What the Newest Medical Show Gets Wrong About Psychiatry

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In general, I don’t watch medical shows. As a physician, I can’t watch without noticing the errors, exaggerations, and unlikely scenarios. I still think ER is the gold standard of medical shows. I watched faithfully from college to med school then my viewing waned when I become a resident, for the aforementioned reason. I recently re-watched the entire ER series. Although I watched it with a more critical and educated eye, it was still amazing.

I decided to give New Amsterdam a chance because I am a fan of Ryan Eggold from The Blacklist and of Freema Agyeman from Doctor Who. It is also based on the book, Twelve Patients: Life and Death at Bellevue Hospital, so I thought it would be more realistic than other medical shows and maybe have a chance at being as good as ER. It premiered on September 26, 2018 on NBC.

You have probably seen the promo ad when the new medical director comes in and fires the entire cardiac surgery department because “anyone who places billing above care, you will be terminated.” Here is the show’s description from nbc.com: “Inspired by the oldest public hospital in America, this unique medical drama follows the brilliant and charming Dr. Max Goodwin, the institution’s newest medical director, who sets out to tear up the bureaucracy and provide exceptional care. How can he help? Well, the doctors and staff have heard this before. Not taking “no” for an answer, Dr. Goodwin must disrupt the status quo and prove he will stop at nothing to breathe new life into this understaffed, underfunded and underappreciated hospital — the only one in the world capable of treating Ebola patients, prisoners from Rikers and the president of the United States under one roof — and return it to the glory that put it on the map.” Sounds awesome, right? Well, there’s a few things I didn’t like about how my specialty was depicted.

Psychiatrist as court jester: The staff meeting that introduces the medical staff to Dr. Goodwin shows a room full of physicians in scrubs or professional clothing with clean white coats. One physician enters late, loudly, and clumsily. He drops things, bumps into others, is disorganized, and a bit unkempt. He is the chair of the psychiatry department, Dr. Frome. He has the opportunity to tell the medical director what he wants for his department and decides to ask for healthy food while all of the other physicians laugh. The depiction of the psychiatrist as a graying, overweight, slovenly white man is simultaneously stereotypical and insulting. Psychiatrists are capable of being punctual, well-groomed and nicely dressed, organized and not the joke of the medical staff.

HIPAA who?: Dr. Frome is now wearing a zip-up hoodie and walking around the psych unit eating Cheetos. He has known an adolescent patient for years and intends to keep her inpatient until she is 18 to avoid returning her to the foster care system. His colleague echoed my thoughts when she asked, “So you are committing a patient just to keep them out of foster care?” Is this legal? What insurance would approve this? What does her guardian have to say about this? Dr. Goodwin tells Dr. Frome, “If you can’t treat her as a doctor, just help her as a human being.” (I didn’t know they were mutually exclusive.) Dr. Frome reads her journal, finds the adult daughter of a previous foster mother mentioned in the journal, and shares the journal with the daughter. So, I guess helping her as a human being has made HIPAA obsolete. But HIPAA be damned, the daughter read the journal and decided to be her new foster mother. At New Amsterdam, you can violate HIPAA if it causes a happy ending to the story.

Haloperidol makes you happy: A woman with a diagnosis of Parkinson’s disease presented “cyanotic and rigamortis.” She has been on haloperidol for two years for depression. That is not a typo. She was diagnosed with Parkinson’s one year later. Levodopa prescribed for Parkinson’s caused insomnia. Hydroxyzine was prescribed to treat the insomnia. This all led to cardiac arrest and rigidity. It turns out all of her symptoms were the cause of a “malignant thymoma” and medication side effects and interactions. Since I am not an oncologist or thoracic surgeon, I won’t comment on the likelihood of this scenario. However, I cannot fathom any scenario in which haloperidol would be used as a first-line treatment for depression. At no point did they mention the patient had depression with psychotic features or schizoaffective disorder, depressed type (and even then, haloperidol would be an unlikely first choice.) I believe that any neurologist who saw a patient with Parkinsonian symptoms on haloperidol would consider drug-induced Parkinsonism in the differential diagnosis. To reiterate, haloperidol is not a first-line treatment for depression and Parkinsonian symptoms are a known side effect of haloperidol.

There were other interesting and dramatic stories (carbon monoxide poisoning at the United Nations, a patient possibly injected with Ebola sent to the US as a terrorist attack, and a death, pregnancy, and cancer diagnosis!) and I still like the actors, but New Amsterdam enhanced misperceptions about psychiatry and didn’t earn an ongoing viewer in me.

Danielle J. Johnson, MD, FAPA is a board-certified psychiatrist. Her interests include women’s mental health and minority mental health. Dr. Johnson is co-author of the book “The Chronicles of Women in White Coats.” Follow @drdanij on Instagram and Twitter. She is a 2018–2019 Doximity Author.

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