study of detailed procedure. This knowledge is provided on-site as needed – or, in complex cases, through brief rehearsal sessions beforehand. In a sense, we delegate procedural detail to the writer and experts, so that we can focus on the bigger picture: making the medic we play not simply accurate, but, in the widest human sense, authentic.
What do I mean by this? Aren't accuracy and authenticity the same thing? Doesn’t showing a doctor doing things accurately bestow all of the necessary authenticity that a performance requires?
I suggest not. I use the word ‘accuracy’ here as the means by which one identifies a character as an exemplar of a particular class of medical professional through procedural action – and ‘authenticity’ as the process by which we create a particular doctor – a unique human individual – within this social group. It is this particularity of character that gives drama its communicative force – a character’s loves, fears and motivations. My job is not simply to represent an acceptable approximation of all doctors through my actions but, through portrayal of an individual medic, throw a light on key human aspects of doctors’ lives and experiences.
The idea of a medical character being judged as representative rather than particular can expose some interesting assumptions and subjectivities in an audience. For instance, Dr Turner is a smoker. I myself am not, and find it repellent. Yet I smoke when playing the part, because it’s a valuable insight into Turner’s character, and a reminder of how such medical hazards were once little understood or heeded, even by medics. I was inspired to make him a smoker after reading a BMJ study which observed the effects of smoking on men over a 50-year period, starting in 1951. 6 A total of 34,439 smokers took part in the research – all of them doctors. However, some medical professionals have been uneasy about Dr Turner smoking. Many would prefer me to drop it, or else show some health impact of his habit. Yet is it more ‘accurate’ to represent a modern medical health exemplar, rather than a plausible period character? Or are some forms of accuracy simply more acceptable than others?
Another complaint I’ve encountered is that depictions of our births are inaccurate because they differ from a modern practitioner’s experience. Yet present-day methods shouldn’t be assumed to apply for all eras and circumstances. An example is the delivery of the placenta, which some midwives say isn’t shown often enough after our births. However, at this time all placental deliveries were physiological rather than Oxytocin-induced, and so could take much longer. Such a delay would simply not be dramatically interesting. Likewise, the screen time given to particular labours may sometimes seem unrealistically rapid. Yet to show real-time birth would produce absurd scene lengths. Passage of time is therefore represented using editing conventions – not strictly accurate, but perfectly authentic for the intention of the scene. Screen drama authenticity is not just a matter of including everything that occurs – it is about selecting moments that serve the story with sufficient fidelity to communicate its key meanings.
Yet what is the value to medicine in these ‘meanings’? Does TV drama have any contribution to make to important public issues in medicine and health? One example suggests so. Last year, our production was asked by BBC’s international development charity, BBC Media Action, to assist a Bangladeshi TV health drama called Ujan Ganger Naiya (Sailing Against the Tide). 7 Bangladesh is a conservative culture, where discussing pregnancy and childbirth remains taboo. Maternal and infant mortality rates are high: 20 women die of pregnancy-related causes every day. Ujan Ganger Naiya wanted to communicate safe maternal health practices to the population by depicting authentic birth scenarios through drama. Yet birth had never been shown on Bangladeshi TV – and the production had no knowledge of how to achieve it. We were delighted to help. Following consultations with our writer and producers, director Georgis Bashar and his team visited our set in Surrey to observe a filmed birth in action. Terri Coates travelled to Bangladesh to provide on-site technical expertise – even employing some of the fake umbilical cords we’d used in previous Call the Midwife sequences. The collaboration was a great success – with a positive response to the birth scenes among Bangladeshi audiences, despite previous cultural fears. The medical accuracy and authenticity pioneered by Call the Midwife had helped to disseminate valuable insights with clinical integrity and trans-cultural impact.
Evidence for the ability of drama to act as a catalyst for wider medical understanding can also be found much closer to home. When the episode of Call the Midwife featuring the mother with diphtheria was broadcast in the UK on 15 February 2015, NHS Choices website reported that user enquiries for information on diphtheria increased by a massive 3720% – with 30,000 visits occurring during transmission. 8 Our viewers weren’t simply being entertained – they were inspired to investigate these issues for themselves, using reliable online medical sources. In an age when complacency or misinformation regarding the safety and purpose of vaccine threatens the return of previously eradicated contagions, the power of dramas like Call the Midwife to raise medical awareness should not be underestimated.
The reason that drama can be so effective as a vehicle for wider comprehension is that it possesses the power to convey feelings, meanings and the impacts of human action through characters in narrative. It connects with an audience not simply by physical depiction of events but via an examination of consequences – emotional, medical and personal. Drama delivers vicarious insight into what other realities might mean for people in other situations. A fictional multiverse of our own possible futures. In doing so, it tells us about ourselves, and about the things we all have in common.
As a result, it shouldn’t surprise anyone that the medic is such a central character in popular TV drama. The doctor is the only practitioner of science that most ordinary citizens will encounter in their lives. A doctor doesn’t simply stand at the interface of science and society – they are that interface – literally the human face of science turned towards its people. A doctor is uniquely trusted to touch our bodies – even to pierce our skin. The human that holds that scalpel is, therefore, subject to the deepest curiosity by the culture that sustains them. My quest as an actor is not simply to interrogate the narrow procedures of that scalpel’s use but to explore the character of the remarkable person that wields it for the good of others.
Like medicine itself, my work is ultimately an exploration of humanity, not of process.