Morbidity and Mortality Review: Good and Bad Doctoring

[possibilities]

It would be interesting to see a tv show where the doctors acted like real doctors do (in a rush, etc.); I'm not really sure how the show would work, but I would like to see it done, if anyone can figure it out.

Maybe it would be like those veterinarian shows, where each consult is a few quick minutes and the show keeps moving.

There wouldn't be as much emotional drama, I guess. And seeing people rushed through doesn't give as many opportunities to think the cat, dog, or parakeet is cute. But if someone figured out the right approach, it could be social commentary in some way. We all know what it's like, but somehow we all accept that TV doctors are not anything like reality, not only in terms of skipping steps and making shit up, but also in how much time they spend on it. Maybe it would have to be done more like a comedy than a drama, because it's the kind of thing where you have to laugh or else you'll cry... or be bored (another strep throat! we've seen 10 of those today!)

[Driad]

9 minutes ago, possibilities said:

It would be interesting to see a tv show where the doctors acted like real doctors do

Yes, and do their romances etc. in their off-duty time when we don't have to watch.

[Driad]

Is anyone writing reviews of the medical aspects of this show (or other current medical dramas) similar to Dr. Scott's "Polite Dissent" Medical Reviews of House ?

[Driad]

Are medical errors really the third most common cause of death in the U.S.?

[circumvent]

I started watching this show on Hulu recently after avoiding it all this time because autism is portrayed so badly in a overwhelming majority of shows. But I decided to take a look.

I cannot say much about the medical part - other than the story about c-diff, which was total bullshit, all lies. I had c-diff and the story simply nonsense - and I know that the show ignores that we life in the US, where insurance companies would never approve their ideas (and probably open a patient, leave them open on the table for hours, having surgeries that last 22 hours, taking patients back and forth for surgeries, this is all TV medicine) but I watch it like I watched House - just to laugh at the absurdity, and for the rare interesting moments.

The autism part though, it sucks. I live with an autistic person, I have met their friends who are autistic, I was married to an autistic person. I know exactly ZERO autistics like Shaun. Not only because no two autistic people are the same, but because they decided to collect stereotypes and combine all of them in one person. It just doesn't fit.

I know autistic people who hit their heads when overwhelmed. They are also married, with kids, a job and can speak in full sentences. 

I know autistic savants

I knwow autistics who have support needs that are less intense but who needed to develop strategies to cope with day to day stuff, and they do

I know autistic people who cannot speak and require full assistance, but who are also insightful and coherent when typing

I know autistic people who have intellectual disabilities but attended college and hold a job.

I know autistics who are intellectually disabled and who need a lot of help, and who are just themselves

I would expect that Shaun, having such difficulty with dealing with people and informal, spontaneous interactions, would not choose the job he did. Or he would fail med school. Or he would just give up and feel more comfortable in med research.

Autistic people learn in a different way, but they learn. Shaun having outbursts for any reason is not realistic. Meltdowns are realistic but he would not be in that job any longer, if he had ever reached that point. Besides, they treat him like a toddler, cuddling him every time he needs to "learn" something. I am sorry, but as supportive as I want to be of autistics, I would not have surgery with Shaun, the way he is imagined.

Again, autistic people learn, including learning when they need help. Shaun has no agency, other than the times when he has a huge meltdown and people cave to his desires. 

I wish the show would focus on how everyone needs help, that the dichotomy high-low functioning is bullshit, that autistic people can be assholes and deserve to be fired when they fuck up in a fireable way. Even if I were sold on the character really being all stereotypes and nothing close to real, they could have made it so that Shaun would have a cognitive interpreter. Just like an interpreter for a deaf person, a cognitive interpreter would be the one who knows how to redirect him to the task (a surgery) or to work with him on how to talk to patients about certain conditions. Even HIPAA wouldn't (or shouldn't) be a problem, since an interpreter also has a code of ethics. 

But I guess inspiration porn sells more ads for the time slot. 

Oh, and the actor is really bad. The robot talk is pathetic.

 

[bros402]

13 hours ago, circumvent said:

I started watching this show on Hulu recently after avoiding it all this time because autism is portrayed so badly in a overwhelming majority of shows. But I decided to take a look.

I cannot say much about the medical part - other than the story about c-diff, which was total bullshit, all lies. I had c-diff and the story simply nonsense - and I know that the show ignores that we life in the US, where insurance companies would never approve their ideas (and probably open a patient, leave them open on the table for hours, having surgeries that last 22 hours, taking patients back and forth for surgeries, this is all TV medicine) but I watch it like I watched House - just to laugh at the absurdity, and for the rare interesting moments.

The autism part though, it sucks. I live with an autistic person, I have met their friends who are autistic, I was married to an autistic person. I know exactly ZERO autistics like Shaun. Not only because no two autistic people are the same, but because they decided to collect stereotypes and combine all of them in one person. It just doesn't fit.

I know autistic people who hit their heads when overwhelmed. They are also married, with kids, a job and can speak in full sentences. 

I know autistic savants

I knwow autistics who have support needs that are less intense but who needed to develop strategies to cope with day to day stuff, and they do

I know autistic people who cannot speak and require full assistance, but who are also insightful and coherent when typing

I know autistic people who have intellectual disabilities but attended college and hold a job.

I know autistics who are intellectually disabled and who need a lot of help, and who are just themselves

I would expect that Shaun, having such difficulty with dealing with people and informal, spontaneous interactions, would not choose the job he did. Or he would fail med school. Or he would just give up and feel more comfortable in med research.

Autistic people learn in a different way, but they learn. Shaun having outbursts for any reason is not realistic. Meltdowns are realistic but he would not be in that job any longer, if he had ever reached that point. Besides, they treat him like a toddler, cuddling him every time he needs to "learn" something. I am sorry, but as supportive as I want to be of autistics, I would not have surgery with Shaun, the way he is imagined.

Again, autistic people learn, including learning when they need help. Shaun has no agency, other than the times when he has a huge meltdown and people cave to his desires. 

I wish the show would focus on how everyone needs help, that the dichotomy high-low functioning is bullshit, that autistic people can be assholes and deserve to be fired when they fuck up in a fireable way. Even if I were sold on the character really being all stereotypes and nothing close to real, they could have made it so that Shaun would have a cognitive interpreter. Just like an interpreter for a deaf person, a cognitive interpreter would be the one who knows how to redirect him to the task (a surgery) or to work with him on how to talk to patients about certain conditions. Even HIPAA wouldn't (or shouldn't) be a problem, since an interpreter also has a code of ethics. 

But I guess inspiration porn sells more ads for the time slot. 

Oh, and the actor is really bad. The robot talk is pathetic.

 

they should've at least at least had him see a therapist to TRY to improve on social skills and everything else

[circumvent]

10 hours ago, bros402 said:

they should've at least at least had him see a therapist to TRY to improve on social skills and everything else

Right, because if they are going to build a character that is pure fantasy, they should at least pretend that he is trying to actually be a Good Doctor, if nothing else, to justify the title of the show. The way it is, he is doing a disservice to autistics everywhere. Way too many people still perceive autistics as unruled children who tantrum all the time for no reason (as opposed to meltdowns that are triggered by sensory input, outside factors of frustration), or as weird adults who have no empathy - something this show actually had Shaun say about himself - therefore being heartless selfish weirdos. Or the other option, which is people with no agency, maturity, feelings or human thoughts. 

[bros402]

14 hours ago, circumvent said:

Right, because if they are going to build a character that is pure fantasy, they should at least pretend that he is trying to actually be a Good Doctor, if nothing else, to justify the title of the show. The way it is, he is doing a disservice to autistics everywhere. Way too many people still perceive autistics as unruled children who tantrum all the time for no reason (as opposed to meltdowns that are triggered by sensory input, outside factors of frustration), or as weird adults who have no empathy - something this show actually had Shaun say about himself - therefore being heartless selfish weirdos. Or the other option, which is people with no agency, maturity, feelings or human thoughts. 

exactly! Some people are autistic, our autism isn't us - we can improve and figure out how to get past our hurdles.

Like I can understand Shaun having a meltdown because of a long day and then the unexpected dryer, sure. I can also understand him bringing cake to the differential diagnosis - that's just seen as quirky. However, he hasn't really tried to improve.

You saw the show Everything's Gonna Be Okay, right? If not, go watch it - it was cancelled, but the unexpected finale was good.

[The Wild Sow]

Well, that was quite an interesting "portable CT scanner" they used on Brandon.  The piece of equipment was actually a C-Arm, a portable fluoroscope.  The only portable CT scanners I know of are the mobile scanners -- the ones out on a trailer truck!  I actually had an MRI on a mobile scanner back in the 90's, before every hospital had their own machine.  But no,  hospitals don't have some kind of "portable" CT scanner, MRI, PET scanner, etc., that you can just wheel down the hall.

Of course, I'm used to seeing CT scanners standing in for "MRI's," etc., on medical shows, because most of the audience wouldn't know one machine from another.  What do I expect at a hospital that apparently employs no radiology or nuc med technologists, and the doctors and surgeons do all their own imaging!  Um, no they don't, because they don't know how, and they're not allowed to.

[Driad]

I would really like to find a medical drama that has reasonably accurate medicine, and more medicine than soap opera.  Are there any?

[NJRadioGuy]

14 hours ago, Driad said:

I would really like to find a medical drama that has reasonably accurate medicine, and more medicine than soap opera.  Are there any?

Agreed, but the problem is that there too many zebras in these shows. ER probably had the best balance. A level 1 trauma center in a really bad part of town with 4 or 5 cases of the week, each with their own human stories attached, and maybe a bit of soap opera going on in the background to keep things interesting.

You might want to tune in to Nightwatch on A&E, though. Real-life, follows along with paramedics in New Orleans working the overnight shifts. LOVE that show, although it was better in the first season.

[statsgirl]

On 3/9/2022 at 11:36 PM, Driad said:

I would really like to find a medical drama that has reasonably accurate medicine, and more medicine than soap opera.  Are there any?

I think Transplant comes closest. I've worked in an ER (ward clerk part time while in college) and I see things on the show that I saw in real life.

Why might it be more realistic?

• There is no superstar like Shaun or Meredith Grey the show has to twist itself into a pretzel to write for.
• The medical case are about how the patients deal with their problems and rarely relies on finding the unicorn medical disease. The refugee storylines are also written realistically. 
• The doctors are from a variety of specialties, an ER doc, a resident, a pediatrician, a surgical resident, not all from one specialty like surgery on this show so they don't have to make everything end up being a surgery including shoe-horning Reznick into places that they shouldn't be.
• There is no moustache-twirling villain like Salen. The antagonists are the kind of people you would meeting in any large organization seeking to maximize the funds for their department.
• And surprisingly, no sex in the on-call rooms.

 

[Driad]

Putting aside for a moment the discussion about the show's handling of autism and about hate watching (see S06.E09) --

Maybe we could talk about what it would take to make an accurate and interesting medical drama.  A show runner who focuses on the medicine instead of the soap opera would be a start.  Hiring good medical advisors (and listening to them).

[bros402]

I've heard that Scrubs is the most accurate medical drama because they have patients with regular everyday stuff. Sure, sometimes they have a rare thing come in - but most of the time, it portrays life for people in a hospital.

The hospital in ER also felt lived in, since you would see things going on in the background unrelated to the plot. A lot of shows like this and House just feel sterile, like nobody exists other than the main cast.

[circumvent]

To me, it is still Code Black - season 1. Because it was based on a real hospital, because the set was designed to match the one at that hospital and because one can actually feel the tension of a public ER. Also the way it was filmed, the cameras used. Because Marcia Gay Harden apparently can do anything. I watched the documentary after watching the show and was really impressed with the accuracies.

Then, Rob Lowe came to season 2 and ruined the whole thing with his hero complex and misplaced rebel attitude, his authoritarian demeanor - I can't stand the storylines of vets being back to civil life and becoming actual super heroes just because of what they did in the military. The show took a dip in quality then. I am actually rewatching season 1 and it is hard to take any of the current medical dramas seriously

[jacourt]

I’m not sure if this goes here but here goes. My son was in the emergency room this week with his wife. Serious shortness of breath very high bp. The doctor comes in and says you are either having a heart attack, stroke or a pulmonary embolism. And walks out. Who does that sound like?  My son was like what the f. In the end he was fine. Pneumonia caused shortness of breath which caused panic attack. 

[Annber03]

Oh, wow, how scary. I'm glad your son's okay. 

[circumvent]

1 hour ago, jacourt said:

And walks out.

Ridiculous! Find his name on the many doctor grade websites, grade him as completely lack of bedside manners - to be polite. the correct word is asshole. No business being a doctor

[jacourt]

They send out surveys. It was noted. 

[bros402]

11 hours ago, jacourt said:

I’m not sure if this goes here but here goes. My son was in the emergency room this week with his wife. Serious shortness of breath very high bp. The doctor comes in and says you are either having a heart attack, stroke or a pulmonary embolism. And walks out. Who does that sound like?  My son was like what the f. In the end he was fine. Pneumonia caused shortness of breath which caused panic attack. 

Woooow, that is a bad doctor. Your son should talk to the patient ombudsman/representative/whatever they are called at that hospital and complain on top of the survey.

[jacourt]

Maybe my family is weird but after all was well we had a good laugh about having a dr Shaun murphy moment. 

[bros402]

11 hours ago, jacourt said:

Maybe my family is weird but after all was well we had a good laugh about having a dr Shaun murphy moment. 

Oh yeah, after it is all good and you know it is just pneumonia that's all good, whatever. But in the moment, holy craaaaaaaaaap

[The Wild Sow]

And once again - St. Bon's shows that their Medical Imaging Dept. is woefully understaffed or non-existent!

The surgical residents are performing a Delayed Enhancement MRI by themselves.  They're not techs - they don't know how.  And they're apparently reading said study by themselves.  They're not radiologists - they don't know how.

Not to mention that the "MRI" was a CT scanner, and the patient's chest wasn't even in the field.

[possibilities]

That really gets to me. I've had multiple CTs and MRIs in the past few years and the techs are completely different than the doctors who order them-- and definitely not surgeons! Also, when I had my MRIs, they were tiny and they even forewarned you that even if you aren't claustrophobic you might need to be medicated to mitigate the anxiety of it! I know that there are more open MRIs available in some places, but not in either of the two hospitals where I had mine done. I could handwave that St Bon has the most up to date equipment, since (despite the Salen arc) they seem to have so much money they don't even care about insurance and will do any and all experimental procedures without a care in the world, but at least they could have a distinction between surgeons and radiologists.

[bros402]

12 hours ago, possibilities said:

That really gets to me. I've had multiple CTs and MRIs in the past few years and the techs are completely different than the doctors who order them-- and definitely not surgeons! Also, when I had my MRIs, they were tiny and they even forewarned you that even if you aren't claustrophobic you might need to be medicated to mitigate the anxiety of it! I know that there are more open MRIs available in some places, but not in either of the two hospitals where I had mine done. I could handwave that St Bon has the most up to date equipment, since (despite the Salen arc) they seem to have so much money they don't even care about insurance and will do any and all experimental procedures without a care in the world, but at least they could have a distinction between surgeons and radiologists.

Maybe the hospital has the best legal & billing department and can convince insurance to cover whatever they want!

that must be it.

[The Wild Sow]

On 2/9/2023 at 12:23 PM, possibilities said:

I know that there are more open MRIs available in some places, but not in either of the two hospitals where I had mine done.

Even so....that was not an open MRI - it was a CT scanner.  Most open MRI machines just have the magnets top and bottom and are open on the sides.  There are also upright ones, where the patient is sitting or standing, and the magnets are in walls on either side.

But no way is a "cardiac" MRI going to take any images when the patient's chest isn't even in the field!  His head was barely into the bore.  But what do the surgical residents know about taking images?  Like I said - they don't know how, because they're not techs!

[bros402]

5 hours ago, The Wild Sow said:

Even so....that was not an open MRI - it was a CT scanner.  Most open MRI machines just have the magnets top and bottom and are open on the sides.  There are also upright ones, where the patient is sitting or standing, and the magnets are in walls on either side.

But no way is a "cardiac" MRI going to take any images when the patient's chest isn't even in the field!  His head was barely into the bore.  But what do the surgical residents know about taking images?  Like I said - they don't know how, because they're not techs!

Yeah - cardiac MRI is a while in the tube. I had a cardiac MRI and MRA back in 2007. It was a lot of lying down

[The Wild Sow]

Another "MRI" with no techs, no radiologist, no head coil, no Gadolinium.....