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As a family physician I generally have not enjoyed watching TV series based in a medical setting. I have not liked <em>Gray’s Anatomy</em> or <em>ER</em>. <em>House</em> was not bad, but for some reason I have enjoyed watching <em>The Good Doctor</em>. I think it is because the issues the primary characters face regularly seem more real than in many of the other shows, even though the structure of the hospital and medical staff are wholly theatrical. I’m not going to comment on the portrayal of a surgical resident with savant syndrome, as I’m not a expert on the topic, and it is really not the topic of this post. Here are some of the things I find realistic, and some that I find far from reality.
<strong>5 Things I Find Realistic:</strong>
<ol>
<li>The intensity of the relationships between the residents reflects the type of relationships I remember from that stage in my career. Residency is exhausting, all consuming, and emotionally intense. That cauldron of intense emotions leads to an analogous intensity of feelings about fellow residents. This leads to emotionally intense personal, competitive, and sometimes conflicting feelings that I see acted out on the show. The competition between residents for “good” cases, for avoiding unpleasant duties, and for promotion relatively accurately reflects my experiences and observations.</li>
<li>The excitement of learning new things and having new experiences comes through in the acting. I like how the young physicians get really excited about challenging cases.</li>
<li>The “courtship” of support from attending physicians as almost a competitive sport is realistic. Winning the support of an influential superior can lead to good job recommendations, a desirable fellowship, or being chosen as “Chief Resident” in your final year.</li>
<li>The exhaustion of long hours and stressful work is on display in the show, though to a much lesser degree than really existed in my time, and I think still exists in a reduced magnitude.</li>
<li>The power that attending physicians have over residents is real. An attending can just crush a resident easily and residents know it. In recent shows Claire is kicked off Dr. Melendez’s team over an insubordination issue, a situation that could certainly happen.</li>
</ol>
<strong>5 Things I Find Completely Unrealistic</strong>
<ol>
<li>Probably most ludicrous is that the star surgeons on the show, Dr. Melendez and Dr. Chang surgeries that span multiple surgical sub-specialties. In a recent show Dr. Melendez did a major GYN oncology case, a complex heart transplantation case, a kidney transplantation case, and complex spinal neurosurgery. Each of these cases would have been done by a different surgical sub-specialist in any modern hospital.</li>
<li>Second is that as first year residents the starring actors were doing quite advanced surgeries. In reality first year residents, a.k.a. interns, would be at the bottom of a multi-year residency team. They would be doing pre and post op work, clinic work, and some second assisting on surgical cases. On some occasions they might be a first assistant on more simple cases.</li>
<li>The three residents are all in the same class and there are no residents at higher or lower levels. In reality residency programs accept residents each year. Most residencies are 4-5 year programs, where responsibility increases each year, and the residents in the first 2 years do very little surgery themselves.</li>
<li>The hospital seems to have almost no other physicians. This team of a few surgeons seems to be working in a large hospital with almost nothing else going on besides their cases. In reality in a teaching hospital there would be many other residency programs. St. Bonaventure Hospital on this show seems to be a major pediatric hospital, so would have Pediatric and multiple pediatric sub-specialty residency programs in both surgical and pediatric non-surgical specialties.</li>
<li>Unfortunately the ethnic diversity of the top-level staff on the show does not reflect the likely lack of ethnic diversity likely to be seen at the top levels in most hospitals (and most other big businesses too) across America today. It is cool that the show depicts minorities on positions of power and influence. Maybe some day reality will catch up with Hollywood.</li>
</ol>
Of course the fact that every character is attractive and charming in their own way is pure Hollywood. Still I have enjoyed the show. Let me know if these observations seem reasonable if you are a <em>The Good Doctor</em> fan too.
