Review: The Resident is television malpractice

1 Comment

The Resident just got renewed for a second season on Fox – and that’s a problem.

I’d heard the controversy about the show — that it ‘peels back the curtain’ and portrays doctors as greedy and corrupt. I saw the show’s creator trolling healthcare professionals on Twitter, and learned they have a medical consultant who’s been accused of sexual harassment and misconduct.

I started watching the first season (it’s streaming on Hulu). I thought it would be a farce, and I’d hate-watch the whole thing. After all, that’s how I got through NBC’s The Night Shift a few years back.

After a few episodes, I can tell you the show is better, in some ways, than I expected. And it’s more profoundly worse than I could have imagined.

The Resident opens in an OR, during an appendectomy. A senior surgeon, Dr. Randolph Bell, tries to conceal his shaky hands. Junior staff pause to take selfies with the great Dr. Bell, including the anesthesiologist. Suddenly, the patient wakes up and moves. Dr. Bell gets squirted with blood from a spurting artery. In a matter of seconds, it’s announced the patient lost two liters of blood, and we watch the patient arrest. After a few half-hearted compressions, they pronounce the patient dead. Bell then engages in the age-old tradition of trying to blame Anesthesia, but everyone puts their heads together to concoct a story about the patient suffering a heart attack. The scene ends as staff start to delete their smartphone photos.

That’s the first five minutes of the show! A total of 8.7 million people watched this botched appendectomy and hasty, awful and implausible cover-up. As the main credits rolled, I found myself hoping we’d soon meet The Resident, and the rest of the premiere would be about our lead character exposing the atrocities that unfolded during that OR case.

But no, the appendectomy barely comes up again. Its purpose was to introduce us to Dr. Bell, who spends the rest of the episode courting donors and hyping robotic surgery. Later, he coerces a more capable immigrant surgeon to perform a procedure, by threatening deportation, while he takes the credit.

The next character we meet is the intern — an Indian doctor who graduated from Harvard and is about to begin his first day at Chastain Park Memorial. As Devon Pravesh heads out the door, his wife calls out ‘You’re going to be an amazing doctor!’ He replies, ‘I know.’

Finally, the intern meets The Resident, Dr. Conrad Hawkins, who greets him with ‘Namaste’ and immediately compares Step One scores (Conrad got a 280 versus the intern’s 267). By this point, we’re 10 minutes in, and I haven’t found a single conversation on this show to be remotely believable or a single likeable character.

Fortunately, we soon meet the nurse, Nicolette Nevin, who explains to Devon that The Resident may have a gruff exterior, but he’s a great doctor you can really trust. It’s also soon revealed they are romantically involved, but it’s complicated.

Nevin continues to pop up through the episodes I saw, to furnish exposition, and stand in for the audience, as selfish doctors and sick patients drive the plot.

One scene from the pilot stood out to me. There’s a feverish young woman, an IV drug user, trying to sign out of the ED against medical advice. The Resident swoops in and notices she’s got Osler’s Nodes along the edge of her palm — and warns her she has endocarditis and will die if she leaves.

She offers to stay, but only if she can get 3 mg of dilaudid. Conrad talks her down to 2 mg. They agree, but then she collapses in the floor in PEA arrest. The intern codes her, and continues compressions for over 20 minutes. Conrad urges him to call it, but Devon is sweaty and determined. After all, it’s his code and his first day. So he presses on, and dramatically achieves ROSC.

People congratulate Devon for persevering, for saving the young woman’s life – but Conrad has none of it. He points out her end-tidal CO2 was low and she was down for a long time – she’ll never wake up. ‘You didn’t save a life,’ Conrad says to Devon. ‘You saved a brainstem. All we want to do is help our patients, but what they don’t teach us in medical school is there are so many ways to do harm.’

MORE: Why Don’t More Emergency Departments Cardiovert?

This scene is ridiculously rushed and heavy-handed, but had kernels of truth to it (unlike the appendectomy death and cover-up). If the show had more scenes like this, I think it could appeal to healthcare professionals and the lay public alike, and serve as a somewhat accurate portrayal of the job.

But The Resident undermined this scene minutes later, by ascribing financial motivations for the hospital wanting to keep the young woman alive, but vegetative in the ICU as long as possible (you see, she has ‘gold-plated insurance’). Then The Resident really goes off the deep end, when Conrad walks into the patient’s ICU room, draws the blinds and shuts off the vent. Nurse Nic walks in and wordlessly stares at him, until he sheepishly turns the vent back on.

So, the show’s called The Resident, but the lead is mostly a jerk so far and nearly decides to kill someone before the end of the premiere episode. By the second episode, he’s swapping blood samples to make sure his friend gets a heart transplant, instead of a congressman. Outrageous, criminal, career-killing behavior is a habit among this show’s main characters, but no one gets jailed or fired or even investigated. That’s the lesson millions of Americans have been absorbing, with each episode.

What really irks me: there is a story to be told, about the corrupting influence of insurance and donors in medicine, and how this can sometimes warp priorities and lead to bad care. There could be a story about how some doctors (and their peers) feel pressured to cover up declining skills, at great cost to patients.

The Resident could be a story of an idealistic young doctor who tackles the system, or learns to work within the system, or even becomes compromised by that system. Instead, The Resident has cartoonish villains at every turn, and the hero’s approach to justice is so reckless as to be nonsensical.

Emergency Physician [and frequent EPMonthly contributor]Esther Choo wrote, “’The Resident’ seems singularly intent on eroding trust in the practice of medicine.” She’s absolutely right. Most of what unfolds in The Resident is so far outside of how hospitals work, so far beyond what we in the field would consider scandalous, this show is a real problem for our profession.

Over-the-top, unrealistic heroes and villains may be OK for shows about business moguls or athletes, but misrepresenting healthcare on TV is different. Every viewer of The Resident will be a patient at some point and they’ll be profoundly misinformed about the motivations behind the care they’re receiving, and what’s going on behind the scenes. We already face skepticism about vaccines, antibiotics, imaging — who’s looking forward to discussing a straightforward diagnosis of appendicitis, with a viewer of this show? And I’d hate to think a family wouldn’t trust their doctor to respect goals-of-care decisions, or a doctor would secretly work against those wishes — but that’s the kind of thing that happens on The Resident.

I can’t escape the conclusion that the fact this show is not in the public interest. Conrad’s quote about ‘there are so many ways to do harm’ applies to TV executives, as well as doctors. The Resident is television malpractice.

Another show that’s streaming on Hulu is ER. Go back and watch the first 15 minutes of the premiere. It manages to show EPs as quite human – tired, overwhelmed, a bit petty or egotistical, and yeah, occasionally reckless. George Clooney’s Dr. Ross debuted as a drunk patient, who then sobered up on a stretcher, before jumping in to help out during a mass casualty event.

ER hardly portrayed doctors as ideal characters, but it also didn’t undermine the public’s trust in medicine. The actors, producers and writers of ER consistently strived for accuracy. And the show was a big hit, running for 15 seasons — proving viewers will watch a medical drama based in reality.

The Resident takes the lazy path, opting for extravagant corruption and irresponsible righteousness. The occasional medical moment that feels plausible just serves to remind me how misleading the rest of this show must appear, to a lay audience. Those of us on the front lines are often asked to do more with less, going the extra mile to help patients as they struggle with limited healthcare access, unaffordable medications, and insurance hurdles. Having The Resident portray doctors as untrustworthy, as the bad guys, rubs salt into the wounds of daily practice. And it creates a wedge between doctors and patients.

I can’t decide if this show is just a symptom of a real and growing divide between doctors and patients — or another cynical effort to generate profit by provoking passions and sowing distrust. What seems clear, though, is that we’ll somehow have to work harder, to repair the damage The Resident is doing. We’ll need to be more transparent, more available, more capable advocates for our patients  so that viewers of The Resident recognize the plots as paranoid delusions, utterly unlike anything they’d encounter in a hospital.

Photo Credit: Guy D’Alema/Fox

ABOUT THE AUTHOR

SENIOR EDITOR
A specialist in emergency medicine informatics at Mount Sinai in Manhattan, Dr. Genes is EPM's resident tech guru. He practices emergency medicine at Mount Sinai Hospital but can be found sharing his wit and wisdom all over the web.

1 Comment

  1. Logan Plaster on

    Nick, I’m so glad you’re writing about this. I have to say I disagree with the Hippo Ed guys on this one. I think the loss of trust (even fear) created by the show and pushed on a large consumer audience has real negative effects.

Leave A Reply