Medical drama - No politics, we're doctors

In the post-'ER' world of American TV medical dramas, a raft of new shows is shifting the focus from the doctors to the nurses. But, says Gerard Gilbert, while they offer gore, adultery and drug abuse aplenty, one subject remains stubbornly out-of-bounds

Given how miserable is the experience of being a hospital patient – let alone the business of being cut open, stitched back together again, irradiated and generally poisoned for our health's sake – we seem to have an inordinate appetite for watching it happen to other people. Hospital dramas and melodramas have been a staple of US television since Richard Chamberlain started checking pulses as Dr Kildare back in the Kennedy era, Grey's Anatomy being just the latest show to lather up this well-formulated medicated- soap mixture of accident, illness and romance.

For many aficionados of the genre, ABC's Seattle-based Grey's Anatomy has almost seamlessly supplanted arguably the greatest medical saga of them all, ER, the NBC series that gave us George Clooney and which ended this April after 15 award-laden years. The last few seasons may have become a bit fagged-out and on the sudsier side, but at its zenith Michael Crichton's saga of a Chicago emergency room was a miracle of intelligence and adrenaline. "The great thing that ER taught us about medical dramas is that they provide a great, high-pressure backdrop to play out the usual personal dramas", says Laura Fries of the Hollywood industry magazine Variety.

But while Grey's Anatomy may provide much of the same – albeit with less surgical excitement and greater emphasis on the personal relationships of the doctors – for many people there is still an ER-shaped hole in the weekly TV schedules. And it's a void that TV producers have rushed to fill, with a glut of new medical dramas this summer and autumn. In fact, never before have the networks sought so much medical help – and if you were looking for trends, you might say that there has been a shift of emphasis from the doctors to the nurses.

Edie Falco – Carmela from The Sopranos – takes the title role in Nurse Jackie, a blackly comic drama about an adulterous, pill-popping New York nurse which has already fallen foul of both Christian groups and nursing bodies. It's been a big hit however for its makers, Showtime, the subscription channel that also brings us those other morally screwed shows Dexter, Californication and Weeds. Indeed New York magazine reckoned Nurse Jackie was "the best series yet in the cable channel's ongoing meditation on the nature of addiction... and the setting for a truly breakthrough female character."

Nursing bodies presumably approve wholeheartedly of Christina Hawthorne, the eponymous protagonist of Hawthorne – a paragon of a head nurse: a beautiful widow who sticks up for her patients and staff, even championing the janitor when he complains that the hospital bean-counters have made him switch to a cheaper brand of disinfectant (you can perhaps already guess where Edie Falco's Nurse Jackie would tell him to stick his disinfectant).

Hawthorne is played by Jada Pinkett Smith – Mrs Will Smith – and her saintly health-care worker stuck in the throat of the New York Times, who reckoned: "Hawthorne is mostly it seems intent on promoting the self-regard of its star, who also happens to be an executive producer on the show."

The heroine of NBC's Mercy is also a nurse, although American viewers will have to wait until mid-season to catch Taylor Schilling as a nurse returning from a tour of duty in Iraq. NBC also have Trauma, starring Derek Luke (Antwone Fisher) and Cliff Curtis as San Franciso paramedics, while the British actor Jeremy Northam (Sir Thomas More in The Tudors) has the starring role in CBS's similar-sounding Miami Trauma.

But it's CBS's other new medical drama of the autumn, Three Rivers, that is the most eagerly anticipated. This one's about transplant doctors – and it is apparently earnest and contemplative, posing ethical questions as it considers the viewpoints of donors and those receiving their organs. CBS has given it the prime-time Sunday-night slot.

You wonder how realistic the transplant scenes in Three Rivers are going to be. ER broke the mould of TV medical dramas when it came to the gory details of emergency health-care. "We wanted to show what it was really like to be a doctor in an emergency room, the explicit surgeries, successful and botched", recalls Dr Fred Einesman, ER's former medical adviser. "In the beginning we said 'that's too bloody to show', or 'we can't use technical medical jargon'. But not for long."

Adds Laura Fries from Variety: "In a way, shows like House up the stakes because with seemingly daily advancements in medicine and outrageous real-life medical stories – think of things like 'Octomom' [the Californian woman who gave birth to octuplets in January] – shows have to rely less on the technical health aspects and more on the extreme measures taken by the doctors."

But if the blood and guts, as well as technical realism, are reaching ever greater extremes, there is arguably one form of realism, the socio-political realism of the US health-care system, that is still not being addressed. As President Obama struggles to turn his health-care reforms into law, there is one ambitious new TV medical drama you won't find in the autumn schedules – so let me pitch it here.

It seems to me that there is a gap in the market for a medical version of The Wire or perhaps The West Wing. The former could focus on one city hospital and include those who don't have health-care insurance, the middle-class patients who don't have quite as much coverage as they think they do, as well as form-filling doctors and litigation-averse administrators. David Simon, I await your call.

The latter show would concentrate on the Washington end of the equation – the reformers, the conservatives, Big Pharma. Fries however argues that the changing face of US medical care is gradually being addressed.

"I've enjoyed USA Network's new show Royal Pains, because it looks more closely at the failings of the American health system. The lead character [played by Mark Feuerstein] is a doctor kicked out of a prestigious hospital because he helped an uninsured patient over a wealthy hospital-board member. His new practice works outside of the usual medical norms – almost going back to the days of home visits and personal care.

"In fact, I would wager that we'll see more medical shows that will work outside the traditional ER-format, sort of reinventing the rules as the rules for health care (especially in the US) seem to keep changing."

Reviewing the latest crop of medical dramas, Fries's colleague Brian Lowry sounds a more caustic note about the way TV medical dramas soft-sell the realities of the US health-care system. "Thankfully, patients [on TV] seldom have to worry about filling out tedious medical forms, being grilled about insurance coverage or suffering from a prior condition", he says. "Getting their doctors to see them on a moment's notice is never an issue. And their insurance companies are presumably more than willing to pay for any and all medical care.

"Come to think of it, perhaps the Obama administration should enlist TV writers and the medical consultants that they employ to take the lead in revamping the health-care industry. After all, who could possibly object to a system that functions as smoothly, humanely and efficiently as all that?"

BLOOD SIMPLE: FIVE NEW MEDICAL DRAMAS

Three Rivers
Every ethical angle about organ transplants is explored, as Alex O'Loughlin ('Moonlighting') leads the dedicated team of transplant doctors at Three Rivers hospital in Pittsburgh. Each story is told from the point of view of the organ donors, the recipients and the medics who look after them.

Hawthorne
Jada Pinkett Smith – aka Mrs Will Smith – stars in this new drama about a saintly head nurse who cares too much (yes, it's possible). Christina Hawthorne is beautiful, widowed and dedicated... did you already guess that Pinkett Smith is also the show's executive producer?

Royal Pains
Mark Feuerstein plays a fast-rising ER doctor who loses his job after he favours an uninsured patient over a hospital-board member, winding up in the Hamptons as a "concierge doctor" to the rich and famous. Breezy escapism for those who thought that 'Burn Notice' put some fun back into the spy genre.

Trauma
The lives and loves of a team of San Francisco paramedics, marking 'Antwone Fisher' star Derek Luke's return to the small screen. Cliff Curtis ('Live Free or Die Hard') co-stars as a genius surgeon who likes to travel by helicopter.

Nurse Jackie
Edie Falco from 'The Sopranos' plays a ballsy New York healthcare worker who pops pills for a bad back and isn't beyond giving the hospital pharmacist a quick one in return for a fresh supply of tablets. Pitch-black humour is the edge here, as you'd expect from the cable channel behind 'Dexter' and 'Weeds'.