In season 5, episode 2 of Insecure, the scene opens with a nervous converse sneaker tapping on the hospital floor. Family members are wringing hands, fiddling with coins in their pockets, and pacing in monotonous circles. A doctor strides toward the family. They nervously collect around him: "Hi." "How is she?" He clears his throat: "There's not good way to say this really, but there's not much more we can do for her. I know it's a lot, but I think it's best if you say your goodbyes now."
The family is standing in the middle of a large waiting room, fake plants casting fake shade; there are at least five chairs filled by others waiting to hear news of their own loved ones. Someone is eating chips.
"It's time," the doctor says. He pivots like a drill sergeant leading new recruits, and the family leaps up to follow, their jaws hanging open.
The scene cuts to the family staring suspiciously at their mother in the bed. "I don't think that's mom." The doctor shrugs it off: "I know it can be hard to take." The daughter, an outspoken lawyer in the show, edges in, "No, this is literally not her. Who is this woman?" The son adds indignantly, "What kind of hospital are you running up here?"
Now, the doctor is looking less certain. "You're sure this is not... Maybe we should get this sorted out somewhere else...before…."
The family, whose mother this actually is, appears in the doorway. The two families face each other with equal parts grief and confusion. The scene concludes with the doctor saying, "I'm so sorry, it's been a busy night here," reshuffling the notes on his clipboard.
Let me first say that I love this show, and it does a lot of things right that are not related to medicine. It makes me wonder, though, that while they have handled many of our societal issues so deftly, why is the medical profession so flagrantly unprofessional?
There are several parts of this scene that I could focus on, but perhaps the first and most flagrant one is announcing what you (the physician) believe to be the imminent death of a loved one in the very public setting of a waiting room.
One of the first things medical students are taught when learning the delicate craft of delivering bad news to a family is to take them to a separate, quiet room. This is so ingrained in us that these very rooms become feared when we ourselves become patients. These private rooms are the spaces that grief requires.
The first 1.5-2 years of medical school are known as preclinicals. Besides understanding basic physiologic concepts and disease paradigms, we spend time trying on the role of a doctor. Learning how to treat patients with consideration and respect is built into the curriculum and is no small part of the profession.
Medical schools often hire patient actors so students can play out scenes and practice handling unique and challenging situations. The actors are good, sometimes unnervingly so.
I remember one such actor that played his role with dedicated zeal. Our goal for the day was learning how to manage patients poised for angry outbursts.
I don't remember the scene exactly, but the circumstances went something like this: The patient had been waiting to see the doctor for several hours. It didn't matter how really, just that you (the student doctor) were entering a room in which the patient was already agitated, having waited several hours to be seen. I had followed my script, returning his anger with compassion, and refocusing his concerns: "So, what brings you in today?" He calmed down for several minutes and started listing off his maladies.
It began fairly typically: A fall on ice several weeks back, but his story took an entertaining turn when he divulged that the fall had occurred while catapulting over the fence of his mistress's backyard. The low hum of her husband's car already in the driveway. How his pants had snagged and how he landed on his ankle at a neat right angle. I smiled nervously. "Are you laughing at me?" He turned it up a notch: "I come here to tell you my problems and get help and you…giggle!" His face had taken on that red helium balloon look of an angry caricature. He was a good actor, and it was easy to forget that I hadn't actually angered the man sitting in front of me, brows furrowed and voice rising. I bit my lip. I needed to become a better actor myself.
That was the time for making those mistakes.
There will always be situations that could have been handled better and conversations that require more care than they have been given, but I'm surprised by the prevalence of errors that you can find on TV. Maybe it's a bit of vicarious roleplay because the patients often rightly become upset. I spend a lot of time thinking, "I'd hate to be that doctor right now."
TV is a better example of how not to be a doctor than how to be one. What happens to the profession when widely popular shows advertise breakdowns in basic communication and respect? Are patients subconsciously learning to expect less, or worse? Are we lowering our own standards?
I'm no screenwriter, but if I were a medical consultant for the show, my version would go something like this: Doctor walks into the waiting room and asks if the mother's family is present, which is the first line of defense against speaking with the wrong family. Assuming that the right family stands up, the doctor waits for the family to gather their things; after all, they've been here for a while. The detritus of waiting surrounds them.
After leading them to a private room, the doctor would explain the severity of the situation. Perhaps most importantly, and this is something I'm only beginning to appreciate, he or she asks if there are any other questions the family would like to ask right now. Maybe now they could say, if it still hasn't dawned on either party, "Are you sure this is our mom?"
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Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.
Cite this: Liana Meffert. TV Doctors: I'd Like to Have a Word With You - Medscape - May 05, 2022.