The Highlanders and Native Americans share many similarities in culture and social structure, and they are both considered to be indigenous, tribal communities. They shared similar naming practices, treated land as a communal resource, and chiefs were chosen via a system that allowed bands/clans to select the best person for the job.
Medical Advisor Claire McGroarty who specializes in trauma/emergency medicine and works with the National Health Service in Glasgow, was brought in to ensure accuracy with Rufus's injuries.
River Run was filmed in two locations. The exterior façade was practically built, which is first floor and the porch, while the second floor and wings were created in visual effects. The interior and a practical, working porch were built on a sound stage.
The title is taken from the Hippocratic Oath. Claire gave this oath when she became a doctor, and it's tested against the ruthlessness of the 18th century.
Aunt Jocasta is played by Maria Doyle Kennedy, known most notably as Queen Catherine of Aragon in The Tudors (2007). Her first acting role was as the character Natalie Murphy in The Commitments (1991), and an image of her in the film was later featured on an Irish postage stamp.