As graduating medical students eager to begin our residency training this summer, we were intrigued to hear that Fox would be depicting this crucial phase of our medical training in its new show, The Resident. After watching the pilot episode, we were appalled and horrified. The Resident is not only poor entertainment; it harms the public by grossly misrepresenting core concepts of medicine. The series follows a young doctor in training, senior resident Conrad Hawkins (Matt Czuchry), as he crusades against the greedy and bureaucratic hospital where he works. We found the show's depiction of medicine to be unrecognizable. The Resident gives a false account of medical education, skewers medical facts, and glorifies unprofessional and frankly illegal behaviors by a physician. Just to name a few examples: In reality, interns don't run codes on their first day. Ice water baths are not used to break arrhythmias. Casual racism does not make you a better doctor. Although a show like this may seem innocuous, it actually has the potential to hobble public health literacy, harm doctor/patient relationships, and erode trust in medicine as a profession. Despite ostensibly making a show about residency, the creators of The Resident do not seem to have a clear understanding of what residency actually entails. In reality, residency is a time to hone clinical skills, explore different areas of medicine, and learn how to lead a clinical team. Different specialties have distinct residency programs, and interactions between services are limited. Therefore, internal medicine residents do not typically watch operations or critique the chief of surgery, as is shown during this show. Furthermore, actual residents have far less authority than depicted on The Resident. Unlike Conrad, real-life residents do not typically have the authority to fire interns. In real hospitals, residents work as part of a team that may include an attending physician, whose approval is needed for most medical decisions, as well as a fellow, one or two interns (ie, first-year residents), and medical students. The gross misrepresentation of the learning process and supervision structures within hospitals in this program encourages a public misunderstanding of provider roles. When real patients are hospitalized, this show may actually make an already confusing process even more overwhelming. In terms of inaccuracies related to medical procedures, The Resident is dizzying. For starters, surgeons do not take selfies in the operating room, because this would break sterility and violate HIPAA. Central lines are not placed by blindly cutting the neck, a structure containing multiple large blood vessels, with a scalpel. Perhaps most disappointing—and most potentially damaging—is the bungled depiction of brain death. In one of the most dramatic scenes in the pilot episode, Conrad surreptitiously turns off the ventilator supporting Chloe, a "brain-dead" patient of his, to end her suffering. However, whether Chloe is really brain-dead is unclear. Brain death is a condition characterized by a lack of all brain function and is completely irreversible. Medically and legally, death is defined by cessation of brain function. Brain death is death. Therefore, when a patient is brain-dead, doctors are not only permitted to remove life support measures, they are obligated to do so. If Chloe were brain-dead, switching off the ventilator would be Conrad's duty as a doctor. If not, this would constitute murder if not first approved by a surrogate decision-maker. Medical inaccuracies such as this in fictional narratives still hinder public health literacy. Making healthcare decisions is scary and mysterious enough to a layperson; unnecessary misinformation, even in "silly TV shows," makes it that much more daunting. Above all else, Conrad's inability to behave in a professional manner is truly frustrating to those of us entering the field. His taunting of Devon (Manish Dayal), an intern, about his sexual interests is sexual harassment. Furthermore, when he forcefully pulls nurse Nicolette (Emily VanCamp), his love interest, into the call room, this crosses the line into sexual violence. At one point, he asks Devon, "Were you affirmative action at Harvard?" This is profoundly belittling and ignorant commentary on the intern's race. Although the tradition of the cranky-but-brilliant doctor on TV is long, the coexistence of unprofessional behavior and clinical excellence is in reality rare. Studies have shown that professionalism is associated with physician excellence, including in areas of medical knowledge and procedural skills. Portraying a bad person on television is not necessarily a bad thing, but glorifying unethical, immoral, and illegal behavior in a profession whose primary purpose is serving human beings at their most vulnerable moments in life serves to erode public trust in the profession. Of the dozens of medical dramas that Hollywood has produced, The Residentranks amongst the worst. Unlike Scrubs, which portrays the grief and growth inherent to medical residency with insight, The Resident depicts a version of residency training with almost no bearing on reality. Furthermore, The Residenttakes promoting medical inaccuracies and unethical behavior in physicians—hallmarks of the former Fox drama House M.D.—to new heights. Fortunately, The Resident is boring and lacks the riveting interpersonal narratives and charismatic characters that propel successful shows, such as Grey's Anatomy and ER. Here's hoping that means it will be short-lived. As graduating medical students, we hope our generation can help redeem the good name of medical residents. We also ask that writers of dramatic medical television make equal efforts. Source
