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Monday Feb 12, 2018

Fox Should Pull the Plug on The Resident

I graduated from residency less than a year ago. I remember what it felt like to do 24-hour calls while taking care of 16 or 17 patients, knowing that any one of them could take a turn for the worse at a moment's notice. I remember what it was like to code patients, some with a level of function so poor that pressing on their chests to restart their hearts felt like a cruel joke. I remember what it was like to be overwhelmed, thankful for having a team member or a senior resident there to help me. I remember what it was like to be burned out, to have no time to care for myself, and to wake up the next morning and do everything all over again. The cocoon of my family medicine residency was hardly malignant, but I still felt this way.

[woman smacks head watching bad TV]

Unfortunately, I also went to a program where, during my intern year, two residents in other specialties committed suicide a few weeks apart. The hospital never discussed why, and multiple factors were likely involved. However, the suicides pushed our facility's graduate medical education department to develop an agenda for maintaining resident wellness and prioritizing access to mental health and counseling services. There was also an attempt at rapid culture change: How can we teach young, inexperienced doctors to be confident, to take ownership of their decisions -- and sometimes the burden of life and death -- while providing adequate emotional support and educational supervision?

Given this background, imagine my disappointment as I watched the pilot episode of The Resident, a new medical drama on Fox. Within the first few minutes of meeting our protagonist, Dr. Conrad Hawkins, a third-year internal medicine resident, we realize he's racist. (He greets the brand-new, Indian-American intern, Dr. Devon Pravesh, with a smug "Namaste.") We also see that he's insecure (he points out his MCAT score of 280 to the intern), and he's a bully (he brags about "breaking" his intern from last year to make him a real doctor). In the next few minutes, he sexually assaults his ex-girlfriend, nurse Nicolette Nevin, by grabbing her, pulling her into the call room and kissing her without her consent.

Hawkins' behavior is neither sexy nor charming. Glorifying this character by calling him, as Fox does on the show's website(www.fox.com), a "tough, brilliant senior resident" is horrifying. At any accredited residency program, he would probably be reported and placed in remediation, if not removed, for his behavior.

Sure, there have been other doctors on television with questionable bedside manner and a history of ethical violations. Hawkins displays this streak near the end of the pilot episode when he tries to turn off the ventilator of a patient in a persistent vegetative state, but unlike the main character in House, Hawkins is not portrayed as an anti-hero. He is simply presented as the good-looking good guy, fighting for justice against a corrupt hospital administration, a corrupt chief of surgery and, in subsequent episodes, a corrupt, evil and unrealistically out-of-control billing consultant. (This is not a joke. I wish it was.)

The show believes it "rips back the curtain to reveal the truth of what really happens, both good and bad, in hospitals across the country." By marketing the show as a vehicle for authentic stories, Fox has forfeited the fuller artistic freedom that comes with a soap opera like ER or Grey's Anatomy or a fictional memoir like Scrubs (which, hands down, is the most realistic and balanced medical show to date). The Resident is indeed a conversation starter, as Zubin Damania, M.D., (also known as ZDoggMD) notes with humor in his reaction video.(zdoggmd.com) But it is hardly the truth, and broadcasting a show to the American public that oversimplifies and fictionalizes health care for the sake of drama may further erode patient trust in physicians and the medical system.

To Fox and the creators of the show: I want stories about our broken medical system to be told. Insurance, finances and the business of medicine should be under scrutiny. Openness about medical errors has improved since the Institute of Medicine (now the National Academy of Medicine) put out its 1999 report on medical errors,(www.nationalacademies.org) but there's room for more accountability.

Sadly, characters like Hawkins only perpetuate medicine's culture of shame, a key factor in why medical errors are downplayed. I understand the show needs drama for viewership and ratings, but it is irresponsible and detrimental to state, as the nurse does in defense of Hawkins, that rudeness, dismissiveness and arrogance are acceptable traits in competent physicians. Don't let your writers be lazy by creating black-and-white narratives of one-dimensional characters. Have them write difficult stories of our complicated medical system with compassion, integrity and nuance, and without a toxic male character in the lead.

Lalita Abhyankar, M.D., M.H.S., is a family physician practicing in New York City. You can follow her on Twitter @L_Abhyankar.(twitter.com)
 

Posted at 04:50PM Feb 12, 2018 by Lalita Abhyankar, MD, MHS

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