Views And Reviews

Frightening realism

BMJ 1994; 308 doi: http://dx.doi.org/10.1136/bmj.308.6936.1108 (Published 23 April 1994) Cite this as: BMJ 1994;308:1108
  1. L Dillner

    It is the morning of the London preview of Cardiac Arrest, and John MacUre, the writer of this six part drama for prime time television, is fielding questions from journalists. MacUre (not his real name) is a senior house officer in medicine who was commissioned to write the series after replying to an advertisement placed by the producers in the BMJ. His story of junior doctors in the NHS differs from other hospital dramas in being frighteningly realistic.

    Cardiac Arrest is set in a large city hospital run by inexperienced, chronically tired, and often callous young doctors who frequently make mistakes and seem cavalier in their eagerness to help patients meet their maker.

    Andrew, the new and convincingly clueless house officer, is seen rewriting piles of drug charts, panicking when a patient arrests, and being bleeped in the middle of the night to flush an intravenous cannula. There was an induction course for house officers - but guess what - there was too much happening on the ward for him to go.

    In fact the series manages to include most of the grievances of junior doctors - intrusive bleeps, closed canteens, cockroaches in the on call rooms, and wards run by nurses who are always off on tea breaks and respond to appeals for advice with “Well, you're the doctor.”

    When Andrew's favourite patient dies after he has forgotten to chase up her electrolyte results (her potassium was over 7 mmol/l) he is reassured by his senior house officer in a scene that could reduce waiting lists faster than any government initiative.

    “You come out of medical schools knowing bugger all - no wonder August is the killing season,” she says. “We all kill a few patients while we're learning.”

    To have told a less accurate story, MacUre tells the journalists, would have been to betray the people he works with. The journalists do not find this admission comforting. “How much of this is based on fact?” asks one journalist nervously. “It's based on realism,” says MacUre. “It gives an accurate portrayal of the working conditions of junior doctors so that hopefully the public will understand the pressures that we are under.”

    One of the journalists is concerned about the effect such honesty will have on people who are about to go into hospital. “It worries me to hell that junior doctors are pressurised, leant upon, not always doing the job they should be doing, sometimes cheating - it's like being on an aircraft and being told the pilot is wildly drunk … It might scare people to death.” MacUre is unrepentant. “I think it would be patronising to think that the public couldn't accept what this shows,” he says. “It shows people who went into medicine wanting to get to know their patients and to be caring people - but the system makes this almost impossible.”

    As an ambassador for junior doctors MacUre is articulate and compassionate. The series is compelling, but so fast and in places so angry that it is not a foregone conclusion that the public will buy his message. In parts it retells the mythology that all junior doctors revel in - incidents that seem hilarious in the bar but look a bit heartless on the television screen. When Claire, the beautiful but brittle senior house officer on Andrew's firm, suggests that a “pine box” rather than antibiotics should be prescribed for a man dying of a mesothelioma you feel that sleep deprivation would be too good for her.

    MacUre is confident that people will gradually see that behind every monster lurks a well meaning medic. He says that every junior doctor who has seen the series is delighted that the public will see what it's like for them at last. The public may be less delighted.