The Good Doctor: Season 1 Episode 4

I wasn’t sure if I would continue to do these posts on the new ABC drama, The Good Doctor. One of the first posts I did got one of the largest responses ever on my FB page. The responses were 50/50 for and against the show. Many people want to champion the series because it highlights someone with autism working in the medical field.

The other half agree that if you’re going to highlight a medical drama— it would be nice to have it be the teeniest bit accurate. I’m not asking for a lot . . . just don’t give patients false hope or have them get such a skewed view of medicine that they trust medical professionals less. We’re already fighting that battle.

My disgruntlement with the show is not the fact that they highlight a character with autism— it is with the medical aspects of the show and how they handle their patients.

That is where my fight is . . . so let’s carry on.

In episode four, the main story highlights a woman who is pregnant with a child who has a large spinal tumor. The woman has already miscarried two children as the result of a clotting disorder she suffers from.

Issue #1: All surgeons cannot do all things. This continues to be a big complaint of mine for the show. One of the general surgery attendings is also a specialist in fetal surgery. I cannot tell you how specialized a field fetal surgery is. There are only a handful of these specialized doctors in the country. A general surgeon is not even, in their right mind, going to attempt something so risky for a notch on their proverbial belt. It would be negligent for them to do so.

Issue #2: OR’s are well lit. In this particular episode, I noticed all the OR scenes are shot in relative darkness. I’m sure this is so it looks uber cool for the viewer and there are times when OR light is dimmed, but we do generally want surgeons to be really able to see what they’re doing. Which is why they get really big lights.

Issue #3: Medical equipment called for— never placed on the patient. During the first surgery to remove the tumor from the child, the mother suffers a heart attack and they place her on a balloon pump that mysteriously never gets put in place. These are obvious pieces of equipment and it is never shown or mentioned again.

Issue #4: Surgery without patient consent. Despite the pretty serious complication of the first surgery, the mother is gung ho to go at it again, despite having had a heart attack. That’s actually believable. Mothers will do anything to save their child. What’s a little surprising is how gung ho the surgeons are. What follows are some pretty mind boggling discussions of who lives and who dies under what circumstances.

The attending surgeon offers a plan to not tell the mother that her surgery will end up being an abortion to save her life. That they’ll essentially lie to her telling her they’re going to take her to the OR for another attempt at saving the infant while really going in to end his life. On a one to ten scale of how unethical a plan that is to even be mentioned is like one hundred. The better person to float out an idea like that? A medical student. A resident. The attending? Those are the people teaching our young doctors— please have them be a representation of some sort of ethical boundary.

To be clear, the surgical game plan can change during an operation, but to go in knowingly deceiving a patient is malpractice.

Issue #5: The baby is just as monitored as the mother during the surgery.  In the scene of the second fetal surgery, the baby is just lying there on the mother’s stomach with no monitoring equipment. The baby is monitored as thoroughly as the mother.

What are your thoughts on The Good Doctor?

Medical Review of Fox’s 9-1-1

I’m so happy to be back blogging! I hope everyone had a fantastic holiday season and is ready for a new year. Today is officially my 20th wedding anniversary! Can you believe that? I know I can’t. It’s crazy to think how much time has gone by.

Considering the occasion, I thought it would be best to write a positive (well, mostly positive) review of a new TV show— Fox’s series 9-1-1. I know . . . you can pop your eyeballs back in. This is truly a rare event considering much of this blog’s time is spent skewering medical inaccuracies in print, movies, and the small screen.

9-1-1 is a series devoted to dispatch, police, and fire calls. I’ve watched the first two episodes and was pleasantly surprised at how much I liked it. Now, it does have some problems. Writing completely to stereotype would be the biggest.

Let’s look at what they did well.

1. The characters face consequences for their actions. I’ve said all along that it’s okay for medical people to do bad things in fiction, but there must also be consequences for their actions. The point of this are many. It increases the conflict in the story AND reflects real life. Too many times in fiction medical people are shown doing bad things without consequence. One firefighter is shown facing some serious repercussions for his poor (saying that lightly) choices.

2. There is respect for HIPAA and also how hard that is for medical people. HIPAA is the patient privacy law. Because of HIPAA, most of us who work on the front lines (EMS and emergency departments) rarely ever hear how our patients do after they leave our care. This is, flat out, not easy for any of us and it makes closure difficult.

3. Shows the problem of poor coping mechanisms. It is true that healthcare people do not always have the best coping mechanisms. Hello, to all the nursing units with the mandatory chocolate drawer. Some develop addictions  and can have bad co-dependent relationships. It was nice to see highlighted that the stress of this work does take an emotional toll.

4. Highlights the difficulty of work/life balance. Of course, all professionals face work/life balance issues, but I also feel like the nature of our work makes it hard to feel like you’re getting a break. If you’re taking care of a medically/terminally ill loved one at home, and then go to work doing the same thing— there can be little room to breathe.

5. Medical information was not distracting. The medical information was kept pretty light in the first two episodes and not too distracting. There were a few minor medical errors I’ll keep close to the vest for now.

Have you watched the new Fox show 9-1-1. What did you think?

The Christmas Season

Hello Redwood’s Fans!

Everyone getting ready to get their Christmas on? I know I definitely am. We already have our Christmas trees (yes, three!) up. Christmas cookie baking is on the horizon. There’s really not much I don’t love about the season.

I’ll be on a blog break until after the first of the year. I’ll actually be working on revising and updating many of these posts. I am still answering your medical questions (that are writing related) and you can reach me at jordyn@jordynredwood.com.

So, until next year– Merry Christmas!!

Care of the Burn Patient

Linda Asks:

In my middle grade novel my main character’s dad was a fireman in NY.
He was present during the collapse of the World Trade Center buildings.
He was burned severely and is in the hospital – near death.

My main character remembers his last conversation with his Dad in the hospital right before he dies.

The dad is hooked up to all kinds of beeping machines and is wrapped in white gauze.
After he talks to his son for the final time, he pushes a button for more morphine.

Questions:

Do they still wrap burn patients in gauze?
Is morphine used on severely burned people?

Jordyn Says:

From the point of view of your character– yes, burns are wrapped in gauze. They are specialized dressings, but a character aged 10-13 could perceive it as gauze only.

Yes, morphine is still used for pain.

My only concern is this character having a conversation with his dad. You don’t describe the nature of how he was burned, but a severely burned patient, particularly one close to death, is likely on a breathing machine and, therefore, unable to speak to his son.

You could change the scene to be that he’s so sick that they are getting ready to intubate the character’s father, and the medical team gives them a few moments to talk before they put the father on the breathing machine. He could still die quickly after from his injuries.

The Use of Hypothermia Post Cardiac Arrest

Emily Asks:

I am playing around with one of my character’s being shot life threateningly, but of course it’s gotta be something he recovers from with time.

This character is in his late 20s and in good health before the incident takes place.

At first, I was toying around with the idea of making the gunshot wound similar to what Kate Beckett had in the show Castle at the end of season three. The trouble is, I do not know how medically realistic her wound was, as you have pointed out Castle’s medical inaccuracies before. If you have possibly seen the episodes in question, could you give me some feedback on the medical aspects of Beckett’s shooting?

In relation to this, her heart supposedly stopped twice during the whole ordeal. I have been researching induced comas, and while they seem to be used for patients having more of a direct injury to the head, in the case when a victim’s heart stopped twice and is resuscitated both times, would there be any reason to keep them in an induced coma for a time due to lack of oxygen to the brain?

Then, after researching, I am playing around with giving this guy a collapsed lung from the bullet, which is small caliber.

1. In what hypothetical cases would this kind of injury require immediate surgery?

2. Are there any complications that could be serious enough for the said character to have to go back into surgery at a later time?

3. My character happens to be a bass singer for an acapella band. Would a collapsed lung affect his career at all even after he made a full recovery?

Thank you for taking the time to read and respond to my questions!

Jordyn Says:

Beckett’s Gunshot Wound:

I had to go back and find some videos that were related to this. Shockingly, I found this scene pretty medically accurate. I found one that showed her coding one time. Though I definitely could have missed some. The determination to put someone in therapeutic hypothermia or targeted temperature management (as now termed) related to their heart stopping is dependent on whether or not they wake up immediately after their code.

A patient that wakes up spontaneously and quickly after a pulse is restored has intact neurological function. Those that remain comatose have a concern for neurological injury related to oxygen loss to the brain during the resuscitation and therefore the medical team could choose to put the pt in a “hypothermic” state to try and prevent this neurological injury.

This is slightly different from a medically induced coma that patients with traumatic brain injury might be placed in to prevent brain swelling. The difference is actively cooling the patient. I have not seen the use of hypothermia in the traumatically brain injured population (though this does appear to be an area of study), but use of medically induced comas, yes.

There are definite guidelines that the American Heart Association has put out that outline this course of treatment. You can find one such article here.

If your character codes and doesn’t wake up– then this would be a reasonable course of action medically, but written under the guidelines in the article.

In regards to your specific questions.

1. It’s more likely than not that a gunshot wound to the chest would go to surgery, particularly if the patient presents with any abnormal vital signs especially low blood pressure. There’s just so much there that could be damaged. The heart. The lungs. The blood vessels.

2. Yes, there could be a number of scenarios where the character could require more surgery such as a blood vessel that’s leaking that’s not found the first time during surgery and continues to bleed. Infection– specifically some sort of abscess formation could be another reason, but that would take some time to develop.

3. I don’t personally foresee a problem with his acapella career after his lung is healed. It would take time to get to the point where he was. If you wanted to affect his career, a patient who is intubated (placed on a breathing machine) can develop vocal cord damage as a rare complication.

Best of luck with your story!

Criminal Minds: Can a Patient be Admitted for Psychological Distress?

In a recent episode of Criminal Minds, a woman was nearly shot and killed by a madman operating a drone. She is saved and uninjured, but is admitted to the hospital just in case she begins to suffer some psychological distress.

Can this really happen?

The situation as portrayed on television— no.

When admitting someone emergently for a psychiatric problem, one of two things needs to be a concern. Either the person is a threat to themselves, to another, or both. You might hear a provider ask, “Is the person expressing HI or SI?” which stands for suicidal ideation or homicidal ideation.

If a person is expressing either or both of these concerns then a couple of things happen. The patient first must be medically cleared by a physician to ensure that there are not any coinciding medical concerns. Once this takes place, they then are put through a mental health evaluation.

Once a mental health evaluation is complete, it is decided what type of psychiatric services the patient may require. Sometimes, it is admission under an involuntary hold. Other times, the patient may be connected with outpatient services.

Think about the many events that have happened just in the US where people will be suffering psychological distress, but are not expressing suicidal or homicidal thoughts. The  devastating hurricaines. The mass shooting in Las Vegas. Put simply, if we admitted every patient that we were concerned for the potential of psychological distress outside of expressing HI or SI— we’d quickly run out of hospital beds. Plus, patients expressing these concerns should not be placed on a medical floor unless they also have co-existing medical problems that they need treatment for. Also, in that case, they require one on one observation.

Although a nice thought, you do have to have a mental concern other than psychological distress from surviving a potentially life-ending event to be admitted into the hospital.

Kardashian Style Ultrasounds on Reality TV

Critics who say reality TV is fake must not watch the ultrasound scenes on Keeping Up with the Kardashians. On a recent episode, Khloe Kardashian visits an infertility doctor with her sister, Kim, and receives an ultrasound of her uterus and ovaries.

Instead of being like most Hollywood scripted shows, KUWTK portrays this scene with spot-on accuracy. Watch the video below… (Caution: Some adult language is censored during this scene).

What KUWTK did right

We can all see that this doctor’s visit is legit. Maybe it was scripted, but at least they recorded the ultrasound as true to real life. Here are the things they did right and something Hollywood needs to study for future TV shows.

1) The physician has the machine turned at the appropriate angle. It is facing the physician and pulled down where he can reach the dashboard. The camera still is able to give him plenty of TV time while Khloe and Kim can watch the scan on the wall monitor.

2) Khloe is pretty much covered with a paper sheet during the scan and the physician or sonographer inserts the probe. This is a very accurate scenario for a real life internal vaginal ultrasound. Sonographers and physicians who scan make sure the patient is comfortable and covered while the scan is being completed. We utilize vaginal scanning to view the uterus and ovaries and also first trimester babies. We scan on top of the belly for second and third trimester pregnancies or other types of imaging.

 3) The machine is relatively quiet. The only noise heard in the background is the cooling fan on the system. No heartbeats or added sound effects are slipped into the scene to make it seem more authentic. Finally, TV got this detail correct.

4) The physician uses the appropriate probe and the appropriate anatomy is shown on the screen. The images we see on the monitor are the uterus and ovaries.  Many times, shows present anatomy on the screen that doesn’t match the discussion they are having or the sounds coming from the machine.

5) The ultrasound equipment is a top of the line GE ultrasound machine. No ancient relic from the 1980s being thrown into a scene because it’s the only thing in the props room. Hollywood must think no one will know the difference. This physician uses modern ultrasound technology to do his job.

Reality TV might get a bad rap for not being truly “reality”, but this scene was the most accurate ultrasound example on TV to date. Maybe Hollywood films and television directors need to learn from Keeping Up with the Kardashians as an example of what to do when filming an ultrasound scene.

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Shannon Moore Redmon writes romantic suspense stories, to entertain and share the gospel truth of Jesus Christ. Her stories dive into the healthcare environment where Shannon holds over twenty years of experience as a Registered Diagnostic Medical Sonographer. Her extensive work experience includes Radiology, Obstetrics/Gynecology and Vascular Surgery.

As the former Education Manager for GE Healthcare, she developed her medical professional network across the country. Today, Shannon teaches ultrasound at Asheville-Buncombe Technical Community College and utilizes many resources to provide accurate healthcare research for authors requesting her services.

She is a member of the ACFW and Blue Ridge Mountain Writer’s Group. Shannon is represented by Tamela Hancock Murray of the Steve Laube Agency. She lives and drinks too much coffee in North Carolina with her husband, two boys and her white foo-foo dog, Sophie.