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11/22/2017

BioethicsTV (November 20-22): The Good Doctor, Ill Behavior, Chicago Med

by Craig Klugman, Ph.D.

The Good Doctor (Season 1; Episode 8): Treating Hate
Browne is treating a patient brought into the ER who has been shot after he held up a convenience store. She soon discovers that the patient has a swastika tattoo. As a woman of color, she finds this abhorrent and her personal feelings quickly affect her treatment of the patient: When both her patient and another patient need surgery but only one OR is available, Browne immediately says that the other patient should get the room even though her patient is in greater need. Her attending says that Brown’s patient needs the OR more and he is brought to surgery. As the patient recovers, he is combative and venomous: He degrades Browne for her sex, race, and being one of the few of “her kind” who could be educated. When he complains of pain he tells her exactly what medication and in what dose to use. Browne sees his track marks and verifies that he is a drug abuser, thus, she feels, limiting her options for treating his pain. Her attending makes Browne sit with the patient overnight, a job that would normally be given to a nurse the viewer is told.

Later, Browne confronts her attending when she is treating another patient. After questioning the attending’s orders in public, the attending turns to Browne and explains that she has been undercut by men during her whole career and that’s hard enough. She goes on to say that women should not be cutting each other down.

When the patient later has a crisis, Browne treats him like any other patient. When he recovers the second time, she tells him that she worked hard and took risks in life because she had no other choice. She also apologizes to her attending for publicly disrespecting her.

In reality, many patients may represent groups or points of view which are against or antagonistic to our own. This patient was a Nazi, a criminal, and he shot a shopper at the market. However, a person in need is a person in need, and one’s personal thoughts must be put aside to treat them professionally the same as the patients that one likes.

Ill Behavior (Season 1; Episodes 1-3): With friends like these, who needs cancer
This quirky comedy from the BBC made its season 1 debut on Showtime in the U.S. The 3-episode season is about cancer and friends. Joel is recently divorced and has received £2 million in the settlement. Tess is a writer at a dead-end job. Together they hire Nadia, an oncologist and substance abuser, who is willing to do almost anything for the right amount of money.  Charlie is a naturopath, recently diagnosed with cancer, who eschews chemotherapy and pursues juice cleanses, massages, and other homeopathic methods to treat his disease. Joel and Tess kidnap Charlie and imprison him at a rural estate where he is tied to a chair and forcefully injected with chemotherapy. The friends are determined to make sure he lives, even if it kills him. Nadia is perhaps the most interesting character. As a physician, she has no problem procuring the chemotherapy drugs for treatment but draws the line at administering them herself. However, when offered sufficient payment, she is happy to abandon her clinic position, her patients, and her claim that the Hippocratic Oath says nothing about taking payment for services. Nadia then administers medical treatment to her imprisoned patient. She also smokes and drinks when delivering the therapy because, as she tells the viewer, keeping a sterile field is important in mixing the chemicals, not so much in delivering them.

Clearly this is a show demonstrating how good intentions in confused people can lead to poor choices. In reality, a doctor abandoning her patients to pursue one, more lucrative patient would require planning of properly transferring her current patient’s care to other professionals. Ideally, a physician should probably not drink, smoke, and snort cocaine in front of a patient and his caregivers. I cannot recommend this series for teaching purposes, but it is an amusing dark comedy.

Chicago Med (Season 3; Episode 1): Organ donation; Fighting poverty
In the new season of this medical drama, a couple is brought to the ER after a car crash. The wife feels guilty because she screamed at her husband while he was driving. The husband dies by neurological criteria and a hospital patient is in need of an organ. The wife, having just heard about his death, is asked if she consents to donate his organs: She does, but it is unclear if she understood in that moment of shock. After the transplant, she asks to see the young man (still unconscious) who received her husband’s heart. She visits the recipient patient and touches his chest as she apologizes to the heart. In reality, there should be time between initially telling a person that a loved one has died and requesting their organs for donation. Also, in many states, a physician, especially one that might be working on the transplant team, should not request permission for a donation: That task is usually done by a representative of the local organ network. As for allowing the family to meet the recipient right after transplant, that is usually a no-go. Donation protocols generally keep identities confidential. Communication is arranged through the local organ network which may only permit anonymous letters to be exchanged at first, require written statements of a desire to meet the other family/patient, and then allow a meeting only under specific, controlled circumstances. Bringing in the donor’s widow to see and touch the recipient right after surgery violates rules, policies, and possibly laws.

A second storyline concerns Stanley Stohl, the ER chief. He discharges a patient after he is treated for a gunshot wound in the leg. When Stohl finds the patient still in the ER hours later, he asks Maggie, a nurse, why the patient is still there. Maggie informs Stohl it’s because the patient lives in a dangerous area and with a leg wound, he can’t move on his own. “If he goes home by himself, he could be shot again.” Stohl responds, “That’s not our problem. We treat ‘em, we street ‘em…I cannot correct society’s ills. I patch people up.” Later, the ambulance driver balks at having to transport the patient home, saying “They’ll kill him.” Hearing this exchange, Stohl creates an excuse of potential nerve damage and admits him for observation. Maggie’s comment is about the social injustice that allows some people to live in safe areas and forces others, usually those who are poor and people of color, to live in dangerous areas. After all, as of November 21, Chicago has experienced 611 homicides by gun and an additional 2,700 wounded by gun shot in 2017 alone. She may feel a need to practice beneficence by trying to give the patient a chance at staying alive: Without use of one leg, he is a target in his home. The chief is also correct, we cannot medicalize all social ills and a hospital bed is an expensive way to protect someone.

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