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Posted on December 6, 2019 at 11:56 AM

by Craig Klugman, Ph.D.

The start of the winter holidays means winter hiatus for many shows. This week only one show dealt with bioethical issues.

The Resident (Season 3: Episode 9): Maternal-fetal conflict; Politics, Business, and Torture; Problems with outpatient surgery in offices

In one storyline, a pregnant patient has trouble breathing during a standard ultrasound. She is diagnosed with an enlarged heart, cardiomyopathy brought on by her prior chemo. Okafor suggests delivering the baby early to protect her heart. This situation is a classic case of maternal-fetal conflict: What is good for the baby (being carried to term) is not good for the mother’s health (relieving the stress on her heart). The patient wants to continue the pregnancy and watch her heart. Three doctors give her a scare talk—she could end up with an LVAD; they will have to deliver the baby at the first sign of problems. This storyline will likely continue with increasing drama. Was this too much of an attempt to coerce a scared mother? Or was it just enough to make her understand the implications of her decisions? My guess is that mom will die and Okafor will have to raise the child (per a conversation earlier in the season).

The main storyline follows up on a previous episode where Conrad tortured Rob Spiro, a patient (and prisoner) to find out where his kidnap victim was being held. Spiro is now suing Conrad for the torture. Red Rock’s (the corporate owners) lawyers barely question Spiro during the deposition. Red Rock’s representative, Kim, tells Bell later that he wants Conrad gone and they can’t fire him without cause since his father is a previous chair of the board. The real reason they want Conrad out is that he was the whistleblower (in the first season) of patients receiving false cancer diagnoses and undergoing dangerous and unnecessary chemotherapy. However, when Pravesh gives his testimony he states that he saw Conrad go into the patient’s room but does not know what happened there. Pravesh actually says that Conrad saved the patient’s life. His lie saves Conrad’s career. Later Pravesh says he did so because Conrad is generally a good doctor and the patient’s need him. In reality, this is a nod to the old trope of doctors protecting their own. Was the patient’s torture tale dismissed because he was a convicted felon? Was the torture justified because the information led to saving a man’s life? If these are people of character (as we train doctors to be), then Conrad was wrong to torture but Pravesh was also wrong to have told a white lie to save Conrad. And of course, the big wrong here is the corporatization of medicine that considers a health bottomline more important that doing the right thing by patients and the community.

In a third storyline, a patient is brought to the ED after a spinal surgery at an office spine center goes wrong. The patient recovers and is angry that she will have a long recovery in the hospital. While a small segment, this is a comment on an increasing trend of “quick fix” physician clinics that offer operations but lack the resources if things go wrong. A 2017 study showed increased complications and worse outcomes for complex surgeries done in physician’s offices. This problem was further highlighted in a 2018 Kaiser Health News and USA Today investigation found that these sorts of places were rife with conflicts of financial interest, send patients home before they should have, overlook high risks of some patients, and a lack of resources/training for dealing with complications.

 

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