In Sunday's Kansas City Star, I preview another exciting season of medical documentary that we've come to expect from Terry Wrong and his crew. They've been doing these unscripted reality series since 2000's "Hopkins 24/7," and the extraordinary effort and access that goes into them becomes clear from the get-go.
I asked Wrong how he does it. An edited transcript of our Q-and-A follows.
What do you have to do to gain the kind of access you had for “Boston Med”?
The access is premised on two things. One is history. That means you have to have done a couple of medical documentary series before and treated them with integrity and operated within the ethical and legal rules regarding both patient confidentiality and media law. I did two series, those turned out well, and of course, Mass General called up Hopkins and said, “How was it?” And they said, “Oh, it was great. Do it.”
The second thing is you need to have your media lawyers and the hospital’s risk management lawyers agree that there is a context in which you can film which obeys all the patient privacy concerns, staff rights and other issues involved in shooting medical cases in a hospital. That’s no small thing. I basically meet with the heads of all the departments I’m interested in filming, the chief of surgery, the presidents of each of the hospitals. People ask me hard questions: “If this happens, what will you do?”
Invariably someone will ask if they can see the show before it is broadcast, and the answer is always no, we’re a major news network, we never show a story before we go to air with it. Then someone else will ask, “What if a doctor doesn’t like the way a story is going?” The answer is — remember, this is not a reality show, no one’s under contract — anyone can say at any time, “I’m uncomfortable,” and stop shooting, but they can’t suppress or retract anything that’s been shot up to that point.
For patients, it’s a little different. Patients have the protections of HIPAA, and that means you want to get informed consent from them. And in an emergent situation, you don’t always have time to get that from them, but at the first opportunity. HIPAA’s a lot more complicated than that. There are a lot of other ways you can identify a person. A tattoo can do it. A Social Security number on an X-ray. You have to be aware of that, and they have to know you are aware of that. We actually take HIPAA classes and we take airborne pathogen training. I don’t want to get into all the classes we take, some of it is proprietary, but suffice it to say we put in several weeks not even reporting or filming, just training. Very few people have time to do this. These projects take two years. What shows can you think of that, from the greenlight to the time it airs, takes two years?
What kind of people do you hire to shoot your show, and what’s the schedule like? The schedule is hell because you’re covering people whose schedules are hell. Surgical residents, when they’re starting out, are supposed to work 80 hours a week — though if you can tell the difference between 80 and 90 hours when you haven’t slept all night, that’s something. We basically move away from our homes and our loved ones and we live in an apartment across the street from the hospital. We respond 24/7. We shift out who’s up in the middle of the night, but sometimes there’s so much going on, we wake everybody up. I myself was on the rooftop with a camera at 3 a.m., waiting for the helicopter to come in, plenty of times — while wondering why I couldn’t get any of the people who are 10 or 15 years younger than me to wake up so I could go to bed.
The producers who gravitate to this kind of work have, if not a medical background, a strong interest in medicine. This time I had a woman whose brother is a neurologist in the Boston area and whose dad is head of neurology at a Boston hospital. Three or four other people had those connections. At least 70 percent of the team had worked with me before, so they were extremely familiar.
What was different this time from “Hopkins”?
If we had just made a carbon copy of “Hopkins,” it still would have been a completely different show. Each individual case has its own human drama because it’s happening to new people you haven’t met, and going to Boston you’re meeting doctors you’ve never seen before. No two heart transplants are alike. There’s tremendous variation.
But I did have a larger, macro purpose. Every time we’re in a hospital we’re learning medical information that helps us to understand the conversation that’s going around us better. We were smarter reporters this time. And we learned a lot of things that broadened our understanding that medicine is an art as well as a science. And what I mean by that is that you can go to one of the very best hospitals in the country and you have what you think is one of the very best doctors in the country, you can still have a bad outcome. Once you get deep into this, you learn no one is guaranteed a perfect outcome. There’s too much variance.
The second thing is that a good outcome to you may be that you go back to your life and are as energetic, perhaps more energetic, than you were before. But you learn that in medical terms, a good outcome can be anything from “you’re alive, and your brain works,” to going back to your life as usual.
(Below: In 2000, editing "Hopkins 24/7." Wrong is in the center, back to camera. Courtesy Johns Hopkins.)
It seems like you are trying to make medical dramas that both patients and doctors can watch and learn from.
That’s definitely true. I’m not going to name medical dramas, but there are ones that show procedures that could never happen in people’s particular specialties. There’s so much drama in real medicine, you don’t need to hype it.
A few sound bites gathered over thousands of hours of video really burned themselves into my brain. One was from an ob-gyn resident who said, “The most dangerous thing a woman will do in her life is have a baby.” It’s true. When you start following around ob-gyn residents — oh my god, the complications that can come up.
She also said, “Everybody thinks they’re entitled to have the perfect baby.” Now if you understood how badly hurt the field of ob-gyn has been by malpractice suits, which are roughly five times what they are in other fields of medicine — and consequently they have difficulty filling ob-gyn positions — that shows how far out of whack the public perception is with the medical reality. That is one public service I wanted to provide with this series.
Another thing is from something that was said to me by a colorectal surgeon: “You know, for all the times that I get it right, those few times where there are complications, they drive me crazy, and that’s what will ultimately drive me out of medicine.” Now, this is a terrific surgeon — but that’s what they have to live with, their own perfectionism. I wanted to show that, too. I wanted to get the expectations of the patients and the doctors more aligned, and show the public what to expect when you go into the hospital.
In light of the health care debate that’s been going on, probably as long as you’ve been filming this program, what message, if any, does this series send? Seemingly the best procedures with the best surgeons that money can buy — but whose money, and how does it get paid for?
There are a couple of issues here. One is the hospitals we focused on are teaching hospitals, where new procedures, new therapies, things that advance medicine, are done. We have always been the leader in those teaching hospitals. We have more than a dozen top-flight teaching hospitals. Surgery was invented here. Anaesthesia. Now, teaching hospitals on the clinical level deliver medical care to the population it serves, regardless of whether the population can pay for it or not. Now, someone does pay for it, and it’s the federal government, the state government, and taxpayers. You can’t make progress without spending money. And I would argue you are better off spending money to make people healthier than to send people to Mars.
I’m half Canadian, so I could make the case that everyone should get a basic level of medical care — but remember, Canadians have had to come to the United States to get MRIs for years because the waiting lists are so long in Canada. And I don’t hear people decrying the state of medicine in the U.S. saying, “I’m going to go get my surgery in London.” American medicine is still at the forefront, and it is still an area where we are a superpower. And if we’re not willing to pay for that, it’s going to show in life expectancy and other indicators.
