In the first few scenes of the pilot episode of ABC’s new show, The Good Doctor, the protagonist, Dr. Shaun Murphy (Freddie Highmore of Bates Motel fame) saves a young boy who falls unconscious after being hit by a huge glass sign at an airport. The viewers later learn that Murphy has autism and savant syndrome, and explores how this affects his experience as a surgical trainee.
What makes The Good Doctor unique when compared to other medical dramas is the focus on the main character’s experience adjusting to the demands of medical training – a world most viewers don’t see and one which has come under greater scrutiny in recent years. Through the lens of a protagonist with autism, the challenges are perhaps exaggerated, with the viewer left wondering if and how Murphy might adapt.
In the first few episodes we see several examples of trainee-supervisor conflict, something most medical trainees experience at least once, with the focus being on how Murphy experiences these situations compared to his peers.
For instance, surgical attending, Dr. Neil Melendez (Nicholas Gonzalez) warns his resident, Dr. Claire Browne, ‘Do I need to remind you I’m your superior…[which] means you have to act like you’re wrong,’ to which she cowers. In contrast, after Melendez threatens Murphy about limiting his participation in the operating room, Murphy retorts, ‘You’re very arrogant…do you think it will help you as a surgeon? Does it hurt you as a person? Is it worth it?’ In later episodes Melendez refuses to acknowledge a correct diagnosis made by Murphy, instead assigning him to busy (‘scut’) work (Murphy asks if he’s being punished), and scolds Murphy about contradicting him in front of a patient.
Dr. Arshya Vahabzadeh is a psychiatrist and a specialist in autism in adults and children at Massachusetts General Hospital. He has also completed three residencies, and points to the acceptance portrayed by the obliging resident as a way that for the show to illustrate a crucial survival strategy; this could be difficult for some with autism:
‘As a trainee you often have to work the system and “grin and bear” much of what you are asked to do,’ he says, ‘[With this character it’s like] a lay person coming in with little knowledge of the system…often there are seemingly illogical or futile exercises that residents are asked to do, sometimes it should just be accepted.’
Dr. Pamela Wible, an expert on medical trainee mental health (whose TEDMED talk on the subject went viral in 2015) and who is featured in the forthcoming documentary Do No Harm, believes that Melendez’s behavior reflects what many trainees experience.
‘Bullying, hazing, and teaching by terror are all too common,’ she says, writing about the issue in detail on her website. Indeed, a recent Biomed Central Study found that attending physicians are often behind this behaviour, with disastrous consequences for trainee well-being. And it’s no longer a secret: in the past few years, physicians have written about it extensively, and scientists have studied it (in fact JAMA dedicated an entire issue on medical education, focusing on both mistreatment and mental health). It makes sense then, for a mainstream medical drama to highlight these issues.
Burnout is also highlighted, in Episode 5, through Dr Claire Browne (Antonia Thomas), a resident who notices symptoms of depression (low mood and difficulty concentrating), which she discusses with her psychiatrist in a powerful scene.
Yet, instead of merely highlighting these elements, The Good Doctor also offers solutions through Murphy’s mentor and hospital president, Dr. Aaron Glassman (Richard Schiff). He seems to set a higher standard for teaching and mentoring among the trainees and the attending physicians. In one episode, we see Melendez complaining to him about Murphy, to which Glassman responds, ‘so teach him,’ reorienting Melendez back into his role as an instructor at the teaching hospital. Later on, we also see Glassman advise Melendez’s superior, advising him to ‘shelve his ego’ when he complains about insubordination.
Cy Wakeman is a therapist who has worked with several physicians dealing with similar real-life challenges, themes that she discusses in her new book, No Ego:
‘For physicians I work with [this reorientation is] a game changer…it’s as simple as switching from “I’m surrounded by idiots on my team” to “I’m surrounded by people I’m here to teach.”…To refocus on what’s best for the patient. A great leader who can do this in a hospital environment can inspire other attending staff, their residents…really anyone,’ Wakeman says.
As well, it helps de-stigmatize burnout and depression among doctors, which reflects the ongoing conversations top medical association – from the American Medical Association to the Canadian Medical Association – have recently brought to light.
The show gets a lot of other things ‘right’ during the first four episodes. For example, in Episode 2, we viewers learn more about the challenge of over-testing, after Murphy orders an MRI for a simple ear infection. Bodies like Choosing Wisely have embarked on this as an important system issue, and several medical schools and residency programs have begun to jump on board. As well, thought leaders like Atul Gawande have urged patients and doctors to be more cognizant of the dangers and cost of over-testing.
Related to this, viewers also see how doctors struggle with medical uncertainty, sensitive issues behind nurse-physician interactions and, in another recent episode, the ethics around disclosure, consent, and capacity in minors. Yesterday’s show took a deep dive into the ethics of serving underserved global populations through the eyes of a family from Sub-Saharan Africa, whose child is brought in to have a complex surgery. The fact that the last two episodes were written by two healthcare professionals – Karen Struck, a trauma nurse from Boston, and David Renaud, a physician based in Los Angeles – has only helped the writing stay true to the experiences of health professionals.
Most prominently, the show normalizes a doctor with a disability. While we don’t have data on the number of doctors in the US who have official diagnoses of autism (much of what is known is anecdotal or in the form of short reports in journals), the show reflects current discussions in the field about disabilities in medicine and the stigma associated with various conditions.
Yet, The Good Doctor oversimplifies autism to a point where some viewers believe the character is unrealistic. Vahabzadeh also points out that savant syndrome is quite rare among people with autism, and that there are limitations to having a character portrayed stereotypically:
‘I think it’s great that a program highlights a character with autism in a professional career…[but]…autism is a huge spectrum,’ he says, ‘It is hard to make generalizations, but the overly robotic nature of the character we see in the show doesn’t hold true for many people I know with autism.’
That said, The Good Doctor is a refreshing new series that places medical training and intellectual disability as characters themselves, while portraying effective leadership – namely through Glassman – a solution that goes beyond typical responses related to mental health in medical training.
On October 14th, the World Medical Association revised the Hippocratic Oath to ensure that respect between trainees and their supervising physicians is bidirectional (previously trainees were to respect their superiors, but not vice versa) – a cue that would undoubtedly help Melendez with his interactions. While it is typically a challenge for some with autism, highlighting empathy may be another strategy for the show to explore the subtleties behind hospital culture, why characters like Melendez are conditioned to behave in the way they do, and the backstories of the characters viewers resonate with the most.
Amitha Kalaichandran, M.H.S., M.D., is a Canada-based resident physician in pediatrics and health/medical journalist whose work has appeared in The New York Times, Boston Globe, and New York Magazine. Follow her on Twitter at @DrAmithaK.