Royal Pains

My wife and I were looking for a new television show to watch the other night, and we found a show called Royal Pains on Netflix.  Apparently the show first aired on USA Network from 2009 to 2016.  It was billed as a comedy-drama about a physician who unexpectedly finds himself providing concierge medicine to the uber rich in the Hamptons.  The preview looked good, and the fact that the original television show ran for 8 seasons suggested to us that it might be good.  It was not.

Perhaps I'm being overly critical, but the way that medicine was portrayed was just blatantly false.  First, the main character, Dr. Henry "Hank" Lawson (played by the actor, Mark Feuerstein) is an emergency medicine physician.  That's perfectly fine, but apparently he is an emergency medicine physician that does everything, including practicing cardiology, surgery, anesthesiology, emergency medicine, and primary care medicine.  Emergency medicine physicians can do a lot of things, but they can't (and don't) provide comprehensive medical care for every disease, every age, or every situation.  

Second, the opening scene shows Dr. Lawson playing basketball on an outdoor basketball court, somewhere in New York City (presumably Brooklyn, based upon the scenery in the background).  One of the players that he was guarding (not very well) suddenly collapses on the court and becomes unconscious.  Dr. Lawson quickly goes into "doctor mode" and starts to assess his new patient, noting that the patient isn't breathing and doesn't have a pulse.  Rather than performing CPR, Dr. Lawson places bags of ice around the victim's head and body.  At some point, the victim magically starts to breathe again.  In my opinion, it's completely irresponsible for television shows to depict CPR (or the unlikely outcomes from that CPR) that is blatantly wrong.  Unfortunately, it's an all too common problem.  Dr. Lawson is told that an ambulance is at least ten minutes away (also not realistic), so he asks the rest of the players if anyone has a SUV (most of them raise their hand).  He loads the victim (after immobilizing his head, neck, and spine with wadded up gym clothes) in the back of the SUV and drives him to the hospital, which just happens to be the hospital where he works.  

Third, Dr. Lawson, who is supposedly on his day off, continues to provide care for the young basketball player, but of course he is suddenly called away to care for an elderly man with a suspected heart attack.  Apparently Dr. Lawson is the only physician that can provide emergency cardiac care at that particular hospital!  As luck would have it, the elderly man just happens to be the hospital's primary benefactor who donated all of the money that was needed to build the hospital (his large picture is shown hanging on a wall in the hospital lobby).  Of course, the hospital administrator has come down to the emergency department and is telling Dr. Lawson to ignore caring for the young patient and focus all of his attention and efforts on the patient who is the donor.  Dr. Lawson at first tries to provide care for both patients (on a side note, neither patient has been tracheally intubated at this point, despite the fact that both are in the operating room, presumably in critical condition), but sadly, the patient who donated all the money to the hospital dies.  The young patient from the basketball game lives.  Dr. Lawson leaves the hospital, believing that he had at least done well in saving the young man's life, and meets his fiancée at a local restaurant.

Later that day, Dr. Lawson is called before the hospital Board of Directors and learns that his license has been suspended and that he has been fired from his job at the hospital.  I won't delve into how physician peer review is supposed to work in real life, but suffice it to say that a hospital Board of Directors (1) can't take away a physician's license to practice medicine (only the state's medical licensing agency can take away a physician's license and only after due process), (2) would never conduct a peer review (they are not "peers"), and (3) would never fire a physician (the hospital's administrator could do so, but it wouldn't happen just because the physician lost a patient).

There's plenty of false information out there in the real world.  We don't need more false information created by the media.  I understand that television shows may not be 100% accurate, but the depiction of medical practice in this particular show (at least the first episode) was not even close to being accurate.  In addition, the lack of alignment between physicians on a hospital's medical staff and hospital administrators is well known.  However, I've never experienced anything remotely close to what was shown in this particular episode of this television show, either as a physician or as an administrator.  I will discuss this lack of alignment in my next post.  Just to close the loop, we turned the show off and won't be watching any new episodes.