You can usually tell when a medical drama has gotten something wrong.

The surgeon is holding an instrument like a pair of scissors. A nurse disappears completely while the doctor does the work of six different healthcare professionals. And somehow, everyone has time to have a deeply emotional conversation in the middle of a code. But when a medical drama gets it right, you might not notice at all.

That's because there can be a whole team of real healthcare professionals working behind the scenes to make the medicine believable. They're called medical consultants, and their job goes far beyond making sure actors know which end of a stethoscope to use.

There isn't one standard job description. Depending on the production, a medical consultant might be a physician, nurse, paramedic, surgeon, pharmacist, midwife, medical educator or another healthcare professional with specialized knowledge.

Some work primarily with writers. Others spend their time on set. Some do both. Their responsibilities can include:

In other words, they're part clinical expert, teacher, fact-checker and behind-the-scenes problem solver. And sometimes, they're also the person who has to tell a room full of writers that the dramatic medical plot they've spent three hours developing doesn't actually make sense.

One of the more interesting recent examples is The Pitt, HBO's emergency department drama. The show's production worked with multiple physician consultants, including UCLA emergency physician Dr. Jacob Lentz. His job isn't simply to answer questions about medicine.

Lentz has helped review scripts, train actors and advise on how the emergency department should actually look and function. That includes details such as where physicians and nurses stand, what equipment is present, what's displayed on computer screens and how procedures are performed. (uclahealth.org)

The actors also went through a medical boot camp before filming. That's important because an audience may not consciously notice whether someone is positioning their hands correctly during a procedure—but a healthcare professional watching at home absolutely might.

Medical consultants can also have a role long before cameras start rolling. For Grey's Anatomy, surgeon Michael Metzner worked as a medical consultant, helping with medical terminology, diagnoses, surgical procedures and other clinical details. (ama-assn.org) That's important because medical accuracy isn't just about what happens in an operating room. It's also about the words characters use.

Would a doctor actually order that test? Would that symptom suggest that diagnosis? Would this team of clinicians handle the situation this way? Those questions can change an entire scene. And if the answer is no, the consultant can help the writers find something that works medically and works for television.

Here's something that can get lost when people talk about medical consultants:

Healthcare consulting isn't exclusively a physician's job. Nurses and other healthcare professionals can bring expertise that physicians may not. For Call the Midwife, practicing midwife and lecturer Terri Coates served as the show's principal medical advisor. She reviewed scripts, advised actors on procedures and helped the production accurately portray childbirth and midwifery. When something fell outside her expertise, she brought in additional specialists. (pmc.ncbi.nlm.nih.gov)

That makes sense when you think about how healthcare actually works. A nurse sees different things than a physician does. A respiratory therapist sees different things than either of them. A pharmacist notices medication details. A paramedic understands emergency care from a completely different vantage point.

There isn't one person who knows everything about healthcare. So why would a TV production be any different?

Imagine being an actor who has to perform surgery on camera, but you still have to look like someone who has performed that procedure before.

That's where hands-on coaching comes in. For HBO's The Knick, medical historian and physician Dr. Stanley Burns helped actors learn medical techniques appropriate to the show's early-20th-century setting. That included things like surgical knots, instrument handling and period-specific practices. (tvrage.com)

And on The Pitt, medical consultants have similarly trained actors before filming. It's essentially clinical simulation—except instead of preparing a future healthcare professional for a real patient, you're preparing an actor to convincingly play one.

Here's where things get complicated. A medical consultant can tell a writer exactly what would happen in a real hospital. But a television writer has a different question: “What would make people keep watching?”

Real healthcare can be slow. A patient might wait for a test. A physician might consult another specialist. A nurse might spend 20 minutes documenting something that takes five seconds to explain on screen. None of that makes particularly compelling television. So medical dramas inevitably take shortcuts.

One study examining CPR scenes in medical dramas found that the way CPR was portrayed frequently differed from published resuscitation guidelines. (academic.oup.com) And that's not necessarily because nobody on set knows better.

It's because accuracy and storytelling aren't always the same thing. A consultant might say, “This isn't what would actually happen.” The writers might say, “We know—but we need the audience to understand what's happening in 30 seconds.” And somewhere between those two answers, television happens.

Medical professionals aren't just checking whether a procedure is technically correct. They're also helping portray what healthcare feels like. What does a nurse actually do when a patient's condition suddenly changes?

How does a physician talk to a frightened family? What does an emergency department sound like? How does a team communicate during a crisis? What would a clinician notice immediately that a normal person wouldn't?

Those details can be difficult to write into a script because they're often things healthcare professionals do almost automatically. A consultant can turn that institutional knowledge into something an actor, writer and director can actually use. That's a different skill from simply knowing medicine.

This is probably the most interesting part for anyone considering a healthcare career:

You don't necessarily have to leave healthcare to work in entertainment.

Medical consulting is one example of a career that sits somewhere between clinical expertise and another industry. A healthcare professional could potentially find work involving:

The exact path varies. Some consultants continue practicing clinically while working on productions, while others build careers around consulting, writing, education or media. The common thread is that clinical knowledge becomes the thing you bring into a completely different environment. And that's a useful way to think about healthcare careers in general. Your degree doesn't necessarily determine the one job you'll have forever. It can give you a foundation that becomes valuable somewhere you didn't initially expect.

Probably somewhere between “it's basically a documentary” and “none of this could ever happen.” Medical dramas have real healthcare professionals helping shape them. But they're still dramas.

The next time you're watching Grey's Anatomy, The Pitt, Chicago Med or another medical series, pay attention to the little things. Somewhere behind the camera, there's a healthcare professional whose job is essentially to make sure Hollywood doesn't completely butcher the medicine.

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