Five Good Rules for Writing Medical Characters or Scenarios

Have you committed “Novel Malpractice”? If you’re self-publishing, a Christian author, writer, or even a publisher—are you sure the medical characters and scenarios in your novels are all correct? As an author and physician, I find many medical mistakes in novels, TV shows, and movies, and I have compiled five good rules for writing medical characters or scenarios.

I even noted a major goof in a novel that won several Christian book awards. Splendid book, marvelous writing, but an incorrect medical premise.

These errors are amplified when writers presume what they saw on a show or in a film is correct. The worst flub of all is the portrayal of amnesia. Don’t get me started on that one . . . but it’s why I wrote this article.

Authors can learn how not to make these flubs. The public holds Christians to a higher standard, so let’s meet it.

A quick quiz

First, a quiz. These questions all came from mistakes I found. (You can play the Jeopardy theme in your head.)

1. A surgeon headed to a vascular fellowship should practice suturing on a banana. True or False?
2. An M.D., D.O., and chiropractor are all medical doctors. True or False?
3. Blood running from the ear immediately after a severe head injury means the person has an epidural hematoma of the brain. True or False?
4. A fellow is a doctor enrolled in a specialty fellowship program after doing a residency. True or False?
5. Optometrists perform surgeries on the eyes. True or False?

The answers are all false except #4.

1. Surgeons have already finished five years of a general surgery residency before applying to a post-residency fellowship and know how to suture. The banana was a cute idea, but wrong.
2. While chiropractors are Doctors of Chiropractic medicine (D.C.), their four-year program focuses on the spine, muscles and joints. In most states, chiropractors are not licensed to prescribe medications beyond homeopathic medicines unless they work in collaboration with a medical doctor or an osteopathic physician. In California and Florida, a D.C. can prescribe nutritional supplements like vitamins and minerals. They may take X-rays and interpret them for massage and spinal manipulation purposes. Medical school is a four-year degree program of intense didactic and clinical learning in a broad range of medical topics. Osteopathic physicians (D.O.s) attend an osteopathic four-year medical school nearly identical to standard medical school and are medical doctors. M.D.s and D.O.s typically do several years of post-graduate training in various residency programs.
3. Blood draining from the ear after a severe head injury likely indicates a severe injury called a basilar skull fracture. The diagnosis of an epidural brain hematoma requires advanced imaging, such as a CT-scan or an MRI. While an epidural hematoma is linked to a skull fracture most of the time, blood draining from the ear can only signify a skull fracture without more information. (Error made by a character in a famous time-travel series)
4. Fellows are medical doctors enrolled in a post-residency fellowship, and these doctors are sub-specializing. For example, an internal medicine doctor or a pediatrician may want to become either an adult cardiologist or a pediatric cardiologist. (Big mistake made in a rom-com! The character, a surgeon, went to Alaska for a “general medicine fellowship” because they didn’t get a surgical fellowship in Boston.)
5. Optometrists (Doctor of Optometry or D.O.) fit patients for glasses or contacts and diagnose chronic eye diseases. Ophthalmologists are M.D.s who perform eye surgeries such as cataracts, laser retinal surgeries, corneal transplants, and retinal repairs. They also treat chronic eye diseases, such as glaucoma and diabetic retinopathy. Optometrist and ophthalmologist are not interchangeable.

Creating the accurate medical scenario

So, how should an author approach a medical character or scenario? Most books on writing and teachers recommend first finishing your draft, and just noting where you need to do more research. The problem is you may end up having to make extensive changes later. I’ve helped multiple Christian and self-published authors with their books, and it’s hard to tell a writer an entire scene or character is based on a mistake.

The number one question I’m asked by writers is, “How long will my character be in the hospital?” Three to four decades ago, a hospital stay was determined solely by the admitting physician. When healthcare costs rose, insurers established programs called utilization review and quality control.

Now Medicare, Medicaid, and health insurance companies determine how many hospital days they will pay for. The doctor can keep you in the hospital, but you would pay for it at your own expense (out-of-pocket). Insurers used to allot a certain number of days based on the diagnosis such as heart attack, stroke, or the type of surgery.

Today, hospitalization (called length of stay or L.O.S.) depends on factors reported to the payor daily or at frequent intervals. The patient’s admitting diagnosis or any fresh problems matter but so does their physical status. Has the patient regained his or her pre-hospital ability to walk, talk, and/or eat? Are their vital signs stable?

Insurers also consider the treatment level. Is the patient staying in a regular room or the ICU? Do they need a ventilator or another form of respiratory support? Do they need high levels of oxygen that can’t be given at home? Are medications and/or nutrition being given by intravenous lines or tubes? Is the patient bleeding, or disoriented, or unable to keep medications down?

The answers to questions like these are all done by the utilization review nurse employed by the hospital, then passed on to the insurers. And if a patient has more than one insurance, the information has to be given to both.

A simple fracture or concussion rarely gets anyone admitted to the hospital, except for the elderly, or a frail adult, or a very young baby. More complex fractures don’t always need admission, either. Medicare developed another wrinkle in the last few years called outpatient observation. Patients are held and treated in the emergency room or a post-surgical area for up to forty-eight hours. After two midnights, the hospital must either admit or discharge the patient.

Many major surgeries now are performed outpatient, including my recent total knee replacement. I had surgery in the early morning and went home late that same day. I’m still shaking my head over this, but I did fine. (Plus, I hate being in the hospital!)

Five Good Rules for Writing Medical Characters or Scenarios

1. Do your research before writing. Interview patients and/or doctors, or base it on personal experience. Make sure the damage you inflict on your character is enough to give the outcome you want.
2. Consult authentic sources. Stick with authoritative sites run by medical schools or recognized names such as Mayo Clinic, the Cleveland Clinic, Memorial-Sloan Kettering, etc. The National Library of Medicine has abundant resources for writers (hint: search for “Stat Pearls”), free images, and patient-friendly materials. Another example is author Susan U. Neal, a nurse and nutritionist, who offers diet and nutrition advice on her website Healthy Living Series. Also, check out my column for Killer Nashville Magazine.
3. Christian historical writers can check with local medical school libraries, which are usually part of the state library system. Physicians or their estates often donate materials to the library of their alma mater. You can access old journals and diaries from wilderness or frontier doctors, or records from city doctors dealing with a typhoid epidemic. This is valuable first-hand point of view material. Medical museums are also a great resource.
4. If you need a character in the hospital, make sure your injury or illness matches the standards for hospitalization of the time. If you’re not sure, consult a doctor or nurse, or contact me (See bio).
5. If you use a physician as a character, make sure you know how and where your character trained, what education they received, and what procedures a hospital has allowed them to perform. That way, you won’t have a fully qualified surgeon practicing sutures on a banana.

A free handout on all of this plus more is available on my website.

I wish you the best of luck with your writing! And if you plan on using amnesia, please—remember to read my upcoming blog article on it or call me first.

About the Author

Physician and award-winning author Dr. Ronda Wells is a wife, mom, and grandma who writes uplifting, wholesome fiction and seeks that elusive first contract. She has helped many inspirational authors, such as Denise Hunter, with their medical scenes. A member of ACFW, Indiana ACFW, AWSA, and the KCWC Planning Committee, Ronda speaks at writers’ conferences on Novel Malpractice: Get Your Medical Fiction Right. Connect with her on her website or @rondawellsbooks on Twitter, Instagram, and Facebook.