How Real is Television's E.R.?

This article was published in the original Podium magazine on Nov 22, 1999, under the tag line, "TV's ER is compared to true hospital stats, and comes out looking fine."

by Raywat Deonandan


Television shows are increasingly striving to package reality as entertainment. Cops continues to show real shirtless men being chased down by the law. Real TV brings us fuzzy video snippets from amateur videographers around the continent. And, of course, Jerry Springer and Professional wrestling continue to further blur that already obfuscated line between theatre and reality.

In the coveted prime-time slot, this trend toward realism is championed by the most successful of modern TV dramas, E.R. Created by non-practising medical doctor Michael Crichton, E.R. remains top-rated and highly praised for its supposedly realistic portrayal of events within a hospital emergency room.

But how realistic has E.R.'s portrayal been? Like its weaker medical predecessors Emergency!, Doctor Kildare, Trapper John, MD and their ilk, has E.R. compromised any claim to an accurate depiction of a real emergency room in the name of character and plot development?

Professors Bill Miller and Truls Ostbye of the University of Western Ontario have compiled the demographic and treatment profiles of a season's worth of E.R. patients as part of a graduate course taught by Dr. Ostbye, and have compared this compilation to real data from the U.S. National Ambulatory Medical Care Survey (NAMCS). Obviously, the NAMCS doesn't reflect the Canadian situation, but one should, in all fairness, compare E.R. patients to real patients in comparably sized U.S. hospitals, and not to medicare-supported Canadian hospitals.

The results of the comparison are somewhat surprising, particularly where racial demographics are concerned. Where one would expect the television show to disproportionately present white patients, as have its predecessor shows, E.R.'s white patients constituted a mere 4% more than the NAMCS data lead us to expect; 78.5% of NAMCS patients were reported as white.

Similarly, ER accurately showed that the majority of patients are below the age of 50, something at which many media gurus would have balked considering the much-hyped demographic trend of "population ageing."

The television show did, however, dramatize most of its patients (57.6%) as having arrived because of injury, while the NAMCS survey states that the majority of ER visits (58.5%) are due to illness or disease. Perhaps the treatment of broken bones and skull fractures, rather than of diarrhea or scabies, presents more potential for romantic drama and visual heroism.

Interestingly, where the E.R. television show deviates the most from reality is in its depiction of the gender split in the patient population. On television, just over 61% of the patients are male, while NAMCS reality dictates an almost even representation by both sexes. Back in the days of Emergency! and Trapper John, MD one might have expected a larger number of females, if only to provide romantic possibilities for those shows' mostly male cast. But in modern times in which gang violence brings in ratings, it helps to have gurneys laden with young male gunshot victims.

In short, E.R. seems to have passed snuff. Even its more nagging elements appear to be supported by reality: most visits to an ER are indeed made between 8am and 5pm on weekdays, and there is an increasing trend of usage among higher socio-economic groups.

Still, most real ER visitors tend to be poor and ill. And being of an ethnic minority group is still a strong predictor of ER usage. Some entertainment moguls no doubt believe that these factors persist as barriers to good ratings. Whether the seeming chaos and hourly crisis of television's E.R. is typical of a real emergency room is yet another issue, one that will surely depend on the city or town one chooses to examine.

But in this one case, in at least a few ways, it seems that art has chosen to imitate life.