We care about medical accuracy on the screen.
WHAT WE DO:
MedCheck provides expert medical coordination services to the entertainment industry, making TV shows and films more realistic and ensuring accurate health information is depicted in popular culture. We tweak scripts to make the medical dialogue more believable, work with screenwriters to select appropriate medical conditions to incorporate into their storylines, and edit sets to ensure that the ER looks believable and that the actor-surgeon is holding the scalpel correctly. Whenever a script includes health information, incorporates a character who works in health care, or calls for a scene with an injury or illness, MedCheck provides the “medical check” that entertainment productions need to deliver authentic, high-quality storylines.
Why Care About Medical Accuracy on Screen?
1. Audiences Appreciate Authenticity
Your audience is more medically savvy than you think!
14% of the US population works in health care.
The average person encounters the health care system frequently. According to the CDC, in 2020, 22% of adults had been in the ER in the past year, while 83% of adults and 94% of children had seen a doctor in the past year.¹
The Bottom Line: Because your audience either works in health care, or has frequent interactions with health care providers and health care settings, this shockingly large amount of collective experience means that:
Medical Errors on Screen Stand Out - These blunders have the power to jolt your savvy audience out of the cinematic world you’ve worked so hard to create.
Medical Realism Adds Dimensionality and Depth - Your actors’ performances, as well as the sets you create, benefit from real-life layers of texture that draw the audience in.
2. Medical Misinformation Harms Us All
Because patients absorb much of what they see on their screens, the entertainment industry has an indirect but powerful influence over the health care system as a whole. As a result, when patients’ screens are filled with inaccurate representations of health care and health information, this leads to:
Unrealistic Patient Expectations
Just as forensics shows like CSI have led the average juror to expect a near-impossible standard of physical evidence in criminal trials², shows like Grey’s Anatomy have left patients with the impression that a diagnosis can always be found and that there is a cure for every ailment.
Unfortunately, when a diagnosis proves elusive or a cure hasn’t manifested in a 15 minute office visit or even a 4 hour ER stay, patients feel disappointed and frustrated, at times becoming verbally or physically abusive toward their doctors and nurses. And this type of aggression isn’t theoretical - the MedCheck team personally know several doctors who were physically assaulted by patients while at work. (For more on the larger epidemic of violence in medicine, click here.)
Provider Burnout
Physicians (and nurses!) go into medicine to help others. To do so, they spend years jumping through every imaginable hoop, from entrance exams and sky-high tuition fees, to tests of endurance like sleepless 36 hour calls or jam-packed days with no time to eat, all punctuated by missed birthdays and holidays. After all this effort, even the most skilled physician can’t satisfy a patient whose expectations are unrealistic or off-base (“I’m sorry but I can’t refer you to the Department of Diagnostic Medicine…”). This tension between unrealistic expectations and what is possible creates friction between patients and their providers. At worst, this can boil over into verbal or physical attacks from patients. Most frequently, however, patients leave dissatisfied or disillusioned with the health care system, and physicians end up feeling like they’ve failed their patients. Rinse and repeat a thousand times a year, and it’s no wonder physicians no longer find fulfillment in a career they once saw as a calling. Coupled with the stressors of the pandemic, it’s no surprise physicians are reporting record-high levels of “burnout,” which the American Medical Association defines as a long-term stress reaction that can include emotional exhaustion, depersonalization, and a feeling of decreased personal achievement.⁵
The bottom line is: unrealistic patient expectations are a huge contributor to health care provider burnout, which in turn leads to high rates of substance abuse⁶, suicide⁷, and career change among health care providers⁸. Portraying medicine and the plight of health care providers more accurately on screen is one powerful way to help extinguish the flames of the unrealistic patient expectations driving burnout.
Stigmatization
Without realizing it, the entertainment industry has helped to perpetuate the stigmatization of various medical and psychiatric conditions, with the latter especially hard-hit. Though 50% of Americans will suffer from some form of mental illness in the course of their lives⁹, mental illness is a relatively infrequent subject of discourse in movies and television. And when psychiatric disorders are featured on screen, they are often characterized inaccurately or treated inappropriately. As a result, audiences may not recognize actual signs of mental illness in themselves or others, may expect inappropriate treatments, and may be given false hope as to what the recovery journey looks like in terms of timeline and efficacy.
In the show Pretty Little Liars, Hanna, one of the main characters, has bulimia nervosa. The show’s depiction of her illness is far from realistic, with her character struggling only briefly, then announcing to a friend one day that she’s fully recovered. In reality, most patients with bulimia struggle for years and receive treatment addressing multiple aspects of biology and psychology, as well as environmental and family factors. False notions of a quick and easy recovery from Pretty Little Liars could lead audiences to wonder why their friend or family member can’t just “get over” their bulimia, leading to stigmatization of patients who follow the expected years-long recovery process.
The stigma of mental illness is further perpetuated when characters talk about someone with mental illness using pejorative language or assigning personal blame, as though the illness is a character flaw. This is especially true when a character struggles with substance use issues like alcohol or drug abuse. As stigma is the greatest barrier to mental health treatment, the entertainment industry, by applying a more thoughtful lens to these issues, holds the power to change the entire societal narrative around them.
Patient Harm
Occasionally, the information presented on screen can result in patient harm. One medical example is the portrayal of seizures in the entertainment industry. All too frequently, the hero or heroine responds to a seizing patient by placing something in the patient’s mouth, ostensibly to prevent the patient from biting their own tongue (or swallowing it, as one version of the myth goes). Unfortunately, such an action puts the patient at risk of injuring themselves (breaking teeth or choking on the object). It also puts the rescuer at risk, as they could injure themselves attempting to insert an object between the teeth of a patient who is moving rapidly and erratically.
A 2011 study published by researchers at Dalhousie University examined how seizure treatment was depicted on the popular television shows “ER,” “Greys Anatomy,” “Private Practice,” and “House.” Despite the express medical focus of these shows, 43% of the time, seizure care was inappropriate (e.g., inserting objects into patients’ mouths or trying to restrain the patients/limit movement). Care was correct in only 25% of cases and was indeterminate in 32% (there weren’t enough details for an assessment¹⁰). Such dangerous misinformation can and does cause well-meaning seizure bystanders to administer potentially harmful first aid. Moreover, such bystanders miss an important opportunity to actually help the patient, for lack of correct medical modeling on screen (e.g., loosening clothing, turning the patient on their side after shaking has stopped, administering a rescue seizure medication).
Netflix’s teen drama series “13 Reasons Why” is another television series that has come under scrutiny in recent years for its portrayal of psychiatric illness. The series centers around a teenager who commits suicide and serves as a retrospective review of her life, delving into her 13 reasons for committing suicide. The show was criticized in many circles for its emphasis on blaming others for suicide (each episode is devoted to how one character negatively influenced the lead). Some have also argued that it glamourizes suicide, while failing to emphasize a multitude of helpful resources that could have averted disaster, both for the main character and its teen audiences. One peer-reviewed scientific study found that in the month following the release of “13 Reasons Why,” American teen suicides jumped 28.9%. While no direct causal link can be proven, the authors of the study concluded, “The release of 13 Reasons Why was associated with a significant increase in monthly suicide rates among US youth aged 10-17 years. Caution regarding the exposure of children and adolescents to the series is warranted.”¹¹
While there are countless examples of Hollywood-reality mismatches that serve to distort patient expectations, here are just a few:
1. Families accustomed to seeing patients regularly resuscitated with CPR on their favorite television shows are shocked to find that CPR did not bring their loved one back, prompting anger and sometimes aggression. The reality is: out-of-hospital cardiac arrest survival rates are only 19% in the very best of cases (i.e., someone witnessed the cardiac arrest and responded immediately to provide care/CPR)³. Survival rates are far worse (9%) if the cardiac arrest is unwitnessed.⁴
2. Patients who regularly see their favorite doctor-actors chatting at the water cooler or engaging in a romp in the broom closet or call room on their favorite shows don’t understand why the wait to see a doctor is often long, or why the doctor may not circle back with them each time a new result posts during an ER stay or hospitalization. The reality is: there is a profound shortage of doctors and nurses in the United States and staff is stretched thin, often with no access to call rooms at all even when they are dangerously tired. When physicians aren’t with one patient, they’re either with another patient, charting to fulfill billing requirements, or coordinating/reviewing testing, not sitting in the doctors’ lounge (if there even is one!)
3. Based on what they’ve seen in a television show or movie, patients sometimes expect treatments or services that simply don’t exist. One such example is the Department of Diagnostic Medicine, headed up by the fictional Dr. Gregory House in the television series House. The reality is: there is no such thing as Diagnostic Medicine. It’s not a specialty nor a department at any hospital. All doctors are expert diagnosticians in their respective fields, and there is no one doctor who specializes in diagnosing everything. Patients with complex problems often need the input of many different specialists to arrive at a diagnosis, and when some patients realize there is no one-stop-shop, this is understandably, a huge disappointment.
How Big a Problem is Medical Accuracy?
Even with the help of traditional medical consultants, productions today are still churning out error-riddled films and television shows. As medical coordinators, we can help you avoid mistakes like these:
Dangerous Medical Misinformation
In the cult classic Pulp Fiction, Mia (played by Uma Thurman) accidentally overdoses on heroin and is later found unresponsive by Vincent (played by John Travolta). Vincent panics and drives her to her dealer’s house (we’ll let it slide that he doesn’t call 911 or go to a hospital…), and together, the two of them save her by injecting a dose of adrenaline (also called epinephrine) directly into her heart. Watch the scene here.
Why It’s Bad: Let us count the ways…
The antidote for an opiate overdose (like heroin) is naloxone, which was approved by the FDA in 1971, so there’s no excuse for a 1994 drug dealer to get this wrong (remember, he was savvy enough to have adrenaline on hand!) Even if the dose of adrenaline helped re-start her heart, she still wouldn’t be breathing because the heroin molecules would still be attached to her body’s opiate receptors, suppressing her breathing. Naloxone knocks the heroin off the body’s opiate receptors so a patient can breathe again.
Intra-cardiac injection of adrenaline just hasn’t been a thing since the 1960s (and it’s never been a thing for naloxone), since it can be delivered just as effectively via IVs or multiple other, safer routes (it’s insanely dangerous to pierce the heart with a needle, even for a physician to attempt it!) I’d wager a drug dealer could find a vein to inject the medication a lot more easily than he could precisely navigate the needle into the patient’s heart. In fact, in this scene, the dealer instructs Vincent to pierce the sternum/breast bone with the needle (wrong) but the placement of the needle on Mia is ultimately parasternal/next to the sternum (correct).
When Mia overdoses, she develops an immediate bloody nose. Bloody noses happen to people who snort drugs chronically (most often, cocaine) due to wear-down of the nose tissue over time and aren’t a sign of an acute overdose.
Even though the scene implies that Mia’s heart has stopped, no CPR is ever performed. There are 6 minutes of screen time between when Vincent finds her, and when he injects the needle into her chest. 6 minutes without circulation/oxygen is fatal, and if by some miracle it isn’t, Mia would be brain dead, not magically revived as she is at the end of the scene.
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How to Fix It:
Use naloxone, the antidote to opiates, in the scene. The message to audiences, particularly now, in the midst of an opiate epidemic, needs to be clear: opiate overdose = naloxone. It’s super dangerous to public health to suggest otherwise.
If shock factor’s needed, use that long terrifying needle to inject into a major vein in Mia’s neck or groin. Injecting into the heart is just silly. If Pulp Fiction were remade today and authenticity was desired, a nasal spray version of naloxone (Narcan) has been available since 2015, and any conscientious drug dealer (and many users) likely has it on hand.
To depict an actual opiate overdose, show Mia’s pupils constricting in the close-up of her face, have her lose consciousness, and then show her breathing slow down until it stops. This is way more compelling (and accurate!) than a bloody nose.
It wouldn’t be hard to have at least one character administer appropriate CPR, and would actually add to the drama and chaos of the scene. The drug dealer’s girlfriend could have done this in the background while the other characters talked through the plan.
Shockingly Unrealistic Scenes
<<SPOILER ALERT>> In the final moments of the latest installment of the Downton Abbey franchise (Downton Abbey: A New Era), audiences say goodbye to their favorite family matriarch, the Dowager Countess of Grantham (played by Maggie Smith). In the two minutes of screen time before she passes away, she makes 5 separate jokes at the expense of family and friends. When her maid starts crying, the Dowager quips, “Stop that noise! I can’t hear myself die,” at which point, she promptly dies. You can see the whole scene here.
Why It’s Bad: In the moments before her death, she looks about as ill as your average joe doing a routine at the Comedy Store on a Saturday night.
How to Fix It: No one wants the Dowager Duchess to suffer, and it’s important she depart this world with some of her characteristic sharp wit, but the scene strained belief. Frankly, we’re more tired after cardio at the gym than she seemed in this scene.
Be Clear on Cause of Death - We’d wager the writers didn’t have a specific cause of death in mind. In the prior movie, her chronic illness was alluded to but never named. If the writers had put their money down on something like congestive heart failure or cancer, then it would be possible to add in realistic details to make her story in the preceding weeks more believable. For heart failure, for example, in the weeks leading up to her death, she’d likely seem more and more breathless, especially with exertion. She might have a bit of a cough as well, little appetite, and she would definitely have lower extremity edema (though this wouldn’t be necessary to show). Around the time of her death, she would have spoken in short sentences or phrases, and seemed quite out of breath.
Incorporate Realistic Details - When people die from chronic illness, the last few miles of their journeys tend to look quite similar, regardless of the initial bodily insult. As organs fail and breathing becomes more erratic, most experience extreme fatigue and confusion or changes in sensory experience. We can spare the Dowager the confusion because she needs to go out with her characteristic sharp-as-a-tack mind for the audience’s sake, but at the very least, she could have seemed more fatigued, and could have paused to catch her breath a bit between jokes. For her to energetically trade barbs and then draw her last breath in the next moment, is truly comical… clearly not the scene’s intent!
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HOW MEDCHECK CAN HELP
How We Differ from Medical Consultants:
Availability - Traditional medical consultants often maintain busy, full-time clinical practices, fitting in entertainment industry jobs if and when they are available. At MedCheck, medical coordination for the entertainment industry *is* our primary focus, as we have sought out flexible clinical commitments that allow us to be as available as you need us. We can accommodate your schedule, not the other way around! We are also available to work with you virtually (over phone / video), in-person, or a combination of the two. Moreover, we’d be delighted to join your team as early as you’d like, even in the months or years before a project is greenlit.
Coordination, Not Just Consultation - We prefer the term “medical coordinators” because our focus is on taking the medical guesswork out of the equation for you, all the way from concept to finished product. Let us coordinate everything related to medicine, from storyline development and script edits, to performance coaching and set advising. Though we can be involved as little or as much as you’d like, our general preference is to be involved in a start-to-finish, holistic sense, as we feel important details fall through the cracks when health professionals are only consulted intermittently to answer specific questions as production progresses. After all, if you don’t know what you don’t know, how can you possibly know what questions to ask, or what details might be wrong?
Publishing Background - We’re writers ourselves, so we can appreciate the blood, sweat, and tears that go into crafting a screenplay. We understand how hard it is to make changes to a labor of love, and will work with you to ensure we balance craft and creativity with medical authenticity. To learn more about our publishing history, please see the “Our Team” section below.
Services We Offer:
1. Storyline/Character Development
Whether you have a working script, or merely an idea in mind, we’ll work with you to hammer out the medical details of the story you seek to tell. We can help with questions like:
“I have a protagonist who develops a <chronic disease / sudden illness> that is <painful / disfiguring / paralyzing / blinding / etc.> What conditions fit these parameters?”
“One of my characters will ultimately die as the result of <an accident / illness / attack.> The death needs to occur within <seconds / hours / days / months / years.> What mechanisms of death fit this timeline?”
“The hero of the story has developed his resilience as a result of a childhood <illness / accident> that he has <fully recovered from / still struggles with.> What should I consider?
2. Script Edits
When your script is ready for review, we’ll pore over it with a
fine-toothed comb to:
Fact-check all health information
Ensure the dialogue rings true
Double-check medical character arcs for appropriate pacing and accurate depiction
3. Performance Coaching
We walk actors through the medical nuances of a script, ensuring they are well-equipped to deliver authentic, multi-dimensional performances. Our performance coaching includes:
Portrayal of Illness/Disability - From instruction in the appropriate type of limp for a given condition, to the sleeping position of someone with late-stage heart failure, we provide the relevant details needed to make a performance stand out.
Crash Courses in Medical or Nursing School - Is your actor portraying a surgeon or doctor? A nurse? We’ll give them the cheat sheets to bypass years of training. Everything from where to place a stethoscope on a patient’s chest or how to do a realistic neurological exam, to where to stand during a patient code or how to scrub in for surgery.
Pronunciation Guidance - All those Greek and Latin medical terms can be tongue-twisters! We’ll help your actors sound confident and experienced.
Technical Tricks of the Trade - Just how do you spike an IV bag? Or place paddles on a patient for defibrillation during a code? How should the surgeon-actor hold the scalpel? We’ll take care of these details so there are no errors to distract from the performance!
4. Set Advising
One of the most important aspects of medical coordination is ensuring a smooth and error-free translation from the script onto the screen. To facilitate this, MedCheck will join you on set to provide real-time input on:
Set Design - Is your ICU room believable or does it look more like an outpatient exam room? Do you have the right equipment on set for the scene? Are the vitals on the monitor realistic for the condition depicted, or do they look silly? We’ll help you make the “set edits” you didn’t know you needed.
Prop Direction - Which scalpel should your actor-surgeon use - a 10 blade, or an 11 blade? How should the nurse hook the patient up to the monitors? We’ll take the guesswork out of the equation.
Costume Edits - We’ll work with your Costuming Department to ensure your health care professionals are wearing the right scrubs, and that the bullet hole in the patient’s shirt looks authentic.
Makeup/Special Effects Consultation - You have brilliant makeup artists, but do they know that not all eye bruising is created equal? The eye bruising from a “black eye” is very different from that associated with a basilar skull fracture. And how does the appearance of the bruising change in the first few hours, or first week, after the injury? Do your special effects artists know exactly how much blood to expect from a particular injury, and how quickly it would pool? The right shade of red for the blood? Where exactly on his body should your character be shot in the scene so that his death is instantaneous? Slow? We’ll give you insight into these important details.
Dialogue Changes - If a line isn’t working and you need to change it, we’re there to help you, ensuring that it sounds right for the particular medical scene or health topic. No need to ask yourself, “Would a doctor actually say this?” We’ll let you know!
Medical Coordinators are Here to Stay
Consider the intimacy coordinators whom you’ve come to rely on to ensure your actors and actresses feel safe and comfortable on set during intimate scenes; they provide expertise that has come to be recognized as an essential service, as your cast’s safety and security are paramount. Extending this line of reasoning, we submit that the safety of patients - your audience - should also be top of mind whenever you incorporate health information or medical scenarios into your productions. Your Art has real, tangible effects on individual patients as well as on the health system as a whole, and whether or not you ever see the direct consequences of your actions, we hope you can appreciate the large responsibility you bear to your audience.
Thankfully, MedCheck is here to take the weight of that responsibility off your shoulders. As medical coordinators, we ensure that the health information you present is accurate and depicted in the most realistic light possible, that your actors deliver nuanced, authentic performances in any medical scenario, and that your audience leaves entertained, free from medical misinformation, and perhaps a bit more enlightened about the health system. MedCheck can help you not only mitigate the risk of harm, but also elevate your work to a new level.
Our Team:
Jennifer Przybylo, MD, MPhil
Dr. Przybylo is a board-certified emergency medicine physician with extensive experience in the stabilization and treatment of a wide range of medical, surgical, traumatic, and psychiatric conditions. She earned a B.S. in molecular, cellular, and developmental biology from Yale University, an M.Phil. in computational biology from the University of Cambridge, and an MD from Stanford University School of Medicine. Dr. Przybylo then completed residency training in emergency medicine at Harvard’s world-renowned Massachusetts General Hospital and Brigham & Women’s Hospital. She has extensive research experience, having worked in labs at the Mayo Clinic, Yale School of Medicine, Oxford Centre for Mathematical Biology, Memorial-Sloan Kettering Cancer Center, and Stanford School of Medicine. She has published numerous scientific papers on topics ranging from tumor microenvironments to mobile health technologies. Dr. Przybylo currently holds medical licenses in California and Massachusetts. As a child, she never missed an episode of “ER” or “Rescue 911.”
Nina Vasan, MD, MBA
Dr. Vasan is a board-certified psychiatrist with extensive experience educating the public on mental health and well-being. She earned an AB in Government from Harvard College, an MBA from the Stanford Graduate School of Business, and an MD from Harvard Medical School. Dr. Vasan completed residency training in adult psychiatry at Stanford University School of Medicine, where she was a Chief Resident. She is a Clinical Assistant Professor at Stanford, where she is the Founder and Executive Director of Brainstorm: The Stanford Lab for Mental Health Innovation, as well as Chief Medical Officer of Real, a mental health startup building a new delivery model for therapy. She has consulted for entities including the United Nations, World Health Organization, and two presidential campaigns. Dr. Vasan currently holds medical licenses in California and New York. Her favorite psychiatrist is Dr. Frasier Crane.
We are writers ourselves!
We co-authored the textbook Do Good Well: Your Guide to Leadership, Action, and Social Innovation. Shaking things up and finding new ways to improve the world around us has always been our passion! We feel strongly that the entertainment industry, with a little help from medical coordinators like us, can become an agent for positive change in health care.
MedCheck physicians have been featured in the following media:
MedCheck in Action.
Katie Couric interviews Dr. Przybylo to learn more about her work in the ER during the height of the Covid-19 pandemic.
Work With Us
To schedule a complimentary introductory call, please tell us a bit about yourself by filling out the form below: