Medical Procedurals Part Two

Dwayne Clayden profile

Like its police counterpart, medical procedurals have a long history in television.

ER (Premiere September 1994)

Author Michael Crichton, author of 18 novels, (thirteen were made into films), wrote a screenplay in 1974 based on his experiences as a resident physician in a busy hospital emergency room. The screenplay went nowhere and Crichton focused on other topics including the novel Jurassic Park (1990). In 1993 he collaborated with director Steven Spielberg on the film adaptation of Jurassic Park. Following the success of the movie, Crichton and Spielberg worked on ER as a movie, but decided a two-hour pilot for a television series would work better than a feature film. The script for the pilot episode was virtually unchanged from what Crichton had written in 1974.

ER aired on NBC from September 19, 1994, to April 2, 2009, with a total of 331 episodes spanning over 15 seasons. ER follows the inner workings of the emergency room (ER) of fictional County General Hospital in Chicago, Illinois. A typical episode centered on the ER or surrounding streets with physicians and staff facing critical issues. In the first season, ER attracted an average of 19 million viewers per episode, becoming the year’s second most watched television show, just behind Seinfeld. In the following two seasons (1995-1997), ER was the most watched show in North America. For almost five years, ER battled for the top spot against Seinfeld, but in 1998, Seinfeld ended and then ER became number one again. Ratings started to fall in season nine, when it fell out of the top 3. As far as medical procedures go, it was great up to season five, then slowly dropped off into more interpersonal drama as well as trips around the world and away from the ER we first came to know. It didn’t help that original cast members started leaving and I’m not sure viewers bonded as well with the replacements. ER is NBC's third longest-running drama, after Law & Order and Law & Order: Special Victims Unit, and, the longest-running American primetime medical drama of all time. In addition to the main cast, ER featured a large number of frequently seen recurring cast members who played key roles such as paramedics, hospital support staff, x-ray techs, orderlies, porters, nurses, and doctors. It was great to see the ‘team’ approach and not just ‘doctors’ knowing all and doing everything. ER's success surprised the networks and critics alike, as David E. Kelley's new medical drama Chicago Hope was expected to crush the new series. In 1994, Crichton became the only creative artist ever to have works simultaneously charting at No. 1 in U.S. television (ER), film (Jurassic Park), and book sales (Disclosure).

The pilot episode of Chicago Hope was broadcast the day before NBC's ER. After the first week, however, the two Chicago-based hospital dramas went "head to head" in their primetime 10 p.m. Thursday night slot. ER was the victor, and Chicago Hope changed time slots. Despite receiving critical acclaim, Chicago Hope just didn’t connect with audiences the way ER did. That’s a shame, as Chicago Hope was, in my mind, the better medical procedural. Just shows what I know! Also shows the power of fiction, and drama, and that viewer’s look for entertainment value more than reality. If Chicago Hope had aired a year or two later, I think it would have had continued success. Chicago Hope performed well in the Monday slot. In the second season, two key personnel left the show. Mandy Patinkin as Dr. Jeffrey Geiger, decided to leave the show. Arguably the star and best liked character, this was a blow to the show. Second was the loss of show creator, David E. Kelley. Those two losses spelled disaster for the show. In 1999, Season 6, both Kelley and Patinkin returned, with a revamped cast now including Barbara Hershey and Lauren Holly, but it was far too late. That was the shows final season.


In 1970, movie audiences were introduced to medical personnel at a Mobile Army Surgical Hospital (MASH) during the Korean War. The 1970 hit was quickly followed by the TV series. Both were based on the 1968 novel, MASH: A Novel About Three Army Doctors, by Richard Hooker. While St. Elsewhere was a fresh new look at doctors and hospitals, and ER took us into the life and death struggles of an emergency room, MASH is still my favourite medical drama. Not only was it a tight, well-written show, it portrayed medicine the way it is really practiced – as a team.

The series premiered on September 17, 1972, and ended on February 28, 1983. MASH struggled in its first season and was almost cancelled. In season two, MASH was placed in a better time slot (airing after the popular All in the Family). The show took off and became one of the top 10 programs of the year and stayed in the top 20 programs for the rest of its run. The series is usually categorized as a situation comedy, though it is also described as a "dark comedy". The TV series, which depicted events occurring during the three-year Korean War (1950–1953), spanned 256 episodes and lasted 11 seasons (8 years longer than the actual war)!

Many of the stories in the early seasons are based on tales told by real MASH surgeons who were interviewed by the production team. Like the movie, the series was as much an allegory about the Vietnam War (still in progress when the show began) as it was about the Korean War. I suppose I’m stretching it a bit (a lot!) by including MASH as a medical show, but what always impressed me was that when the ‘stuff’ hit the fan, everyone chipped in. And that’s what it’s really like in an emergency, whether on the street or in a hospital or MASH unit. It’s all hands on deck. Klinger and Father Mulcahy were just as important to the survival of patients as the skill of the surgeons and the talents of the nurses. They worked hard together, and partied even harder. That, to me, is the way it really is. According to the New York Times, the series finale (1983) titled, "Goodbye, Farewell and Amen", became the most-watched and highest-rated single television episode in U.S. television history at the time, with a record-breaking 125 million viewers! By comparison, the 2017 NFL Super Bowl drew 111.3 million viewers. In 2013, the Writers Guild of America ranked MASH as the fifth-best written TV series ever and TV Guide ranked it as the eighth-greatest show of all time.

For me, the pickings were fewer for good medical procedurals than police procedurals. I will give an honourable mention to Scrubs. Not for medical procedures - it was just darn funny! I can hardly wait until next month, though. The new TV season starts and I’ll have a whole new list of “Things TV and Movies Gets Wrong in Police and Medical Procedurals”!

What does any of this have to do with your writing? I think you need to be accurate in your writing about the things that are factual. If you want to change the fact, then you need to have a very good reason or have created a unique world where the ‘facts’ are different. If you are writing police or medical procedurals, here’s where you can check your facts.


About Dwayne Clayden

Dwayne Clayden has served in many roles over his 40 years in Emergency Services including as a police officer, a paramedic, an educator, and as an EMS Chief. Dwayne is a respected writing instructor teaching authors the craft of writing and storytelling. Dwayne previously published four paramedic textbooks and has spoken internationally at EMS conferences over the last twenty years. He also speaks to fiction writers Associations (ARWA), Calgary Crime Writers, and Writer Conferences like When Words Collide (WWC). Dwayne also uses his knowledge of EMS in his crime thrillers. His first novel, Crisis Point, was a finalist for the 2015 Crime Writers of Canada, Unhanged Arthur. Dwayne is the author of “What TV and Movies Get Wrong” series. He is also the writer behind ‘First Aid for Writers” which helps fiction writers incorporate accurate medical and police procedures in their writing scenes.

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