Consent | Redwood's Medical Edge

When The Good Doctor starts messing with pediatric scenarios . . . well, I just cannot keep my mouth closed. You can see other posts I’ve done on The Good Doctor here, here, here, and here.

In this episode (spoiler alert!) Shaun is convinced that a pediatric patient, a boy around the age of fourteen, has been misdiagnosed with cancer. This patient first comes to the hospital for a bone fracture and Shaun goes in to consult. Shaun is over identifying with this patient because he looks just like his brother that died during his younger years.

https://goo.gl/images/e6VaK2

Issue #1: A first year surgical resident consulting on an ortho case. There’s really no reason for Shaun to even be consulting on this case. An orthopedic resident, yes. If no orthopedic resident, then an ortho attending. But this is outside the realm for a general, first year surgery resident.

Issue #2: There is a tendency in these shows to separate parents from children during treatment. This is not really done or encouraged at all anymore unless the presence of the parents put the child at risk in some manner.

Issue #3: This child has had a cancer diagnosis for SEVEN months and his parents haven’t told him he has cancer. This is unconscionable. We don’t need to lie and hide the truth from children. They are so much stronger than we give them credit for! Also, this is highly unethical and would not be supported by any decent pediatric medical team. Great effort would be made to help the parents give their child this news. It doesn’t benefit him or protect him to be told this lie. Plus, is he not receiving treatment? The episode proves this point when the patient tells Shaun he already knew he had cancer.

Issue #4: Because his parents haven’t told him, Shaun decides to without their permission. Again, we would work very hard to have the parents tell the child this news. It’s unethical for any healthcare provider to do this without the parents permission no matter what. So much would be done to help these parents talk to their son. I’ve never seen this happen in pediatrics . . . like ever.

Issue #5: In order to prove his alternative diagnosis, Shaun decides to perform a medical procedure on the patient without the parent’s consent. This is legally dicey and Shaun should suffer disciplinary repercussions for doing so.

Issue #6: A patient after having open heart surgery is in recovery with only an IV and simple monitoring. Any patient who has had open heart surgery will have a variety of tubes— like chest tubes. It’s not a simple recovery.

Are you watching The Good Doctor? What do you think of this surgical resident getting away with all these bad things without repercussions?

Today, I’m continuing my discussion of an uber popular book that didn’t paint medical people in a good light— like at all.

You can find the first post here. I’m not mentioning the author or the novel here to protect the author from angry medical people everywhere (okay, perhaps it’s just me.)

What follows is the same encounter, different section. As a quick reminder, this fourteen-year-old girl believes she’s been raped and is looking for guidance from a female physician.

What follows in italics is an exert from the book.

There had been a question burning in my throat for the last ten minutes, but it was her reaching for the handle of the door that forced me to say it. “Is it rape if you can’t remember what happened?”

The doctor opened her mouth as if she were about to gasp ‘oh no’. Instead, she said so quietly I almost didn’t hear it, “I’m not qualified to answer that question.” She slipped out of the room soundlessly.

Problem: There are so many problems with this response from this doctor to her patient that I am flabbergasted as to even know where to start. First, how about starting with a doctor who cares enough to simply ask a few follow-up questions?

Such as, “Please, tell me what happened.”

What is shocking is just the amount of information that has been disseminated to the population about getting mutual consent before a sexual encounter. In fact, in just the last couple of years was the infamous “Tea Consent” video which you can view below.

In fact, the video states, “And if they’re unconscious, then don’t make them tea. Unconscious people don’t want tea and can’t answer the question, ‘Do you want tea?’ because they’re unconscious.” So it seems the issue of whether or not this was consensual would be fairly easy to determine.

No consent, then a crime has occurred.

The first signal to this physician is her patient’s memory problems. This is very concerning for her getting slipped a drug so that she could be raped. If the physician feels this is something she can’t explore, especially considering the patient’s age, then she should seek outside guidance. This could rise to the level of needing to be reported to the police.

Never just stop and not say anything more. This young girl is clearly in crisis. A doctor is qualified to help this patient, particularly one in this setting, who should be clearly educated in circumstances just like this.

Who else can this girl turn to for answers if not a trusted physician?