nm0063: as far as the history of the medical drama goes on T-V er i'm going to 
be showing a documentary er after the lecture er called er i think it's called 
Docs on the Box it's part of the Docs on the Box er theme evening on B-B-C-two 
couple of er it was about three years ago now er and in in that theme night 
there was a documentary er called Playing Doctor and it's it's interviews with 
it consists of interviews with er well the programme makers medical dramas and 
that gives quite a good history anyway it's very good actually gives g-, quite 
a good history of the er er development of the medical drama in in the U-K and 
in the U-S so we'll be seeing that anyway er after after this lecture so what i 
want to concentrate on is Cardiac Arrest mostly er although some of the things 
i'll be saying obviously one can extrapolate and generalize to other medical 
dramas and other programmes as well okay so i'm going to start er hot docs hot 
docs this is the cover of 
the Radio Times can you see that it's got Helen Baxendale [laughter] and er 
Mandy Patinkin yeah it's hot docs why we're addicted to medical dramas why 
we're addicted to medical dramas er and the and the date of that is ninety-five 
June ninety-five and that's really the high point of the medical drama in 
Britain it's at that point the medical drama was the er the power genre of the 
nineteen-nineties today er the power genre is obviously something different er 
you might call it makeover television tune in on a on prime time on a Friday 
night er there's a succession of makeover programmes rooms being madeover 
people er gardens so on and so on so i-, it's a different power genre but 
certainly the mid-nineteen-nineties nineteen-ninety-five er think there were 
about three covers of the Radio Times that had references to medical dramas on 
it er so the Radio Times was quick to cash in on er what had become this power 
genre of the mid-nineteen-nineties the medical dramas they were seen by the 
Radio Times as 
sexy and post-modern and of course they give a strong visual hint on the cover 
about the answer er ah only a couple of minutes in are there roadblocks up in 
Leamington or something 
sm0064: 
nm0063: mm okay so why we're addicted to medical dramas answer Helen Baxendale 
Mandy Patinkin should have it should have been George Clooney obviously but er 
B-B-C were showing Chicago Hope er so they can be er they were seen as sexy and 
post-modern medical dramas yeah sexy and post-modern and of course there's that 
playful use of the word addicted yeah so a-, at once we get the glamorous 
address of those programmes in terms of star appeal and in terms of the 
seductive visualization of medical procedure now with reference to Cardiac 
Arrest i want to argue that this series is is transitional hi there namex a 
transitional series one that revises the concerns of earlier British medical 
dramas er within a generically aware context and this generically aware context 
is kind of in 
dialogue with other British and U-S medical dramas what Cardiac Arrest does 
specifically is is to enact a shift of attention from a concern with the 
patient and nation as victims of welfare cuts er to a concern with junior 
doctors er as victims of a pernicious system and in addition to that a sense of 
the junior doctors themselves er er er being situated as victims there's 
another sense that they they have to en-, e-, endure and suffer the weight of 
their generation of a kind of depoliticized er generation that doesn't have er 
er direction as i said much of what i'll say about Cardiac Arrest can be 
extrapolated er and applied to other er nineties medical dramas and indeed 
instances of the er professional genre what interests me about this programme 
is the way that it self-consciously adopts er a radical formal a narrative 
rhetoric while abandoning our previous er er we might call ol-, old-fashioned 
er political commitments so in a sense i think it's er not so n-, so much 
conservative or 
reactionary but it doesn't really have an alternative to its er er to its n-, 
er cynicism and and in some ways er er nihilism okay i'm going to give you some 
discursive contexts for er the medical drama in the nineteen-nineties er in 
other words ways of er these were ways of thinking about er er health care and 
the politics of health care in the world in general not just in the t-, in the 
television medical drama but in the world now clearly the n-, the biggest or 
the most im-, significant di-, discursive context is that of privatization okay 
so in the nineteen-eighties there was er considerable anxiety er about the er 
well the anxiety and and fear about the possible privatization er the creeping 
by the back door privatization of er er that may have been put in place by the 
Conservative Party indeed privatization was indicative and er closely connected 
to Margaret Thatcher's Conservative Party er rhetoric now this sense that this 
idea that the the N-H-S the National Health Service could would be er 
interfered with er by er the ideology of business and the market was 
particularly offensive for some on the political left and this was because they 
saw the N-H-S as strongly indicative of the potential for reforming capitalism 
so there's a section and and it wasn't just confined to the political left this 
this was also a popular perception that the N-H-S was really a symbol of the 
way in which capitalism could be reformed and er made into something that was 
caring yes that even though that that it was possible through state reform 
through state intervention to limit er the pernicious er penetration of the 
market and and around health care that was particularly er er potent because er 
the idea of universal provision er free health care f-, er for all was er a 
very potent symbol of er a kind of caring state if you like so the idea that 
this could be tampered with er er er er er er by the Conservative Party was 
particularly er offensive to some er er er people and it was also this idea of 
interfering with er the N-H-S 
er was also indicative of of the f-, of the idea that or the sense there that 
some on the right on the new right at least did not care yes one of the key 
metaphors in in in the medical drama and in these discursive contexts is the 
idea of caring yeah so there's a sense that the Conservative Party did not care 
enough about about the people or about the N-H-S particularly er in regard to 
those who couldn't afford private treatment and one of the recurring er er 
sequences in medical dramas in the nineteen-eighties at least is is er the 
question of the waiting lists of those who can't afford you know there would be 
characters this particularly strong in Casualty always had this Casualty in 
particular had a very strong er er kind of moral sense to it i wouldn't i 
wouldn't say it's so much political very strong moral sense that if you know 
you'd you'd have characters coming along and they couldn't afford er er er 
private health care but then there were other characters in a 
similar situation who were jumping ahead of the queue yes queue jumping because 
they could pay for it okay so this was seen as particularly er offensive now 
i'm going to be quite er controversial and say that to be really fair to the 
Conservative Party er er er which most people aren't these days er the the left 
had always romanticized the N-H-S and this is partly because they had a strong 
very potent symbolic potential as a state institution as i've said reining back 
the iniquitous er stretch and reach of capitalism and this is despite the fact 
that fees for medical prescriptions and other fees for for dental and optical 
care er were in fact introduced by the Labour government pretty soon after he-, 
er er the N-H-S was er founded it was also the case i think that the 
Conservative Party realized that it would be political suicide to privatize the 
N-H-S and far from deregulating and privatizing it er if that the in fact the 
Conservative Party did not do that er what we got is a r-, is a a er quite 
a a strong er and repeated re-, system of reregulation er and centralization of 
the N-H-S er so a lot of er the rhetoric of kind of er N-H-S trusts and budgets 
and so on and so forth this idea that one can introduce a market system was 
really er er er simply about face value er on the face of it yes there was one 
would use the words like budget but in fact a lot of the the money was was 
controlled centrally er and and some people have said what you actually got is 
a kind of Soviet style er system of N-H trust that really mimicked er free 
market rhetoric now it's also the case that the medical industrial complex in 
er in well in the world and in in Britain is heavily dependant on state subsidy 
heavily dependant on state subsidy and that's provided through the N-H-S so any 
moves to privatize totally privatize the N-H-S would be economically 
problematic for those er multinational er companies er okay so that's one 
discursive contact er context it's not to deny the reality of 
shortage in the N-H-S that was reflected in various ways by medical dramas in 
the nineteen-eighties and Casualty as i've said regularly showcased er such 
issues er Casualty is very much issue led and as i've said it it it tries to 
encase issues in a moral rather than a political context er er although i say 
that er Norman Tebbit er wanted Casualty to be or or saw Casualty as indicative 
of the B-B-C's er Trotskyite tendencies yes [laughter] and he he was very very 
concerned about er er the sorts of images and and scenes and narrative stories 
that were being shown on Casualty so it's not to deny the reality of 
difficultive cuts and shortage in the N-H-S but to know that the political 
reality was more complex than was dramatized in even the most overtly critical 
dramas instead these dramas and Casualty is m-, a sort of main example er 
redirected their critical energy to aspects of medical culture because these 
aspects of medical culture were indicative of er the momentum for 
privatization what i mean by medical culture is er and it's very similar in the 
in the cop show genre as well er the question of er the macho yes the quest the 
issue of er consultants and doctors not treating their patients as human beings 
yes as er treating them as vehicles for disease and vehicles for treatment 
rather than as a-, as a-, as as people rather than caring for them and this has 
become quite a big issue certainly toward the end of the nineteen-eighties and 
in er the nineteen-nineties so that a lot of er health policy [sniff] er even 
the most recent er Frank Dobson's er er paper er talks about you know we should 
stop the consultants being so snobbish towards their er patients we should make 
them er er treat treatment should be about manners in a way and the courtesy 
that should be extended to the consumer or to the customer or to the patient er 
so er in a way it's easier to dramatize and visualize those a-, aspects of 
culture than it is to go into er kind of the er quite 
complicated economic reality whereby the N-H-S subsidizes er a medical 
industrial complex it's rather difficult to imagine how that could be 
visualized yeah whereas it's rather easy to to visualize er er a kind of a 
consultant surgeon er being a bit er superior to er the mother of a of of an 
ill child or something like that that's gr-, reasonably easy to put on the 
screen er o-, okay now one example of this er of television's interest and 
concern with medical culture is a programme called The Nation's Health this was 
a series of four documentaries er written by G F Newman and shown on Channel 
Four in nineteen-eighty-two and th-, this The Nation's Health was seen as as 
very very critical of er the medical establishment Anne Karpf in her book er 
Doctoring the Media says that The Nation's Health was a watershed in medical 
television because it directly subverted the address of all that went before 
this is a quote from er ne-, er er Anne Karpf and she says Newman delivered an 
almost 
unqualified attack on the medical profession doctors under his gaze emerged as 
insensitive self-seekers pondering their next er contract over the first 
incision they blithely offered the s-, their services privately in lieu of a 
lengthy N-H-S wait they conspired with drug companies they were racist and 
sexist to a man the power and aloofness of intimidating consultants and 
surgeons were depicted with devastating authenticity er Karpf is quite good 
although she doesn't quite see the er the implications of what she's saying but 
she's quite good at pointing out what's very strong in The Nation's Health and 
it's that critique of of er ma-, it's really male culture m-, er and The 
Nation's Health has its central character is a is a woman called Jessie Marvell 
and she er and the f-, the four er episodes er follow her as she goes through 
different er aspects through through of of of the N-H-S the the the er you know 
casualty to geriatrics to er er mental health care so it's very much concerned 
with that that sense 
of culture about er er if you like a a really er really truly insensitive er er 
er er medical culture and very much a male er machismo culture now this is 
rather similar to Cardiac Arrest in a way because both shows offer a simi-, 
similar criticism of the specificity of the National Health Service and of the 
medical and of the medical culture in The Nation's Health er usually male 
doctors do not treat their patients as people but as vehicles for disease and 
and er injury er there's the sense that these people embody the macho science 
fuelled journey that exemplifies er heg-, hegemonic myths of progress and 
achievement and the people the sick people the patients were left behind in 
this impersonal journey and Cardiac Arrest offers a similar criticism except 
that those who are badly treated are not so much the patients although they 
might suffer along the way er but the junior medical staff the junior medical 
staff who are overburdened and undertrained by consultants who were 
similarly happier to canvass more lucrative er private treatment so i'm going 
to show you two clips er one from The Nation's Health episode two er called 
Decline and one from Cardiac Arrest now in The Nation's Health we see a 
consultant surgeon er well discussing the possibility of er er er er N-H-S and 
private er treatment to one of his er patients then i'll show you a a rather 
similar scene from Cardiac Arrest okay so this is The Nation's Health it's from 
nineteen-eighty-two 
nm0063: okay that scene actually comes after er an earlier consultation that he 
has with a woman where he advises her to have a hysterectomy he says oh we'll 
do some exploratory stuff i'll think we'll do a hysterectory hysterectomy as 
well 'cause you don't need that little box any more we'll just whip it out okay 
so there's that whole sense of quite it's almost like violence in in in 
attitude yes and and The Nation's Health's very critical of that a similar 
scene in Cardiac Arrest except look at the way the the focus changes 
the the people who are suffering aren't so much er the patients but er the 
junior er doctors okay this is episode two i think two or three 
nm0063: okay so you can see that the the the practice of privacy in Cardiac 
Arrest and in The Nation's Health has different consequences for each the the 
problem with private practice in er and it's become com-, something of a 
commonplace in medical drama by nineteen-ninety-six it's very common to see er 
er this sense that er er private health care is in some way er er is is is is a 
priority over er over N-H-S health care which it is er it's clearly a r-, a 
kind of a reality er but the people who are are suffering who are er er from 
this are the are the junior doctors of course by implication their patients 
also die and kind of don't get very good treatment and in that sequence from 
Cardiac Arrest Andrew tries his best er but it's clear that he has no idea how 
to perform this operation as those of you who've seen it will know and he has 
to call in Claire who's who's drunk er 
and she manages to do it okay so there's Cardiac Arrest repeats the example 
from er The Nation's Health but within another context and the context is the 
supervision and training of junior doctors so this change from a wider interest 
er from interest in the wider implications for society er for patients and for 
doctors of of privatization is refocused in Cardiac Arrest to an exclusive more 
or less exclusive concern with the treatment and well-being of the next 
generation of doctors now when it began in nineteen-ninety-three Cardiac Arrest 
self-consciously situated itself in relation to s-, er G F Newman's er The 
Nation's Health and the writer Jed Mercurio er he uses the er pseudonym er John 
MacUre er in just before the first episode explicitly situated er er his his 
programme Cardiac Arrest in relation to er The Nation's Health and said 
Newman's The Nation's Health you know did very well in eighty-two but it needs 
updating you know more than ten years later it needs updating for the 
nineteen-nineties so the most similar concerns in Cardiac Arrest are 
unsatisfactory medical culture still remains central concern but other 
discursive contexts updated er discursive contexts are now regularly er offered 
now some of these contexts can be detected in other genres such as the crime 
genre so er and i'll talk about that in a minute er well i'll talk about it now 
er so other th-, things that you'd see in other professional genres er er er 
and you you see in the medical drama as well things about equal opportunities 
yes in Cardiac Arrest er you'll see Claire Maitland and her immediate superior 
arguing about you know what it is to be a woman in er in the N-H-S in the 
nineties and how you know they have to behave er very very strictly in a very 
strict professional manner er so equal opportunit-, and you see that also of 
course in the crime genre if you look at things like er well Prime Suspect 
being the obvious one er Between the Lines things like that also er er 
questions of 
race are are returned to er in i-, in Cardiac Arrest but there are others that 
are really specific er to the medical drama and to Cardiac Arrest okay first of 
all is the way that privatization issues of privatization and the kind of 
culture of the N-H-S is er understood through ideas of new management the 
hospital manager is a kind of new figure er who arrives er er in the nineteen-
nineties now hospital managers are generally are generally speaking are 
presented as a pernicious presence in the hospital they are interfering without 
any professional knowledge of medicine they're fuelled by the ideology and 
management speak of private business from which they were recruited and their 
attempts to import that business culture er into the running of the hospital is 
shown as directly hostile to the requirements of adequate and professional 
medical care now interestingly Cardiac Arrest takes this development a stage 
further er and says well it's not just it's not just inappropriate people 
from business who are being recruited to run the hospital but it's sort of 
anyone but doctors yes so in a sequence that was used to trail an episode in 
the second series the older consultant Ernest Docherty er the old chap 
recognizes the new and very young manager in the corridor the manager's about 
eighteen years old okay er to no one in particular but really sort of to the 
camera he says yesterday he was on the checkout in the canteen today he's 
running the hospital yes so the inference is is kind of clear from that er er 
er exchange that kind er professional paternal experience exemplified by 
Docherty counts for nothing er but youth in a suit you know that's the future 
that's the future of er hospital management okay so that's one discursive 
context er now clearly that goes out of control a little bit in Cardiac Arrest 
toward the end er where the hospital manager himself gets suspended and there's 
this kind of Foucaultian sense that you don't know where power is yeah so they 
have to bring in some lord governor from that we've never seen before in order 
to sort out the the power conflicts in the hospital so even the managers 
themselves are getting are kind of er accountable to some unseen force yes that 
comes from outside the hospital er now the other discursive context is public 
relations P-R in the hospital the importance of P-R for the hospital is also 
indicative of its transition to a business culture so Cardiac Arrest staff are 
regularly suspended for going to the newspapers to tell stories of mistreatment 
there's er an anxiety about the prospect of medical incompetence being leaked 
to the press and that kind of looms over nearly every medical decision there's 
also the issue of H-I-V the revelation that some medical staff have er er H-I-V 
er and there were kind of regular dramatizations of parents er er sorry of 
patients finding this out that they've been treated by someone er with er H-I-V 
and then er er kind of complaining about it so for 
British medical dramas and that sort of indicates the way that British medical 
dramas er are starting to pick up on that danger and anxiety about litigation 
er relatively recent in Chicago Hope it's more or less the norm that patients 
are expected to sue er their doctors er it's relatively recent in the British 
er er medical drama so this prospect of litigation further er enhances and 
intensifies that conflict between doctor and patient yes we saw the conflict 
being described in The Nation's Health in terms of kind of a macho culture and 
a and a disdain for the patient but now it's it's er more professionalized it's 
almost it's about you know can i sue you if you do something wrong so every 
decision er every medical decision has a kind of that kind of anxiety hanging 
over its shoulder and of course there's a relation i mean these programmes use 
news stories as plot stimulants so there is a relation to er more recent cases 
and we're getting a lot more of these cases of d-, of surgeons 
for examples in Bristol er not er meeting their quality targets er and clearly 
that's going to er continue so all of these matters pe-, er and the final 
discursive context i'll return to that a bit more in the seminars is rationing 
N-H-S rationing okay so this is about the question about who deserves treatment 
first yes if one has to prioritize er health care and medical attention which 
patient deserves treatment and which patient doesn't now clearly in the outside 
world there are issues about for example sex change operations and cosmetic 
surgery and further down you know do you operate on a smoker or someone who's 
eaten fresh fruit and vegetables all their life all this kind of issue about 
choices yes in the N-H-S and this feeds in to er medical dramas and into 
Cardiac Arrest okay so those are the discursive contexts now i want to talk a 
bit more about er Cardiac Arrest and genre because i think the change in 
Cardiac Arrest from attention to er issues 
around welfare cuts in the welfare state to m-, to something that's more 
focused on the welfare of junior doctors that shift of attention is also in ta-,
in parallel with a a another shift of attention that happens in other genres 
er and that's toward an interest in the details of professionalism to the 
details of professional life or more specifically the way in which professional 
procedure the rules the laws the manners er the conduct of er professionals 
becomes central to the content of many television programmes in other words the 
interest of these programmes is in the way that these professional codes of 
conduct are mediated through individual characters and examples of the sort of 
professional genre would be The Bill a lot of The Bill is spent lot of 
characters in time in The Bill is spent with characters discussing the the what 
they can and can't do yes the rules of conduct yes what's appropriate to do 
Casualty clearly er London's Burning er the professional genres ge-, genres 
about 
professional er er people and in general that er in the earlier nineties that's 
concerned with the emergency services clearly now it's being er er opened up a 
bit and and g-, and generalized so this and in other words the turn toward the 
spectacularization of professional discourse takes place in the early nineties 
and is er as i've said initially concerned with the emergency services in in 
drama and later on in the documentary genres now this is er er er in the 
medical drama this spectacularization of er professionalism er is er part of 
one mode of er er er of the narrative the other mode is is something that's 
more action based okay so what i want to think about is er if you like 
different modes of mise en scène diffe-, it's almost different styles er on 
the one hand there's the style er there's the mode which i call reflection 
which is more concerned with the er spectacle of er er professional discourse 
mediated through characters on the other hand there's the mode of action 
which generally speaking is the immediate and intense delivery of of health 
care to casualty er patients and these modes are attached to setting they're 
generally specific to one place the hospital or less frequently the character 
sometimes er characters it's quite rare in in in ward based medical dramas like 
er E-R and Chicago Hope and Cardiac Arrest but sometimes the characters you 
know er Doctor Greene will will go shopping or something and and and sort of 
take the two modes with him so there'll be modes of action and reflection but 
they've taken outside the hospital and that's quite rare er indeed w-, w-, the 
space where the two modes kind of the transition from one mode to the other 
where that takes place is the hospital corridor and Anne Karpf in the late 
eighties in her book er Doctoring the Media argues that the the corridor it 
becomes a central place in the er in the in the television medical drama where 
anything could happen there's a kind of unexpected er things er happening in 
the 
periphery or in the background of a shot could suddenly become important er and 
clearly one of the ke-, you know the k-, the the er the sort of classic er 
icons of the genre is the is the is the the stretcher on a trolley bursting 
through swing doors yes that's one of the key ways in which we see the 
transition from reflection to an action mode okay so just to recap by 
reflection i'm referring i'm concerned with sequences where medical staff are 
discussing whatever is of narrative importance either between themselves or 
with the patients so this mode is therefore evident by heavy reliance on 
dialogue and it's often stylistically nondescript concerned as it is with 
relaying standard delivered performances the action mode re-energizes style and 
depicts the urgent treatment of medical cases and various er styles are 
recruited to emphasize the contingency the immediacy and the urgency of those 
cases in fact in that transition to action mode er the ward based medical 
dramas delight in foregrounding 
the radical contingency of accidents and the sudden turn for the worse that can 
befall patients unlike the horror film where moments of gore liberation are 
carefully prepared for by sound and image er the nineties medical drama profits 
from the realistic assumption that accidents can happen anywhere any time so 
the sudden event of an ambulance stretcher bursting through those double swing 
doors is clearly the most familiar icon that signals that transition that move 
into action mode okay just give you an example of that action mode this is from 
Cardiac Arrest okay and th-, as i say the transition is sudden okay it's not 
prepared for er this is a the most extreme example i could find okay and it's 
quite er unsettling but clearly the pace of the cutting changes the lighting 
changes we're introduced er exordited music is introduced er we're offered a 
different style yes so it's an R-T-A accident an R-T-A 
nm0063: 
okay er so that's really there's no preparation for that moment where the the 
tube goes in you don't that's just given to you and it's lit very very brightly 
yeah so you don't miss you know you can't miss it er it's quite interesting 
that sequence because i mean it's it's very very extended er and very very 
excessive i think sort of shots of er er of of that woman in pain er how that's 
used to balance er against Scissors' decision when he sees the driver of the 
car who who ki-, who she dies obviously who ki-, he killed this woman er he 
doesn't treat her he doesn't treat he doesn't treat the driver of the car 
because the driver of the car is male is white yes he's er just made a lot of 
money yeah i got a bit pissed 'cause i just made a lot of money yeah he's given 
as many of the characteristics yes that are associated actually with that older 
male culture as possible and Scissors therefore who's quite a good doctor yeah 
and he refuses to treat him okay so there's a there's a 
kind of balancing going on there there's a there's a s-, there's a you're being 
offered you know should he be given treatment for causing that you know that 
extreme level of pain so the the move from reflection to action takes place 
generally speaking takes place in the hospital corridor er and of course the 
hospital corridor's is the place between the unregulated outside world and the 
regulated but falling apart inside world of the hospital and that's er that's 
what er Mark Greene refers to at the end of the episode of E-R you saw on 
Friday yeah it's as he said something about there's a sense of the ins-, 
outside getting inside i thought we could kee-, this place should be safe but 
in fact it's got into the hospital yeah so the style in a in the mode of action 
the style changes to a faster tempo use of Steadicam or hand-held camera rapid 
cut cutting the fragmentation of bodies yeah so you got a lot of shots of kind 
of bits of body hands bits of faces yes rapid fragmentation of bodies the 
dialogue 
changes it becomes a very very fast medico er medibabble yes lots of sort of 
babbling about medical er technobabble yeah er okay so that that style changes 
we often get low-key lighting which is contrasted with bright shots of the 
injuries themselves er like in this sequence where er we had that very very 
bright shot of the plastic tube being inserted into the body cavity er and lots 
of special effects er bleeding is usually visible attached to a pulse er 
generally speaking it's explicit but not hard core er The Nation's Health er is 
a bit of an exception because The Nation's Health used real operations er 
surgeons who were willing to er have their operations or their er op-, their 
medical procedures filmed so actually The Nation's Health is very hard core in 
what it shows there's a lot of coyness actually even in contemporary medical 
drama er so that bit where er she's er the patient's aborting her child we 
don't see that yes what we see is Raj seeing that okay so there's 
kind of a limit to those special effects i guess limits of taste er so well the 
sense of of that er action mode is is not really of an ordered procedure but 
more one of confusion and there's also the sense that the patients are 
resisting there's there's a a kind of er a frequently used er shot of patient 
attached to lots of lines and then moving around yeah sort of struggling 
against it sort of you know it's quite a potent image because it signals a 
sense of needles moving around in the skin the possibility of yes attachment to 
er er kind of er er er drugs and things and of course the outcome of those 
scenes of action scenes has a greater impact on the doctor and the hospital 
rather than the patient generally speaking we don't follow up er what happens 
to the patient in any real detail the exception of course in Cardiac Arrest is 
the boy who's waiting for er dialysis er er for a k-, a kidney er donation er 
that's rather unusual to keep returning to one patient again and again clearly 
his function is to show hel-, the Helen Baxendale character is to place her in 
a position of care yes she's given him as her little boy you know to look after 
and be nice to okay we'll talk more about Baxendale in the seminars [laughter] 
there's a sort of a sigh of [laughter] oh no [laugh] [sniff] okay now modes of 
reflection er are not quite as stylistically er inventive but i think are very 
very interesting they're usually a lot quiet quieter but can also have stylized 
moments what i want to think about is the way in which er the dialogue is 
constructed around er th-, the sen-, that sense of professionalism generally 
speaking the programmes i've been talking about Cardiac Arrest and other 
medical dramas and even the you know the police series and the er London's 
Burning and things like that have professional advisers whether they're from 
the Met or whether they're actual doctors or surgeons er so there's er that 
sort of level of authenticity is given er er er er to those er er to the er the 
action procedures and to er the exchanges that er er er the dialogue exchanges 
in 
mo-, modes of reflection you can generally spot when these er exchanges are 
going to happen in Casualty it's usually er prefaced by er Charlie will say a 
word [laughter] yeah a word in my office and they go away into a little space 
and they have their words yeah and these are what i'd call reflection modes 
okay so a word is is kind of an obvious signal but sometimes it doesn't happen 
like that sometimes it's just cut to the er mode of reflection i call it 
reflection as distinct from any other narrative mode in there 'cause it's a way 
in which the the the professionals are talking about er what's happened in the 
modes of action but talking about their procedure rather than talking about er 
sort of their personal matters or anything like that although clearly the 
personal issues get er er embedded in those exchanges so i've i've kind of 
created a rather schematic sort of frighteningly simple er way of thinking 
about these exchanges let's put it on the overhead now the er that's better yes 
here we go okay exchanges between 
er between professionals okay so the first one goes senior to junior i've never 
written on one of these before see if i can do it okay senior can you see that 
that's meant to be an arrow by the way yeah okay that's the direction senior to 
junior you can spot these pretty quickly er they're generally the ones that 
start this is the way we do things around here yeah this is the procedure that 
we that we use around here yes it's that kind of address to the junior doctor 
er okay senior to junior often you get that at the beginning of a series yes 
where the the senior to junior dialogue is about also telling the viewer about 
this is the sort of this is the kind of thing we do in this genre yes this is 
the kind of programme it is we do this around here yeah now you've noticed er 
you've probably noticed i put competent and not competent there er this is 
about medical competence but it could refer to the one's you know the 
competence of the character as a police officer or as er a fireman or or a 
lawyer or 
whatever er generally speaking the junior in this this er first relationship is 
not competent yeah that's why they're juniors they're learning the ropes from 
the senior the senior is training them the senior is competent yes clearly a 
not competent to competent not competent senior to competent junior doesn't 
work this is the way we do things around here junior oh no it isn't you don't 
do things like that doesn't really doesn't really work okay also this exchange 
is an invitation er in Cardiac Arrest and the other medical dramas for the 
junior to explain why he didn't do he or she didn't do things as they should be 
done around here personal circumstances prevented me from doing it properly i 
haven't been trained er to do that properly yes now that exchange that 
explanation really comes at the bottom it's the most radical so it's the reply 
if you like not competent junior to senior that's the reply happens down at the 
bottom there but it can also be 
kind of more radical than that it could be when the junior member catches out 
the senior member breaking the rules or bending them to their own liking and 
that often happens in that privatization con-, context so you get a competent 
junior er talking to a a competent er er senior saying in fact you're bending 
the rules around here yes you're not doing things as you should and that 
happens a lot in Cardiac Arrest obviously [sniff] so what's crucial is is the 
discrepancy in that exchange is the discrepancy between how things should be 
done the real this is how we do things around here and the offi-, if you like 
the official version and the actual practice okay [sniff] obviously the other 
one is equal equal rank to equal rank i've got handouts of this so you can so 
junior to junior to finish it up senior to senior 'cause these people are 
ranked equally and this is often a source of disagreement and conflict yes this 
is the way we do things around here no it 
isn't we do it this way they're both of the same rank yes er but the 
disagreements are likely to be caused by personal conflict so this equal to 
equal e-, exchange is likely to be particularly potent er er if the equals are 
sleeping together yeah which they often are in those sorts of exchanges and in 
fact personal relationships start disrupting all of these exchanges so senior 
to junior where the senior is having a relationship with a junior has that kind 
of second level second order level er beneath it i'll show you an example of it 
this is an example of a senior to junior er address but clearly it also has 
this other second order er structure to it because they're lovers as well okay 
and again it starts off this is how we do things around here yeah 
nm0063: so clearly the relationship changes the point when he says masterful it 
changes from that senior to junior level to v-, one of equal to equal yeah 
they're equal in the bed in the sack as it were 
okay now this relationship is further complicated by another factor and that is 
that each of their as i've as i've mentioned at the bottom each of the senior 
and juniors can be good or bad very very schematic i know but can have positive 
or negative er characteristics so it's entirely possible for a competent senior 
doctor for example like Adrian devre-, DeVries to be a bad character generally 
speaking bad characters went to public school yes they er belong to that older 
ma-, machismo culture that doesn't care about er the patients yes er it's again 
it's this level of care if there's a low level of personal investment in the 
patient the lower that level is the more the the the the particular doctor will 
be seen as a as a bad doctor however competent and clearly the Baxendale 
character's very very interesting in this respect 'cause she's very competent 
yes in what she does but her level of care of personal investment is quite 
quite low on the other hand she's a recurring 
character in cardia-, for the three series of Cardiac Arrest yeah so you can 
see the in the in the second in the third series the one we're watching at the 
moment where in which she's trying the series tries to give her the and teach 
her how to care for her patients first of all it gives her the kidney the the 
young boy who wants a kidney donation and then secondly it gives her er this 
issue about Adrian DeVries and whether he loves her and whether she can 
understand people properly if she's never been in love yes okay which is part 
of the project of the of the final series of Cardiac Arrest so you can have 
good or bad doctors and the my t-, next clip i'm going to show you a senior to 
junior exchange from er E-R okay and this is just after an action mode so the 
mode l-, it leaves an action mode it's a defibrillation yeah and then it 
switches quite quickly into a r-, reflection mode yeah they're talking about 
the action and it's Greene telling er Noah Wyle what's his name 
sm0065: Carter 
nm0063: Carter er 
sf0066: [gasp] 
nm0063: yes he's sort 
of telling him off [laughter] for er for being not competent yes so he's 
accused of being not competent of not doing the procedure the way we do things 
around here okay you notice the er the Carter character is rescued okay because 
he cares yes that's why he's rehabilitated as a good character 
nm0063: okay 
nm0063: and in st-, Cardiac Arrest juniors doctors generally start off 
incompetent but good that is their midi-, medical skills are lacking but their 
interpersonal skills are okay they have time for their patients er they may be 
incompetent at what they do but they're good still because they ask for 
supervision and advice some don't however Liz Reid the character the new doctor 
in Cardiac Arrest doesn't ask she clearly doesn't care either okay and she's a 
good example of a junior doctor who's incompetent and bad yes as i've said 
competent but bad doctors are 
often senior like Graham Turner and Adrian DeVries and as i said the bad 
aspects of their characters generally come from that public school education 
and also their interest in private practice the result no human concern with 
the patient's welfare what you tend to get throughout the series is a move from 
er er from different positions yes both as we saw there within particular 
scenes and also the long term of the series er so as i've said Helen 
Baxendale's character moves from being competent and bad to competent and good 
Scissors for example is comp-, is good and good yeah he's competent and he's 
good er er the the the younger character Andrew yeah is sometimes incompetent 
but always yeah always a good character so these ref-, moments of reflection 
modes of reflection stage the tension between maintaining the stability of 
professional procedure and a satisfactory personal life the second the 
satisfactory personal life is always prioritized over 
the stability of professional procedure so doctors who can only relate to 
patients on a procedural level are bad doctors those who offer authentic 
personal investment in what they're doing are good what happens in Cardiac 
Arrest is that a new generation of doctors are prevented from being good by the 
system so they lose faith in their own ability what Cardiac and this is why the 
importance of training they can't be good because they're not supervised or 
trained to be yes they can't be competent i mean they're always good 
nm0063: i think the second tendency is generation specific there's been a lot 
on the news er recently about er Generation Y is it there's Generation X a sort 
of a new n-, study of sixteen to twenty-one year olds saying that their their 
aspirations are different they're supposedly ambitious er seventy-two per cent 
of them think that whatever they do in er w-, however they vote they'll make no 
impact on political life seventy-two per cent think they c-, they c-, they will 
make no 
impact er but i think the one of the innovative things about Cardiac Arrest was 
the youth of the actors yes they were all in their early to mid-twenties when 
when it started er this is a quote from an interview i did with the writer with 
from Jed Mercurio i asked him about why the the er er er the c-, doctors were 
so young was it just realism er he said that was really apparent when we came 
to casting it first they meaning the production company they were thinking of 
people in their thirties i said no they've got to be younger for realism it was 
really about a twenty-something bloke where everything he'd do is life-
threatening and all the women are nuts i wanted it to be really grungey Kurt 
Cobain killing himself and he references this as a kind of key er er event 
while he was writing the series really grungey about people in their mid-
twenties with no sense of belonging that's what i thought the series was about 
but the producers didn't get it and the producer's er is Tony Garnett 
yes there's this kind of rather interesting disagreement er between Mercurio 
the writer and Tony Garnett now you probably know that Cardiac Arrest began as 
an advertisement i think in the British Medical Journal or the Lancet asking 
for a junior doctor who would want who would does anyone want to write for 
television for a T-V sitcom a T-V comedy about er hospitals er er Mercurio 
applied and got the job er but wanted it to be something different something er 
more realistic er in in particular er i'll show you he's in the in in the 
documentary i'm going to show you but in particular he's very influenced by the 
Hill Street Blues idea of a kind of grainy er er er realism er so in a way 
[laugh] you know Mercurio was a junior doctor yes he er part of the way the 
programme is sold is through the fact that it's authentic because he's lived it