Medical dramas are as popular as ever, but most writers don't have medical degrees. When they need an expert, they call on someone like Dr. Oren Gottfried, a renowned spinal surgeon to set the scene.

Dr. Perry Wilson: Watching actors play doctors on TV can be uplifting or completely cringe-inducing, but behind the scenes, many of these shows employ medical consultants to try to keep the action that happens on screen at least somewhat believable. To talk about medicine on the big and little screen, I am joined today by Dr. Oren Gottfried.

Dr. Gottfried is a busy spinal surgeon at Duke, a researcher who's published extensively on outcomes and neurosurgical techniques, but by night, he's a medical consultant for shows including Royal Pains on USA, Elementary on CBS, and Chicago Med on NBC. Dr. Gottfried, thanks for joining me on Doc to Doc.

Dr. Oren Gottfried: Thanks for having me.

Wilson: First of all, you got your MD from the University of Arizona. You did your fellowship at the University of Utah and Johns Hopkins. I did not see California or New York City on your resumé, so how did you get started consulting for TV shows?

Gottfried: I received a cold call when I just started at Duke, a new position in neurosurgery. I was just looking for patients and I received a call from Los Angeles. I thought it was going to be a transfer of a patient from a far distance, and it turned out it was a Hollywood writer, Hollywood producer that asked me to help with a pilot he was working on. I thought it was just one project and I'd have fun with it, but it led to what's going on now eight years later.

Wilson: [LAUGHTER] It's been eight years. Has it just been word of mouth, that one producer talks to another producer or do you send your resumé to people? How do they know to call you?

Gottfried: I have remained just open-minded to new phone calls, new emails, people, and I do think it's word of mouth that gets me the next position. In Hollywood, shows get cancelled, writers leave. Actually, any time someone leaves a show, I think it's a possibility of an opportunity. If I've done well with that writer or producer, they sometimes call me up on their next show, so I feel like it's the gift that keeps on giving and surprisingly it hasn't become overwhelming. It seems like any show needs me in a particular period of time, and then doesn't need me for a little while, and another show comes in. But at any time, I might be managing two or three or four different shows.

Wilson: What kind of things are they asking you about? Is this highly technical or more general? Can you give us a sense? What are the questions that come in?

Gottfried: It's very diverse. My role on each show can range from simply reading a script, reading an outline, troubleshooting, brainstorming story arc to saying how to pronounce a word so the actors know how to say a particular word, to going on set and actually making sure the scene looks really accurate. My role changes by day, and I have different roles with different shows. I particularly enjoy the storytelling and sitting with the writers.

            I frequently will call into a writer's room and speak to anywhere from 10 writers, and we just go through a process and a story arc, and I provide the technical attributes, what disease would fit the storyline, what would the people look like, what would they be doing, and then follow through to the script. I follow it through to production, so I do hear some very odd questions, and I do have to use my imagination quite a bit. Sometimes it's difficult. What comes to mind right now is I was once asked, "What part of the brain controls time travel?" I needed to justify which area. Just so you know, I'm not going to tell you, but I figured out what area of the brain would most likely control jumping or being in different periods of time.

Wilson: Now I sort of need to know. What show is this on? We can watch the show.

Gottfried: Some of these shows I have… honestly, I've signed non-disclosures. Once the show has aired, I feel very comfortable talking about my role, but a lot of times these are company secrets that I'm not allowed to divulge. But each one of my shows has interesting questions they pose to me.

Wilson: Okay. I'm going to put in my guess. I believe it is going to be the superchiasmatic nucleus. I'm putting my nickel down on that as the seat of time travel and the human brain. Has anyone come to you with something that you've had to squash? Have you just said, "You know what? This is too ridiculous. It could never happen that way." What's an example of something like that.

Gottfried: In general, if I go right to the answer of, "This is impossible," then they're just going to say, "Next." They're going to find someone to give them an explanation. I'm kind of tactful. I mean I interact with patients all the time and different audiences. I think of a way to kind of focus the attention on the relevant parts of the story and tell them what's not accurate. Really, it comes down to if it's been reported in a case report or I can at least imagine that it could happen in reality, it's probably good enough. But when you start getting into less than 1 in 100 possibility, I really let the writers know. If I'm friendly with them and we've worked together, they will value my opinion, but sometimes when I'm working with a new audience, they just really need me to tell them it's okay and go ahead with it.

            I've decided at times to just give up and let them go for it, but my role is to tell them the reality, and when we stray from reality and the writers decide to continue to stray from reality, at least they know they haven't made me happy. In the bigger picture, I know that people are going to come up to me and tell me, "That wasn't very accurate." In the end, I need to stand up for my work, and I feel very strongly it's my role to just be honest with the writers.

Wilson: It sounds like you actually have a creative role, in some cases, where they're coming to you and saying, "We need a character to be in this situation. How can we get her there?" Right? What kind of disease puts her in that situation? Is that something that is sort of particularly challenging? Is that something you like to do and do you have any stories about trying to get a character from Point A to Point B using your medical knowledge?

Gottfried: Yes, what comes to mind is my work with Elementary. The show is now in its sixth season, and I've helped them along the way. But when they first called me and told me the situation I needed to figure out, I mean I'm a doctor. I work really hard to promote health, and they need me to solve a medical mystery, a murder mystery, and I need to give them the technical details of how the mystery would be solved. But I also have to think of it in terms of the bad guy, the villain, and that was difficult at first. Some of the questions would make anybody look at my Internet searches very suspicious because there's murders with odd weapons. There's bombs… I mean just really weird things. But I can give them the technical truths of what would happen to the victim, how could this bad villain hide the crime, and to give examples of shows that already aired.

            One time I was asked, "How would a prisoner in the operating room escape from the operating room?" I mean fortunately I have enough medical tools to understand the situation and get that person out of the operating room and running away from the good guys. I do have to think outside the box, and it's not all just medical. I use other medical specialties, research forensics, and fields that are beyond my normal spectrum of things I treat.

Wilson: Well, it sounds like an awful lot of fun. Is this a good supplement to income? I mean is this something that doctors out there should sort of see as a moonlighting opportunity, or is this just for the sheer enjoyment?

Gottfried: I think at the base level many of us doctors watch TV and we're very critical of dramas we see, and we always think, "What would I have done? Or I can't believe they have that specialist doing that procedure." I feel like any doctor could say, "I want to get active in that process," and you can go two directions. You can have a blog or go online and say, "I don't like what's going on on that show and this is why." Or you actually can get involved. There's a group called Hollywood Health and Society, and any physician can call them up and put their name on a list and be the expert of their field to go ahead and say what the accuracy is.

            But in general, it's not a field that will supplement someone's income. I do it because it's very fun and I enjoy the process, and I enjoy the people. Writers and producers are definitely different than doctors, although there are many doctor producers, so I've dealt with that crowd as well. But in general, doing my day job is what I need to do. But for creative outlet, working with these producers and writers has been great, but it's not necessarily a moonlighting opportunity.

Wilson: What's the biggest medical misconception that you have to correct? Is there anything you see over and over and over again that you have say, "That's not right?"

Gottfried: I mean I think running a code we can all look at the criteria and see what the steps. I think going to shocking… I always question when I'm watching a show. "Do we know it's a shockable rhythm? What's the rhythm?" The order of the steps. I don't run a lot of codes, but I certainly have to keep my credentialing up, so running a code seems to be sometimes off.

            Sometimes there's just bleeding from odd spots, that pretend brain tumor, and sometimes it just gets annoying. But in general, I think most of these shows are paying a group of people to be their actors, and the shows don't have a budget to bring in extra actors to be specialists, so a pet peeve I hear from many is, "That specialist wouldn't be doing that surgery or that procedure." I understand from the perspective of the production. They've just hired some all-star actors to be on the show. They're not going to bring in five new actors to be the specialists in every field. But when I speak with doctors and look at online reviews, a common critique is, "That doctor shouldn't be doing that procedure." But if you can overlook some realities and accept that it is a TV show and it's not a medical student educational video, I think it's easier to watch the shows and then go into detail of why you like that show and what are the positive attributes. [00:10:00]

Wilson: Now let's say that just hypothetically speaking you were to leave medicine and start your show, be showrunner for a brand new show. What would Dr. Oren Gottfried want to see in a medical show on television right now?

Gottfried: Well, my bias would be absolute reality, but it'd have to be still exciting. I mean I do have the opportunity. I have pitched and shopped shows before. It is theoretically possible, but my arrangement would always be not to skip medicine, to use it as a supplement. I would definitely need a co-creator, co-showrunner, but there are formats where doctors can jump right into a situation. There are a few examples active right now, and reality is another area.

Actually, reality series medically based don't have the same infrastructure as dramas do, so it is possible. But I would say it'd have to be ultra-intense, ultra-realistic, and has to engage the audience. At this point, I feel like I know how to tell the story that is good for mass production and mass audiences, but I wouldn't give away all my secrets, but we definitely have to one-up some of the existing patterns of shows.

Wilson: Dr. Gottfried, I'm sure I speak for all of us watching, but the next time we are criticizing a medical show or enjoying a medical show, when those credits roll, we'll be looking for your name as the medical expert. Thank you, once again, for sitting down with me today.

Gottfried: Thank you. I enjoyed it.