Guest Post: Is "The Good Doctor" Medically Accurate? Part I

We sometimes publish guest blogs on topics we think you might find interesting. Today, we are publishing on TV shows and medicine. This is part I. 

If you have ever watched the "The Good Doctor" with its awkward lead character Dr. Shaun Murphy, you probably wondered how accurate is its depiction of life at an average American hospital. The short answer is: "about 50% accurate, with a lot of leeway given for dramatic effect." The long answer is the show aims to mix interesting, once-in-a-lifetime cases with a fast-paced interplay between a limited number of main characters. Medical accuracy is a necessary casualty in this mix. This is quite common among medical TV shows. For example, a common critique of Grey's Anatomy was the fact it never showed nurses doing anything, while the main MD characters did everything RNs would do.

To get a more in-depth look at these inaccuracies in the show, let's look at some of the major inaccuracies:

Medical inaccuracies

• Tension pneumothorax

In the first episode, Shaun sees a billboard sign crash on a child. As the child deteriorates, he looks at his veins and makes the diagnosis of tension pneumothorax, which he proceeds to address with an ad hoc chest tube drainage system. There are a few inaccuracies that would make this scenario highly unlikely in real life: 

1. Distended neck veins do not indicate tension pneumothorax per se; they could be caused by a number of conditions, including cardiac tamponade (or compression of the heart). Even if he were to arrive at the diagnosis, it would be difficult for him to establish which lung has the pneumothorax. 

2. The treatment for emergent tension pneumothorax (and it is emergent, because we can see the victim crashing) is needle decompression -- not a chest tube. In fact, wasting time trying to put together the system he did would put the victim at risk of dying from obstructive shock. 

• Pericardial effusion

In that same episode (#1), Shaun is locked out of the hospital as he incoherently mumbles about having to do an echocardiogram. Anyone out of medical school should be able to blurt out pericardial effusion, but it seems Shaun was not able to.

Interestingly, the kid also gets pan-CTed, so presumably, his effusion would have been caught on CT of the chest without need for an echo.

Non-medical inaccuracies

• Surgical residents

Generally, residents do rotations on various services: general surgery, plastic surgery, etc. What is inaccurate is how one of the characters does neurosurgery in one episode and then general surgery on the next, and then back and forth. It is obviously done for expediency, but it would be an inaccurate depiction of how residents work.

This brings me to the term "surgical resident." When medical students are accepted into residency, they are usually set on a specific speciality. "Surgical resident" is a vague term, although in the context of this show, it probably refers to general surgery.

• Disability and work

In the first episode, the hospital board debates quite openly denying Shaun a position based on the fact he has autism. Aside from the fact residency positions are not really "given" by a vote of the board but rather through a matching system, denying someone a position they are qualified for solely based on disability is illegal. If he were denied a position because he was autistic, he could sue under the Americans with Disabilities Act of 1990, and would likely win a handsome compensation.