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?

The Good Doctor is Bad Medicine Part 1/3

The Good Doctor is a medical drama that’s first season just started airing on ABC. Of course, anytime a new medical drama hits the airwaves I get messages from people curious about my opinion.

The drama focuses on first year surgical resident Shaun Murphy who has autism. I’ve watched the first two episodes and though the premise of the drama is mildly intriguing— I don’t find the medical aspects or interactions between the medical staff worthy enough to keep watching. Unless, I keep analyzing episodes for this blog. We’ll see.

Episode 1 features the fight of a hospital administrator to get him accepted into the program. On Murphy’s way to the hospital for seemingly his first day, of course, he saves a life at an airport.

A teen is showered with glass and suffers life-threatening injuries to the neck and chest. An older male, who identifies himself as a doctor, begins to render aid by putting pressure on the wound. The doctor says, “His jugular vein has been cut.”

Issue #1: Placement of direct pressure. Murphy chastises the older doctor for holding direct pressure improperly (for a pediatric patient) and for occluding the patient’s airway because of it. The doctor adjusts and the patient begins to breathe again. Truthfully, there are differences between the adult and pediatric airway, but I’ve never heard of adjusting pressure d/t anatomy. You have to put pressure on what’s bleeding. If that causes problems with the airway, then the patient requires intubation to protect the airway.

Issue #2: Doctors having sex in the call room. Can we please just get rid of this stereotype? Please, just please. There is never as much rampant sex as portrayed on TV in hospitals. In my almost 25 years of nursing, I’ve heard ONE rumor.

Issue #3: Airport Security. I cannot believe in this day and age that, regardless of what someone says, hospital security would allow anyone to grab a knife and run wildly through the airport without being arrested— even if a patient’s life is in danger.

Issue #4: EMS response. Considering this is an airport, the EMS response time is laughingly long.

Issue #5: Chest tube. Of course, Dr. Murphy places a chest tube in the patient as well as makes, MacGyver style, a chest tube drainage system. Once this is done, he triumphantly raises it above the patient and the patient dramatically improves. Just, no. Drainage systems should always be level or below the patient to drain. Never above. Like never. You can check out this nifty nursing video that explains just that.

Issue #6: Direct OR admission from the ambulance. The now stable patient is met by a surgical resident and goes straight from the ambulance to the OR. No, just no. First of all, why does a stable patient need to go to the OR? Secondly, everything first to the ER. The ER attending will make a decision to consult surgery and a plan will be made to take the patient to the OR.

Honestly, there’s more in this episode. Can we talk about the language the doctor uses to get consent? I’ll spare you until next post where I examine episode 2.