Wednesday, September 27, 2017

Review of TV show "The Good Doctor"

Just when you thought there could not be another bad medical show, ABC TV presents “The Good Doctor.” It’s about an autistic young man going to California to become a surgical resident.

Just after he lands at the airport in San Jose, an overhead sign breaks and causes the unluckiest 8-year-old boy on earth to suffer three life-threatening injuries. The Good Doctor gives a bystander, who sort of sounds like a doctor but is not too confident, an anatomy lesson about where to hold pressure on a bleeding internal jugular vein. He then notices bulging of the left arm veins and diagnoses a tension pneumothorax.

He looks for a knife “with a seven-inch blade” at a TSA checkpoint, grabs a lesser knife, makes a chest tube and underwater seal from various supplies he finds in the airport, dumps half a bottle of whiskey on the kid’s chest, and inserts the makeshift tube. All of this happens on the floor of the airport concourse.

Of course the kid wakes up and starts breathing normally.

Meanwhile the board of directors of the hospital is debating the hiring of an autistic surgical resident. In this hospital, its president, who met The Good Doctor when he was 14, hires the residents, and the chief of surgery has no input. [Matching? What matching?]

A subplot begins with a male and female doctor being walked in on after having sex in the top bunk of an unlocked call room in the middle of the day. [Top bunk. I’m not making this up.]

In the ambulance on the way to the hospital, The Good Doctor notices the amplitude of the cardiac monitor waveform is slightly less than it had been and diagnoses a pericardial effusion.

When they get to the hospital, he tries to tell a resident that the child needs an echocardiogram, but she doesn’t listen. For some reason, he doesn’t identify himself and is removed by a security guard who thwarts his many attempts to get back into the hospital.

In the OR, the attending cardiac surgeon admires the makeshift chest tube and drainage bottle.

Then he notices a decrease in the waveform amplitude on the monitor. He wants to know why The Good Doctor suggested an echo, so he and the resident leave the patient to go find him outside the hospital. On his way out, the surgeon orders an echocardiogram and tells the rest of the people in OR to “keep him stable.” [Good plan.]

Within minutes the attending is notified by phone that the echo is normal.

The Good Doctor says it is impossible for the echo to be normal. They all go to the OR and look at the study which The Good Doctor reads as subtle pressure on the right atrium. The resident now decides The Good Doctor is right. She says a shard of glass probably migrated down the internal jugular vein and [somehow?] caused a pericardial effusion [affecting only a portion of the heart] and convinces the attending to operate. The Good Doctor watches the surgery from the door of the operating room in his street clothes. You guessed it; they find a small piece of glass. [Not sure exactly where it was and how it caused the effusion.]

Meanwhile after much discussion about the pros and cons of hiring an autistic resident, the board of directors of the hospital votes “no” on The Good Doctor. But it turns out videos of him placing a chest tube on the airport floor have gone viral and several members of the board pull out their electronic devices and view it.

I haven’t even discussed the flashbacks to The Good Doctor’s childhood revealing what made him want to be a surgeon, but I will tell you a bunny was involved and he once got a toy scalpel as a gift.

He finally gets the job. As he walks into the OR for his first case after scrubbing, a nurse ties his mask on for him.

That's not how this works.That's not how any of this works.

One positive. Freddie Highmore who plays The Good Doctor is excellent.

Almost nothing that occurred during this episode was remotely plausible. Of the many such medical shows I have reviewed, this is one of the least realistic. And that is saying something.


Anonymous said...

While these nearly impossible scenarios are hard to accept for those in the known, they are what drive TV viewership. The mundane daily routine of dealing with EHR is not going to the subject of a TV drama. And besides, maybe Joe Public viewer will come to believe the surgeon an omnipotent Wonder.

Skeptical Scalpel said...

I agree the excitement of seeing a doctor operate on the floor of an airport is what the viewers want.

I wish your last sentence was true. But I think these shows promote false expectations about what can be done. Everything is accurately diagnosed and successfully treated in 43 minutes and almost no one ever dies. That's not how it goes in real life.

Jack Williams said...

I have no problem in hiring the G.D whatsoever. He went to M.S and qualified for residency. God forbid if you got sick don't use him but he has the right to practice medicine, he earned it. Speaking of the match it is a joke, if a program violates the rules the NRMP punishes it by identifying it and maybe throwing it off the match. This is a reward for the program as the publicity makes 12,000 unmatched doctors rush to the program.
With regard to your question to me in the previous but somehow related post, I don't claim to have the solution but I have some ideas. Directors should stop doing the "dirty work" for bad system in rejecting nearly 12,000 qualified doctors in 2017 alone, according to the NRMP, instead they should advocate for including them in practicing medicine. They should be creative, for example: 1 year training and not 3 is enough for primary care doctor. I know you disagree on this, but if the PAs who have one year of medical knowledge and one year of clinical rotations can practice medicine why can't the MDs without residency who have two years of medical knowledge and two years of clinical rotations practice roughly in similar capacity under some supervision? it defies logic.
Congress can help in improving the GME by not paying the hospitals directly, instead Congress can issue vouchers to the residents and let the hospitals compete for those vouchers.

Anonymous said...

I understood that he already finished his residency, and this was a hiring process. I understood that this is a super intellectual person with beyond normal abilities. I understood that he wanted to be a surgeon because his brother and only friend died infront of his eyes and he wasn’t able to help him (and he wanted to make a lot of money). The plastic scalpel and the bunny are what make him the contrasting simple person with autistic limitations and fixation. The drama TV series is art that presents surgeons as highly skilled sophisticated individuals and not butchers as some people tend to see them. Give the show another chance next week and I’m sure you’ll come to see that it’ll have more realistic features than other medical shows. And this time it’s all about surgeons!

Skeptical Scalpel said...

Jack, if a program violates the NRMP rules, it may be banned from the match for a year. That would be a serious problem for any residency program. Most of the violations of the match occur when applicants who match change their minds and let the program know a month later that they are going to show up.

In this year's match, there were >8000 more applicants than there were positions to be filled. Everyone can't have a spot. The number of residency positions that the government pays for has been capped for more than 20 years. No one has the "right" to practice medicine. Let the buyer beware. I've been blogging about this problem for years but thousands of people continue to go to offshore schools and then lament the fact that they cannot find a position.

PAs practice under supervision. My opinion is that the average graduate of medical school needs more than one year of training to practice independently. This opinion is shared by the majority of experts on the subject.

I don't see how the government paying residents independently is going to solve the problem of having fewer residency positions than there are applicants.

Anon, the good doctor was being hired for a residency position. In the beginning of the show, he says to the man holding pressure on the kid's neck, "I'm Dr. Shaun Murphy. I'm a surgical resident at San Jose St. Bonaventure Hospital."

I did acknowledge that the actor who played the lead role was excellent. He was a likable and intelligent character. It is refreshing to see an autistic individual portrayed as such.

My problem with this show and most medical shows is that the medicine was unrealistic. It simplifies issues that are much more complex than what is depicted. I believe this leads to false expectations of what physicians can and cannot do.

Jack Williams said...

Scalpel, the NRMP is parsing the numbers in order to downplay the issue of unmatched doctors and mislead the public. According to the NRMP in 2017, there were
approximately 43,000 registered applicants and 31,000 positions. It doesn't take harvard graduate to know that there were 12,000 unmatched doctors. The NRMP uses the phrase active applicant, is one who submits a certified rank order list. There were about 36,000 active applicants, meaning there were 7000 registered applicants who did not submit lists and most of them because they did not get interviews, therefore the NRMP deceivingly did not count them toward the number of unmatched doctors. I would go further than that even the number 43,000 is misleading because there were applicants who stopped applying. With this data I think that banning a program from the match even for 3 years is meaningless because its positions would be filled easily. There were unmatched doctors before the BBA of 1997 meaning that the problem is in the medical establishment and not in the Congress. I would not advocate throwing money at the problem. Congress is already paying the hospitals generous money. Because the hospitals are overpaid, the same money can be distributed as vouchers to all qualified doctors then the hospitals would follow the money and find position for the last applicant with voucher. I was talking about the G.D when I said "he has the right to practice medicine" because he earned his right. Every doctor with license has the right to practice medicine the G.D is no exception at least he would have had temporary license while resident in the hospital and the logical extension he would get full license after finishing the residency. Many states now require only one year of accredited training for licensure. I strongly believe that those unmated doctors can win class-action lawsuit against the state medical boards to practice medicine at least in similar capacity of the PAs on the basis of equal opportunity under the law. The State Medical Boards can't require arbitrary and preferential requirements for licensure. If such a lawsuit is filed I would predict that the trial would be a battle between the expert witnesses on both sides and given that the PAs have only one year of medical knowledge and one year of clinical rotations while the MDs have 2 years of medical knowledge and 2 years of clinical rotations I believe that eventually the unmatched doctors would win.

Skeptical Scalpel said...

You are ignoring the fact that there are far more medical school graduates then there are residency positions. The AAMC has already expressed concern that there are not enough training sites available for the current number of people in the match.

I'm afraid your voucher solution will never work nor will it ever be adopted. Good luck to the unmatched doctors and their class-action suit.

Lady Anne said...

Working on a patient on the airport floor? Isn't that what killed President James Garfield? OK, that was a railway station, but it's totally ridiculous.

artiger said...

Hard to blame Hollywood for putting out fantasy and selling it as realism. They see a viewership with an ever-declining IQ and are just acting on it. "Idiocracy" was more than hilarious, it is (unfortunately) happening.

Skeptical Scalpel said...

Lady Anne, not only on the floor, but The Good Doctor took the plastic tubing for the chest tube from vending machine.

Artiger, IQ or not, most of the public has no idea what can and cannot be done in medicine. I'm sure The Good Doctor's exploits seem reasonable to them.

artiger said...

OK Scalpel, perhaps "ever-declining IQ" was not the proper about "increasing gullibility"?

Skeptical Scalpel said...

I think the public has always been gullible.

Lady Anne said...

I think the public watches too much TV. If NCIS can get lab results in under twenty minutes, what's taking you so long?

Skeptical Scalpel said...

The pneumatic tube system is down.:-)

John L. Shafer said...

It has a version of korean I think. It also has a gret personality of every character.

Unknown said...

I am a layman and would like you doctors to tell me why the Good Doctor raised the bottle of whisky connected to the boy and a suction then was created? Instead of sucking out air from the chest would it not just pump whisky inside there?

Skeptical Scalpel said...

I didn’t see that episode or any other one after the first one. Perhaps he was trying to create a siphon effect. If the problem was air in the chest cavity, it would have been at a higher pressure and would have spontaneously come out obviating the need for a siphon. If he was trying to drain fluid or blood from the chest, maybe the siphon effect would have worked, but active suction via a water seal system would be more efficient.

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