Carry on, doctors and nurses

As the latest American import, ER, hits our screens, Rhys Williams exam ines the authenticity of that staple of TV programming - the medical drama
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A lot of tape has passed through the VHS since Andrew Davies, the award-winning writer of A Very Peculiar Practice, accused television executives on both sides of the remote control of attempting to "narcotise the viewing population" with tired, f ormulaic drama geared at chasing ratings.

If it was not a series about policemen in Yorkshire then it was Derbyshire, except perhaps it could be doctors this time but played by policemen.

Although it seems like an age, Davies's attack came only three weeks ago. But it might as well have been three decades for all the impact it appears to have had on the thinking behind the current schedules. Tonight the BBC's great ratings hope for the year, Dangerfield, takes to the screen - cops meets docs as Nigel Le Vaillant (Julian in Casualty) plays a GP who doubles up as a police surgeon. Two classic genres for the price of one. At the same time, ITV will offer the first episode in the second series of the remake of that well-roasted television chestnut, Dr Finlay's Casebook.

In case you thought you could escape the stethoscope in that traditional haven of originality, Channel 4, Wednesday sees the UK premiere of the US television drama phenomenon of recent years, ER. Written by Michael Crichton (of Jurassic Park fame) and produced by Stephen Spielberg, ER ("emergency room", the US equivalent of a casualty department) has claimed audiences of 27 million, taking it to number four in the ratings.

Doctors and nurses have always been a film and television staple. According to Peter Ansorge, commissioning editor of drama series at Channel 4, medicine can be a compelling format because "it's obviously a tremendous source of drama and conflict, life and death issues, something to which we can all relate".

For American programme makers, it has always been a convenient way to sate the viewing public's lust for gore and suffering without unending scenes of shooting and beating - blood without violence, action adventure with a conscience.

It was not always this way. Despite the recent rash of corrective drama, the popular conception of the medical profession still hovers romantically between Sir Lancelot Spratt, the bluff, gruff senior consultant brought to screen life by James Robertson Justice, and Dirk Bogarde's Simon Sparrow.

In the Fifties, doctors were presented as paragons of virtue, nurses as secular nuns. They were steeped in the benevolent idealism that Trevor Howard spouts at Celia Johnson in the railway station caff in Brief Encounter from the previous decade. "All good doctors must primarily be enthusiastic," he explains over a cup of tea and a bun. "They must, like writers, painters and priests, have a sense of vocation, a deep-rooted unsentimental desire to do good."

Your life was in their hands, and if they were dishes like Richard Chamberlain's Dr Kildare, the early Sixties American creation, well, you would practically die to be there. Doctors were now the dreamboats. Nurses swooned, while women patients lay proneand simpering. In Britain, Dr Finlay became the catch of Tannochbrae, while staff in ATV's twice-weekly medical soap Emergency Ward 10 spent more time entangled in each other than in their patients' dressings. Despite the romantic distractions, it delivered the upbeat message that doctors cared for their patients as well their nurses.

Handing the principal part of senior consultant to an actor who looked remarkably like a reptile meant that ATV's Seventies soap, General Hospital, was always going to be shorter on romance. Its storylines were bland but it reinforced the theme that the men in white coats were figures that commanded patients' respect and nurses' deference.

Revisionism came fleetingly in 1983 with G F Newman's four-part drama for Channel 4, The Nation's Health, which laid bare a crumbling Health Service poisoned with greed and hatred, in which patients were maltreated. From across the pond came St Elsewhere, from Mary Tyler Moore Enterprises, creators of Hill Street Blues. Like Kildare, the doctors were young, attractive and dedicated. But in contrast to their fictional antecedents, they were fallible. The series, however, lacked the grit of the Hill, and it was up to the BBC's Casualty in 1986 to debunk the conventions about healthcare that TV has nurtured.

In capturing intense drama against the backdrop of a service in decline, the series provoked outrage from government ministers and earned praise from those health workers unconvinced that the NHS was safe in Tory hands. Casualty was hard, fast and exhilarating, condemning its mainstream predecessors to the status of cosy middlebrow drama. The programme took the romantic preconceptions of the genre and tore them apart. There were male nurses for a start. And women doctors. Health workers smoked, drank and took drugs. Patients no longer meekly sat by, but instead yelled abuse. Nurses graduated from decorative handmaidens to purveyors of expertise and common sense. The politics of inner-city change were refracted through the experience of those charged with treating the consequences. However, in squaring up to controversy, it lost its focus on the doctors and although it can still pull in 17 million viewers, many believe it is past its best.

The mantle of true revisionism has now fallen on Cardiac Arrest, penned by a junior doctor in the West Midlands. John MacUre (not his real name) wanted to show that long hours transform eager junior doctors into heartless automatons.

Patients are processed like data on a system that is close to crashing at every turn. Filmed on video and in harsh, white, nuclear dawn light, Cardiac Arrest shows exhausted, inexperienced junior doctors muddling through with vodka and sick jokes.

The first series last April had Tory MPs talking about "all the usual propaganda" and the Royal College of Nursing complaining about the portrayal of its members as "callous". But coinciding with the death of Dr Alan Massie, the 27-year-old who collapsedafter an 86-hour week at Warrington District General Hospital, it appeared to ring true.

With episodes entitled "Welcome to the House of Pain" and "The Killing Season" (a reference to the arrival of junior doctors in August), viewers faced up to the possibility that if they fell ill, hospital might just be the last place they would want to be; that if doctors cared, they did not have time to show it.

The medical drama, along with its programming stablemate, the police series, is now barely recognisable from its forebears. Just as the community-minded bobby of Dixon of Dock Green has given way to the bent copper in Between the Lines, then the committed idealist of Dr Kildare has been replaced by the cynic in Cardiac Arrest.

Where does the latest American import fit into all of this? In providing a corrective view of medicine to prime-time America, ER's agenda mirrors Casualty or Cardiac Arrest. It is pacey and multi-stranded (45 medical stories and 87 speaking parts in the two-hour pilot alone). There is no conventional narrative, the action providing a backdrop against which the characters will doubtlessly develop and interrelate. In that sense, the patients are secondary.

There is plenty of blood, as you might expect from a series edging towards reality, but when the senior nurse magically recovers from a drug overdose that would have killed an elephant, it is clear that ER is well and truly rooted in medical fantasy land.

Dangerfield tonight 9.30pm BBC1; ER Wed 9pm C4