This week: Jed Mercurio
Why he matters: The former doctor was the writer of ”Cardiac Arrest”, the ground-breaking 1990s medical drama which offered the first realistic depiction of the parlous state of hospital medicine in the NHS, and of very human doctors indeed. This was followed in a similar vein by ”Bodies”, which he adapted from his novel. He has also written comedy and science-fiction but is best known to TV viewers today as the showrunner of both “Line Of Duty” and “The Bodyguard”.
Jed Mercurio does anger and cynicism well. It seeps through in his writing and public utterances.
He recently told a conference: “A lot of medical dramas still work on the idea that someone comes into a very busy hospital, and [that] alongside their medical problem, they receive a talking cure about their family and emotional problems from the doctors.
“[But as] “anyone who has ever been in hospital knows, they don’t care and they don’t have the time.”
He added that most medical dramas do not want to portray the “cynicism that starts to infiltrate your work as a doctor when human suffering becomes quite banal to you”.
[Editor’s note: post-publication Mr Mercurio got in touch to say ”My comments about doctors not caring…are lifted from a Guardian article I’ve repeatedly stated distorted my views. I did a session at MIPCOM in Cannes in which I confined my comments to TV doctors seemingly having the time and interest to get involved in the non-medical problems of their patients such as affairs, family rivalries etc and other soapy storylines. I didn’t say doctors find suffering “banal”. I said it was “mundane”, meaning doctors encounter it on a daily basis.”]
This iconoclasm was also to the fore during his recent conversation with Royal Society of Medicine president Sir Simon Wessely.
Touching on the issue around anti-vaccination, Mr Mercurio reveals his discontent with current politicians: “Part of this problem is that nowadays, politicians are lying so much, who would believe them if they say: ‘you need to get vaccinated’?
“If a liar like Matt Hancock says ‘vaccinate your kids’, would you? These are the figureheads of a lying government and political class, who lie about everything.
“Facts used to be sacred; now stupidity is a virtue. The way the world is going now, lack of faith is going to kill us, people and climate. The medical profession needs to stand up: it’s still strongly trusted.”
Mr Mercurio’s portrayals of medics as deeply human and often flawed individuals, and his warts-and-all picture of the NHS and medical environments were a shock to many viewers.
“Before ’Cardiac Arrest’ and ‘Bodies’, all the TV dramas about medics had them as kind of heroic, saintly Doctor Kildare figures”, he remembers.
“When I started as a houseman and SHO [in the 1990s], the general public perception of medics was very out of date. Casualty was on, even back then, and there was ITV’s Medics. And the perception in the mainstream was that the 1960’s Doctor In The House was still relevant. It was strange talking to those outside medicine about what you encountered in the job. I met perceptions of medical professionals that were purely shaped by fiction”.
The young medic answered an advertisement in the British Medical Journal for a script consultant to a new BBC medical drama.
“My advice then became storyline suggestions, which they asked me to flesh out. Then they came back and asked me to attempt to write a script.”
Gallows humour
Mr Mercurio adds he “never thought I would create and write”. His interest while in medical training was in aviation medicine.
“I became a flying officer cadet during my house jobs, and I flew at university, which helped on career path to becoming a medical pilot. We were military pilots, trying to do scary things, like aerobatics at 7 or 8 G. The end of the Cold War narrowed down the career opportunities, with areas like aviation medicine being earmarked for cuts.
“By that point, ’Cardiac Arrest’ was on the air. I remember that I left the Series Two shoot to go for my last army interview”. ’Cardiac Arrest’ was written under the pseudonym John MacUre, as for the duration of its first two series Mercurio was still an NHS employee in training.
Cardiac Arrest was written “from the perspective of junior doctors like me and my friends, who often felt quite marginalised and ignored. And we portrayed other staff through that lens, informed by the way they interacted with us. Other medical shows were more ensemble, with equal-ish screentime for all. And we portrayed the cynicism of some staff, whether born from a stress response or gallows humour.
’Cardiac Arrest’ ran for three series. Mr Mercurio says he “was still working as an SHO when series 1 went out. I took a sabbatical for S2, and only by S3 when I’d left medicine did I have any real influence in how the show was performed and edited, and that was my apprenticeship, and transition to ‘maybe this is my career now’.
Mr Mercurio moved the focus from the general emergency medicine of ’Cardiac Arrest’ to obstetrics and gynaecology with his next show ’Bodies’.
“O&G is a better speciality to investigate medical negligence, as the consequences and stakes are so high. And O&G has not been portrayed much. Also, you have the dramatic expectations of a happy event. And there’s a conceptual simplicity of O&G – a baby can only come out one of two ways.
Mr Mercurio recalls that the creative team made the negligent consultant in ’Bodies’ ”a nice guy, for dramatic effect. It’s not really true, though. When you look at the research about negligent consultants, they’re actually sociopaths, being evil to everyone around them. There was a run of those cases in the 1990s. Remember Rodney Ledward and Richard Neale. That was the beginning of looking at those systemic problems, around the time of Bristol children’s heart surgery; then we had Mid-Staffs, Morecambe Bay, Telford…
“In ’Bodies’, we had the psycho character consultant played by Keith Allen (in the show, his car number plate was VAG1). He has all the best lines and is the most clinically competent. At times, we really drilled into what was going on. I was trying to make the point that the politics in the NHS had overtaken the clinical measures”.
Despite his huge success and the passage of many years, Mr Mercurio still rankles about some of the responses in the media to ’Bodies’. “Perhaps predictably, [former health secretary] Virginia Bottomley didn’t like it, and a scathing BMJ review claimed ‘the writing is technically good, but its heart is a block of ice. It could never happen’.
“Anyone watching ‘Bodies’ who knows the medical game, knows that its heart is certainly not ice. As a viewer, you’re made to care about outcomes and the characters who do the right things. ‘It could never happen’ is an absurd thing to write, it’s repeatedly happened, several times. ‘Bodies’ was about negligence and error, and patronage.
“When we were doing ‘Bodies’ [it ran between 2004 and 2005], it was the time of the perpetual new NHS initiative, which were meant to be dealing with the institutionalised problem of not enough clinicians and too many patients.
“Of course, those initiatives didn’t make real changes: there was a lot of pushing things around the plate without making any real difference.”
Errors will happen
Mr Mercurio doesn’t feel that his more realistic portrayals of medics and medicine have dented public confidence in the profession. His response is – “look at opinion polls on the most trusted professions. Doctors and nurses are at the top and journalists and politicians are at the bottom.
“Doctors and nurses remain in high public standing, quite rightly. It’s to the credit of the medical profession: the public trust us for the right reasons and mostly, we only fail when things get so stacked against us that anyone would fail.
“I wish medical institutions would push back when professionals are being scapegoated. I worry about how in tune with real working doctors the GMC are.
Mr Mercurio does not appear to think initiatives to improve clinical quality have improved.
“The new Healthcare Safety Investigation Branch will not work. It’s been modelled on the Independent Office for Police Conduct, which is the best example of an organisation that doesn’t get it right because it’s so complex, [and has] vested interests.
“Medicine is trying to be ethically neutral towards error. Those of us who’ve done the job know that it’s genuinely impossible to do the gold standard every minute: errors will happen. Other organisations are much better at putting remedies in place within a blameless context.
“Medical institutions think the public would be shocked a doctor could make a mistake. People have been saying for years that ‘this will shock the public too much to see it’. That attitude is incredibly isolating and makes it harder for doctors to do the job.
“And the biggest mistake is that it makes it harder to effect change. Medicine is a partnership between clinicians and patients, which is nothing like the situation between police and criminals (unless there’s corruption …).”
Mr Mercurio concludes his conversation with Sir Simon by wryly reflecting that his writing has not put his own family off the professions he has explored: “my daughter’s at medical school, and my son wants to be a policeman.”
Bedpan readers might also enjoy Mr Mercurio’s appearanace on Nick Robinson’s Political Thinking podcast
Coming up: The state we’re in with Will Hutton
If there is any political or influential figure you would like HSJ to interview, please email alastair.mclellan@wilmingtonhealthcare.com.
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