by Craig Klugman, Ph.D.
The Resident (Season 1; Episode 14): Treating Loved Ones; Chemo for Healthy Patients ; Chicago Med (Season 3; Episode 20): Doctor and jury
The Resident (Season 1; Episode 14): Treating Loved Ones; Chemo for Healthy Patients
In the season finale, we learn that Hunter has been telling healthy people that they have cancer (when they do not) and giving them chemotherapy. She is committing Medicare fraud and also artificially bumping her success rates at curing cancer. Pravesh informs Lily, a frequent flyer, that she does not have cancer and is a victim of Hunter. The residents tells Bell that they have informed the FBI of the problem and they suggest he suspend Hunter immediately. Hunter and Bell, however, are having a relationship and Bell tells her to go to her clinic and get the questionable records so they can destroy them. When she gathers her records, the FBI shows up, having been tipped by Bell that she was destroying evidence. His motivation was to protect the hospital and his own position.
In a second story line, Micah Stevens, a former heart transplant patient returns. Scans discover that he has an aneurysm on his aorta that could blow, an uncommon side effect of his transplant. The problem is discovered after he has sex with Okafor and he is the first person she has truly loved. The surgery is risky because scar tissue makes it hard to see the heart. Most surgeons recommend doing nothing. But Dr. Austin is arrogant enough to believe that he can save the patient. Okafor scrubs in to assist. The ethical question is whether the patient should have the surgery or not. The surgery has a high risk of mortality, but so does doing nothing. The danger of operating on a loved one is shown by Okafor constantly second guessing Austin—telling him to slow down and to be more conservative. When Austin asks her to suture, she says no, that she cannot. Austin says, “You broke the cardinal rule of the OR: You are emotionally involved with this patient. Is that why you can’t operate Dr. Okafor or are you just not up to the task?” He is correct that a physician who treats a loved one risks losing objectivity. However, Austin is also egging her on. He actually says that her passion will make her do a better job. She sutures in the dacron replacement.
The lesson that Austin teaches her is exactly the wrong one. He is known for being arrogant and for taking risks that no one else will. He also has a remarkable rate of success. But he encourages her to violate professionalism. In one sense, he tells her to think about the patients as people instead of just objects on which she works. On the other hand, he encourages to violate the precept that one does not treat a loved one except in an emergency when no one else is available.
Chicago Med (Season 3; Episode 20): Doctor and jury
This episode is the season finale and it wraps up several storylines including a separation surgery for conjoined twins; Goodwin’s ex-husband attempting suicide after his girlfriend died; and the homeless children’s’ encampment sees an epidemic of Hep A including Choi’s own sister who is addicted to pills.
In a long running arc, Dr. Charles has been caring for a heart transplant patient who also has a personality disorder. The man manipulates people for his own needs and Charles has begun to believe the patient may have been involved with a series of disappearances of young women in towns where he has lived. Charles attempts to gain entry to the patient’s apartment. After the super refuses to let him in, Charles looks through the window where he sees a stuffed animal that was taken from a missing woman’s room. When Charles confronts the patient, the patient collapses and Charles does not give CPR. But the patient’s daughter just walked in so has Charles decided not to save a patient whom he suspects did wrong or did the patient orchestrate that moment to turn his daughter, who is also Charles’s resident, against her mentor? We have to wait until next season to find out.
The question these actions raise are when does a physician go over the line from helping a patient to becoming a detective of a patient’s potential wrong acts? Charles should have turned over his suspicions to the police (who did seem uninterested in a previous episode) rather than trying to solve a crime on his own. A second question is whether a physician can refrain from starting CPR on a patient that they suspect of being a bad person. As tempting as this may be, the physician is not judge, jury, and executioner and unless there is a court order, a DNR order, an advance directive, or an oral conversation to the effect, Charles should have begun CPR. Starting CPR would also have determined whether the patient was faking or was in real distress, but that would hardly leave a cliffhanger for the viewer.