Medical dramas heal themselves

Like our healthcare system in general, the big network medical dramas all entered the new season with leftover issues -- tone problems, narrative problems, personnel challenges and, of course, the fate of millions (viewers and dollars) hanging in the balance.

It would easy to blame last season’s writers strike, but for the most part the issues were more organic. ABC’s “Grey’s Anatomy had turned around a disastrous slump, using the season finale to put the moldy old Derek-Meredith question to rest, but even so it remained more soap than drama.

Its spinoff, “Private Practicehad grown just plain silly, with main character Addison (Kate Walsh) so dippy she was virtually unrecognizable as her former self and the Oceanside Wellness Group chock-full of doctors more determined to exploit every L.A. stereotype available than actually treat patients.

Over at Fox, House“ seemed to have traded Vicodin for helium -- the cast just kept getting bigger, the stories more scattered and uneven until you had a bunch of great actors forced to stand around watching Hugh Laurie hold the show together by the sheer force of his will. (He looked thin and extra haggard; we worried quite a bit.)

“ER” has it easy by comparison; it’s only facing the age-old challenge of the final season. After 14 years and a cast of millions, the NBC show that changed televised medicine forever is ending. Will it go out with a bang or a whimper? And, more important, will George Clooney be involved?

One week into the season (or in the case of “House,” three), and the prognosis is positive for everyone.

If there were an Emmy for problem solving, Shonda Rhimes should win it. The creator of both “Grey’s Anatomy” and “Private Practice” has put her shows on similar rehabilitative treatments: a very welcome focus on the medical part of “medical drama.”

In a brilliant one-two punch that revitalizes both narrative and tone, Seattle Grace and Oceanside Wellness each face external, financial crises that not only supersede all those sticky icky internal ones, they also may be a direct result of them.

This season opened with Seattle Grace having fallen from the third-best teaching hospital in America to the 12th, a pointed-enough reminder that a romantically distracted staff will take its toll that the Chief (James Pickens) finally grew a spine (go, Chief!). Love is still very much in the air at Seattle Grace, with the welcome addition of Kevin McKidd (late of “Rome” and “Journeyman”) as a macho military doc, but there is a definite shift back to the patients and the pressures of the medical life.

Farther south, Oceanside Wellness is simply broke; unbeknown to the rest of the board, Naomi (Audra McDonald) took out a second mortgage, which she now cannot pay. The various doctors have simply not been making enough money, probably because they’ve been spending too much time with shower heads and intra-office crushes.

Brilliant, and also hilarious in its acknowledgment of the show’s shortcomings, this uber-narrative opens up all sorts of new stories, including a killer ethics dilemma in the season premiere that reminded us why we liked Addison so much in the first place.

None of this is easy, of course. The trick of a great medical drama is to make certain that the characters are doctors who happen to also be flawed human beings, not the other way around. Otherwise they come off as being as reckless in their jobs as they are in their love lives, which isn’t quite as forgivable. But there’s a reason there are so many doctors on television: When it works, it works big.

“House” never strayed from its medical roots; creator David Shore and executive producer Katie Jacobs have been almost fanatic in keeping all eyes on the cases and the main character even as they increased the cast. Strangely, to solve this issue, they’ve . . . added a new character. To be fair, they’ve also (temporarily) subtracted one, but still, an interesting approach.

On temporary leave is Dr. Wilson (Robert Sean Leonard), who has, while grieving the death of girlfriend Amber, realized what a leech House has been on his life and left Princeton Plainsboro. Not missing a beat, House found a new sidekick in Lucas Douglas (Michael Weston), a private detective he hired to follow Wilson and then, because this was so much fun, everyone else.

If this seems a bit ridiculous, Douglas is such a delightful addition that it doesn’t matter, or at least not much. Like House, he views most people, including House, as exhibits in a zoo, which gives our favorite sardonic narcissist someone he can actually talk to.

The detective also provides a structure that almost justifies an ensemble cast for a character-driven procedural. Every time he finds some tantalizing bit of information that House just can’t resist sharing -- like last week’s revelation that the adulterous Dr. Taub’s wife had a secret bank account -- each character gets a long overdue moment in the spotlight. Douglas won’t thrive indefinitely -- for one thing, we want Wilson back -- but he’ll definitely buy the show enough time to sort out who’s essential and who’s not, while giving everyone an episode in which to shine.

The writers of “ER” don’t have to think beyond this season, and they opened with a bang. The ambulance explosion and the subsequent death of Greg Pratt (Mekhi Phifer) is the kind of story usually reserved for finales, or at least midseason cliffhangers. But then, as the ultimate modern medical drama, “ER” has always done things just a little bit differently. Which is exactly why it’s lasted 15 seasons.

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mary.mcnamara@latimes.com