Credit: abc.go.com
Have you ever questioned the medical accuracy of your favorite TV shows? As a medical professional, I often find myself analyzing the portrayal of health conditions on screen. Recently, I tuned into an episode of The Good Doctor, drawn in by the premise of a primetime hospital drama tackling endometriosis. Eager to see how mainstream media would represent this complex condition, I was unfortunately met with a depiction that strayed far from the realities of endometriosis and its surgical treatment. It became clear that the medical advisory team behind the show lacked a fundamental understanding of endometriosis.
The episode centered on a young woman experiencing pain and infertility, a common plight for those with endometriosis. Her desire to become a mother was a central theme, yet the narrative took a concerning turn when the possibility of a hysterectomy was never discussed with her before the surgery. Consent, a cornerstone of ethical medical practice, seemed to be overlooked for a significant portion of the episode’s surgical drama.
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The surgical scene unfolded with a team of surgeons surrounding the patient. While in reality, endometriosis surgeries are often performed with a smaller team, the sheer number wasn’t the biggest issue. The procedure began laparoscopically, using a multi-port umbilical system. This initial approach was accurate, and the diagnosis of endometriosis during the laparoscopy was also on point. However, what followed was an exaggerated and unrealistic 27-hour operation – a duration that stretches the bounds of medical plausibility to the extreme.
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The on-screen surgeons located endometriosis lesions on the ovaries and proceeded with a dissection of the Fallopian tubes. The extended dialogue and back-and-forth questioning amongst the surgical team seemed designed for dramatic effect, rather than reflecting the focused environment of an actual operating room. The situation escalated dramatically when the patient began hemorrhaging, leading to a laparotomy – a large abdominal incision. Twelve hours into this fictional marathon surgery, the show introduced the need for bladder removal and reconstruction using intestinal tissue. Finally, a hysterectomy was deemed necessary due to a mass compromising blood vessels. The process of obtaining consent for this major procedure then shifted to the husband and, inexplicably, to a junior resident, completely bypassing the patient’s previously stated desire for motherhood. The episode culminates with the patient waking up to the news of her hysterectomy, a scenario laden with dramatic, but medically questionable, choices.
The inaccuracies in this television portrayal are numerous. The open laparotomy depicted was unnecessary, as experienced surgeons can manage large endometriosis masses laparoscopically, including bladder involvement and repair. Furthermore, the term “invasive endometriosis” used in the show is misleading and creates unnecessary fear. Endometriosis, while it can deeply infiltrate tissues (Deep Infiltrating Endometriosis or DIE), is not cancer. Referring to it as “Deep Fibrotic Endometriosis” (DFE) would be more accurate, highlighting that the condition involves scar tissue surrounding endometriosis tissue. Laparoscopic hysterectomy for extensive endometriosis has been a standard procedure for decades, typically lasting three to eight hours, making the 27-hour timeframe presented by the show completely unfounded. It’s crucial to emphasize that hysterectomy for endometriosis should always be a carefully considered decision made by the patient, with access to specialists who can explore uterus-preserving options.
Shifting gears, I want to address feedback regarding my previous column on Irritable Bowel Syndrome (IBS). Jeffrey Roberts, founder of IBSPatient.org, raised important points in response to my opinion that IBS is sometimes used as a “wastebasket diagnosis.”
“I have seen your credentials and I know that you are a very skilled doctor in your field. When it comes to your medical opinion of Irritable Bowel Syndrome (IBS) you are very wrong. Your comments about IBS as being a wastebasket diagnosis is hurtful and harmful for the 20% of the nation that suffers from IBS. IBS is not a collection of gripes as you have described. Rather the quality of life for an individual who suffers from IBS is equivalent to someone with kidney disease, forever tied to a bathroom versus a dialysis machine. What is even more disturbing is that more women than men are diagnosed with IBS in western medicine. Given your field of work, we would have expected someone like yourself to have a little more insight about IBS. Gastroenterologists who manage IBS follow a patient’s history and symptoms using the Rome Criteria to diagnose an individual with IBS. It is not a wastebasket diagnose given that many researchers have spent most of the careers trying to unravel the cause and to find treatments for the millions of sufferers nationwide. IBS is not caused by diet and specifically by not eating well. We all wish it was as simple as that because then we would all be cured. I am personally surprised and disappointed that an expert in your field would not have first done a morsel of research before answering this question about IBS versus endometriosis. It is true that many women do seek help for symptoms which could be confusing. Some even have unnecessary surgery when IBS is really the cause. We ask that you please be a little more sympathetic and please spend some time doing some research around current papers on Irritable Bowel Syndrome.“
Sincerely,
Jeffrey Roberts, MSEd, BSc
Thank you, Jeffrey, for your thoughtful and informative response. It’s important to clarify that my column presents opinions based on my extensive experience in treating endometriosis, not definitive statements of researched fact. My clinical focus was primarily on patients with extensive endometriosis and adhesions from prior surgeries. In my practice, a thorough pelvic exam was paramount. If a patient presented with pain but exhibited no tenderness during examination, I often questioned an endometriosis diagnosis and explored other possibilities. This is not to diminish the reality of IBS, but to highlight the importance of differential diagnosis, especially when considering surgical interventions. Patients with significant adhesions from multiple prior laparotomies often presented with pain and symptoms mimicking partial bowel obstruction, which could be confused with IBS. In these cases, surgery to release adhesions often provided substantial relief.
In conclusion, while medical dramas like Doctor Who TV – and in this specific case, The Good Doctor – aim to entertain, it is crucial to recognize the potential for misinformation. The exaggerated and inaccurate portrayal of endometriosis surgery does a disservice to patients and the medical community. It is vital for viewers to understand that these shows are fictionalized and should not be taken as factual representations of medical conditions or treatments. For accurate information about endometriosis and other health concerns, consulting reliable medical resources and healthcare professionals remains essential.
Editor’s note: The opinions, beliefs, and viewpoints expressed by Dr. Harry Reich in this column are solely his own and based on his experience.
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