Tuesday, February 5, 2013

“Monday Mornings” Review Part 2

Yesterday I posted a review of the new medical drama Monday Mornings. I based it on a 5-minute preview that was available on line.

I was very critical of the way surgical M&M conference was portrayed. Then I thought maybe 5 minutes wasn’t enough. Against my better judgment (again), I watched the whole show.

I stand by my first impression. The show is a typical medical soap opera filled with the usual array of doctors—the arrogant one, the beautiful one, the arrogant and beautiful one, the black guy, the Asian guy, the devious one, the vulnerable one, etc.

Forgetting about the acting and the heavy handed directing (extreme close-ups, focusing back and forth, quick cuts) and the funereal music, I will just point out a few errors and implausible medical situations.

A child bumps his head playing soccer and appears fine. The ED docs order an MRI “as a precaution.” (And you wonder why the cost of medical care is so high?) It shows a large brain tumor which the arrogant neurosurgeon declares is an emergency that requires surgery that same morning. The patient has uncontrollable bleeding and his blood pressure drops accompanied by blood squirting out of his head, which I have never seen happen especially since the kid was hypotensive. No code is called, but the neurosurgeon without even applying pressure or packing the bleeding area, opens the chest and does internal cardiac massage. Since there was no chance that would work, it didn’t. He is understandably upset. (More about this later)

A woman is brought in as a possible “suicide by car” because there were no skid marks. She is intubated but moving. The chief of trauma walks by, shines a flashlight in her eyes and declares that it was not a suicide, but rather a bomb went off in her head. He means she had a hemorrhage. She then undergoes surgery for a brain aneurysm. There is no way that he could have made that diagnosis with a flashlight. The patient would have had a CT scan anyway since even kids who have no signs or symptoms of brain injury get MRIs in that hospital.

There is a Korean doctor who is one of the worst stereotypes I have seen in recent memory. His command of the English language is limited to 3-word sentences and his bedside manner calls to mind Donald Trump. When asked whether a procedure he recommended was really necessary, he replied, “Not do—dead.” He was told to improve his English by the chief of surgery in a hallway conversation. He also grilled the med students without mercy. However, he is a genius at deep brain stimulation.

At the end, the neurosurgeon who lost the child on the table (I will omit the part where he has a flashback to his own childhood) has to face the music at (da-da-da-dum) M&M conference. It comes to light that the tumor was much worse than anticipated and the kid would have died anyway, but the crafty chief of surgery was holding back a card. He somehow found out that the child’s estranged father had Von Willebrand’s disease, which the neurosurgeon was unaware of. It usually is a very mild bleeding disorder and would not cause fatal hemorrhaging. The type that does cause hemorrhaging would surely have come to light with easy bruising or other issues in at 10-year-old boy. And wouldn’t the mother have known about this and told the surgeon? After all, the chief of surgery knew. The neurosurgeon was appropriately beside himself about this and refused to be consoled by the pretty one who no doubt he will hook up with in a future episode despite the fact that she is married.

In the final scene, which is one of the few believable parts of the show, the chief of trauma tells the neurosurgeon that a trauma case is on the way in and he needs to pull himself together.

As we have all been in the position of feeling terrible about a complication or death but had to go back to work the next day, that scene at least rang quite true.


NurseWriter said...
This comment has been removed by the author.
NurseWriter said...

Same reason I hated "House, M.D." That hospital was so profitable, I guess, because the residents did neurosurgery, lab work, MRI/CT scans and IV medication administration...just not bedpans. That's why we have nurses!

artiger said...

This show sounds like a massive train wreck...you know it's going to be messy, but you can't help but take a look.

Don't sweat it Scalpel, it's just an hour of your life that you'll never get back.

Skeptical Scalpel said...

Thanks for commenting, Nurse and artiger. As I think about it, the nurses were invisible at Chelsea General, the fictional hospital for Monday Mornings.

It was like a train wreck and while an hour was wasted, it was excellent fodder for a blog.

Paul Ivsin said...

There is a new 'Monday Mornings' billboard on my walk to the office -- doctor smirking smugly with the caption "I do so love it when I get it right".

That quote would seem to imply that he doesn't get it right very often, so that it's a cause for joy when he actually does. Seems nicely in parallel with your review.

Skeptical Scalpel said...

Paul, thanks. I'd love to see the billboard.

Sharon said...

It's a David Kelly production, so what would you expect? I am surprised that Gupta would allow such deviation from reality as far as the medical stuff is concerned. After all, it is based upon his book. That said, we have to remember this isn't "reality" TV, but a fictional drama, slated to appeal to the masses, i.e. ratings.

Anonymous said...

And Sanjay Gupta has his name associated with this...perhaps he should have it removed?

Skeptical Scalpel said...

Thanks for commenting.

Sharon, Sanjay's book did not get overwhelming positive reviews on Amazon.

And Sanjay must have had some input into the medical part of these story lines. I just don't understand why they have to cut so many corners.

While it may appeal to the masses, I think it can promote unrealistic expectations for patients, e.g., everything is solved in 45 minutes or all doctors are sex-crazed maniacs.

RuggerMD said...

Well, lets face it...as I sit here all alone in my office on trauma/acute care surgery call, I can say that this life is really pretty boring.
They have to make it idiotic somehow for ratings.

artiger said...

I wonder what our colleagues across the pond think about "Doc Martin"?

Anonymous said...

I generally agree with your comments, although I read the book Monday Mornings and loved it. Not sure what reviews you are referencing, but it was a New York Times bestseller, and had an excellent Times, USA Today, Independent and WSJ review. I am a neurologist and thought the program was quite good. The only thing I didn't like was the arrogance toward other specialties.
First off, can you really call this a medical soap after one episode? I think you may be hasty on this, and perhaps guilty of your own criticism. I loved the diversity of the cast, and found it representative of many hospitals in the US (I was trained in England). The child who received the MRI received a CT scan first which is not that unusual with sudden onset of headache that is persistent after a head trauma. I hate to say it: but you are completely wrong about the brain aneurysm patient. This was actually outstanding medical detail for the trained eye, and I am surprised you missed it. A "bomb going off" was a reference to the aneurysm itself. She had a blown pupil on the left, but was still moving her right side. The indicates an oculomotor palsy due to mechanical compression from a pcomm aneurysm. It was in fact quite brilliant, and as a surgeon you should've caught that! Regarding the Korean doctor, yes it is a bit trite, but language barriers are a real issue for foreign trained medical doctors. With regard to Von Willebrands, fully half of patients are diagnosed after major trauma or surgery. There is a good chance, the mother did not know he had the more serious variant, especially given his young age. Yes, this is a show that must be ratings driven, but Gupta has offered up a detail orientation I have not seen before in a medical drama.

Anonymous said...

I think such shows ALREADY create undo expectations in patients and their families. A recent patient with an ileus after bowel surgery had a family member angrily tell me to "do something" and accuse me of not treating their family member. "Tincture of time" is hard to explain to patients but sometimes is the best treatment!

Skeptical Scalpel said...

Agree it must be made more interesting than it is for ratings, but why do they need to unrealistic medical situations?

I've never even heard of "Doc Martin." I think it's a shoe company. :-)

I agree that patients and families have unreasonable expectations because of show like this.

Next-to last anonymous, I appreciate your detailed and enlightening comments.

I stand corrected about the right-sided movement and the blown left pupil. I still say the patient would have had a CT scan anyway. Regarding the child--is it possible that a tumor that big that was "everywhere" would not have caused any symptoms?

You're not a surgeon, so believe me that blood doesn't squirt out of the head in hypotensive patients having craniotomies, nor does it soak through today's paper gowns and get all over the scrub suit as occurred in the show. After the death on the table, the neurosurgeon likely would not have approached the child's mother alone. I always had a nurse, social worker and/or someone from pastoral care along when I delivered such devastating news.

I hope you read my first review of the M&M conference. The link is in the first sentence of this blog. It was not an accurate portrayal of conference or the way one suspends the privileges of a physician in 2013.

Regarding the soap opera, I will guarantee you that Tina and Ty will hook up within the next three episodes.

The Korean surgeon is an offensive stereotype. Not only is his English bad, he is portrayed as a robot without empathy. I am surprised that Koreans are not speaking out. I'm not the only one who thought so. Read this http://is.gd/RAkKSq. There are many others.

My point about the Von Willebrand's was that the mother must have known that the father had it. How could she not know? In order to keep the post a reasonable length, I didn't point out that the chief of surgery is even a bigger a--hole than he seems because he waits until M&M conference to spring the news about the clotting disorder to the neurosurgeon. That's not the way one treats one's staff. Most chiefs would have discussed it privately with the neurosurgeon first. Then an educational presentation and discussion about Von Willebrand's would have followed the case presentation.

artiger said...

I concur, that is not how we act in surgery in 2013.

"Doc Martin" is a British quasi-comedy on PBS Sunday nights. The protagonist is a former vascular surgeon who develops a fear of blood, and winds up taking a GP position in some small village. Although not entirely realistic either, you might find it humorous (and more palatable than the other show we've been discussing).

Skeptical Scalpel said...

Maybe I should check out "Doc Martin." Thanks.

Anonymous said...

"Doc Martin" is a hoot. It's filmed in a beautiful English village populated with off-beat and funny locals.

"Despite his medical brilliance, Dr. Martin is gruff, ill-mannered, and lacks social skills. His cold, abrasive manner offends many of the villagers. They perceive him to to be short tempered and lacking in a bedside manner, whereas he feels he is performing his duties in a professional and no-nonsense manner, not wasting time chatting with the villagers."

It's probably best to view the series from the start, maybe through Netflix.



Skeptical Scalpel said...

Ok. I'm convinced.

Libby said...

Doc Martin sounds like Britain's version of "House, MD". Maybe with less license with real medicine. I loved House...and although I'm not a doctor I certainly questioned many of the same things that you cringe at. I got a kick out of some of his antics.
My GP was described by his nurse as "House with a personality" ...genius but actually likable.

Skeptical Scalpel said...

My problem is that I don't watch sitcoms or soaps so I have no real way to compare these shows. I just know the medical ones I a seen are pretty bad.

Leo A. Gordon, MD, FACS said...

The intent of the morbidity and mortality conference is education through the analysis of error and complication. There must be some dramatic way to get this message across to the audience. I have written two books about this conference, have moderated a morbidity and mortality conference for eleven years, moderating 528 conferences with 1584 presentations. I guess the conference itself makes good medicine but not good television. I am giving the show a chance. I hope that the writers will portray this hidden effort to improve care in an appealing manner. A well run fairly moderated conference shows medicine at its best. Analyze the error, remember the cause of the error and there is a better chance (if the conference is effective) that the error will not be repeated.

Leo A. Gordon, MD, FACS
[The MandMMatrix@Gmail.com )

Skeptical Scalpel said...

Well said, Leo. I agree that M&M conference can be a great learning experience when done correctly.

I hope you read my original review of Monday Mornings that appeared on Physician's Weekly on 3/4. I dissected its abysmal portrayal of an M&M conference in more detail there. Here's the link: http://www.physiciansweekly.com/m-m-conference-medical-tv-shows/.

You are too modest. I recommend to all my readers your wonderful and funny book, Gordon’s Guide to the Surgical Morbidity and Mortality Conference. Here's a link to it http://www.amazon.com/Gordons-Surgical-Morbidity-Mortality-Conference/dp/1560531037/ref=sr_1_1?s=books&ie=UTF8&qid=1359745043&sr=1-1&keywords=leo+gordon.

Anonymous said...

I agree the show left much to be desired. I burst out laughing when the Neurosurgeon performed a thoracotomy for no apparent reason. I do hope the show improves however- the first episode was written by David Kelley alone- the second is actually written by Sanjay Gupta.

Anonymous said...

So NOT watching it!

Skeptical Scalpel said...

Not watching it and never will again. It has been canceled.

Anonymous said...

Because our air is not the cleanest, do you feel this is why there is a push on supplemental oxygen? For example, not sure if it's China or not, but their air is so bad that they need the canned air to breathe. What is your take?

Skeptical Scalpel said...

I don't think it's about air quality. It's about a total misunderstanding of the minuscule effect of supplemental oxygen in athletes. Maybe some trainers and team doctors understand it but think there is a placebo effect when oxygen is give.

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