Learning from the TV doctors

You couldn’t help feeling a twinge of sympathy for Dr. Tyler Wilson in the opening episode of “Monday Mornings”, TNT’s new medical drama.

Wilson, a neurosurgeon, has made an error in judgment that resulted in a child’s death during brain surgery. Now he’s being pilloried at fictional Chelsea General Hospital’s weekly morbidity and mortality (“M & M”) conference, presided over by Dr. Harding Hooten who has a reputation for mercilessly dissecting every misstep by the surgery staff (he accuses a transplant surgeon of being “a vulture” for trolling the emergency room in search of potential organ donors).

Alas, there’s much this show doesn’t get right. The doctors are caricatures. The medical cases are melodramatic and outlandish.

Even the M & M sessions are over the top, observes a critic who should know – Dr. Barron H. Lerner, a professor of medicine at New York University Langone Medical Center. Dr. Hooten’s tactics were common once upon a time but nowadays the atmosphere at M & M meetings is more measured, Dr. Lerner wrote in the New York Times.

Doctors should admit their mistakes but the goal is to learn from error and improve the practice of medicine, Dr. Lerner writes. “Even the best doctors make mistakes. Impugning them publicly – or even privately – can make them clam up.”

What gives “Monday Mornings” its unique hook for drawing in viewers is the exploration of the darker side of medicine and how doctors cope with their mistakes and personal failings.

As recently as 10 years ago, this was mostly a matter for discussion behind closed doors. But times have changed, and an open approach toward acknowledging and understanding medical mistakes is supported by current research.

When this happens, organizations have an opportunity to learn and do better, Canadian researchers concluded last year. “Systems that provide healthcare workers with the opportunity to report hazards, hazardous situations, errors, close calls and adverse events make it possible for an organization that receives such reports to use these opportunities to learn and/or hold people accountable for their actions,” they wrote.

Health care also has been moving towards what’s known as a “just culture”, which seeks to find a balance between the all-too-human tendency to make mistakes, especially in the complex, high-intensity environment of health care, and the need to be accountable for safe practice.

It all makes you wonder, though: Where do patients and families fit into this? All too often they’re at the mercy of a system that’s prone to error and populated by personalities that don’t always like to admit how fallible they can be. And invariably it’s patients and families who pay the highest price when something goes wrong.

You don’t have to look far to find negative feelings and even considerable anger towards health care professionals when things go badly. Members of the ProPublica patient harm community recently took sharp issue with the term “second victim” that’s often used to describe the doctors and nurses involved in a serious error.

“It’s just wholly inaccurate because family members are the 2nd victims,” one commenter wrote. “Providers are at best 3rd victims.”

And although the majority of studies on disclosure have found that what patients and families want most after a medical error are 1) an honest, compassionate explanation; and 2) assurance that the health care organization has learned from the event, the evidence is scarce that this actually occurs with any consistency.

Where “Monday Mornings” does seem to get it right, more often than not, is in its portrayal of how the doctors respond to bad outcomes and to the families involved. Dr. Wilson is crushed by the death of his young patient, can’t stop ruminating about it and wants to tell the patient’s mother the truth – that her son died because the surgeon failed to obtain an adequate medical history that would have revealed a high-risk genetic condition in the child’s family background. Dr. Tina Ridgeway is shocked and defensive at being sued for allowing a resident to perform surgery that accidentally damages the olfactory nerve, ending the patient’s career as a chef. And this week we saw Dr. Sung Park rethink his truly awful communication style after being chastised at the M & M for mishandling the decision-making for a brain-dead patient.

In other words, they’re not all heartless and uncaring.

Nor is the show too far off the mark in depicting how families react when things go wrong – shock, grief, anger, insistence on knowing what happened and, in Dr. Wilson’s case, a mother’s unexpected effort to reach out and console him.

If art imitates life, the intersection among doctors, patients, families and bad outcomes is still pretty complicated but some of the barriers might be starting to come down.

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