“The Good Doctor” produces a low tension episode after last week’s high leaving me feeling deflated

This is a part of a weekly series where I watch a new episode of ABC’s “The Good Doctor” (as it comes out in the UK – so I’m a little behind the US sorry!) and review it for it’s realism in portraying autism and medicine. This week’s episode is titled “Believe” – Season 2, Episode 16. There will be spoilers from the very start. The cover image is not owned by me and is the property of ABC, all rights reserved.

First off, I want to apologise for this post. I am trying to get myself back into writing and so it may sound a bit naff, but the only way I can see myself getting there is by writing. Therefore, like Shaun in this episode, I’m going to be working through in order to find out what I want. Or something XD

The Good Doctor returns with “Believe” (I’ll save the Cher jokes), which shows us the aftermath of Shaun being told he could no longer be a surgeon. Overall, this goes about as expected (an acceptable trope really). Shaun goes to pathology, sees some of the benefits, but then doesn’t like the loss from it, tries to get back into surgery and ultimately gets told no (for this episode at least – I imagine that will change fairly soon). This is fair. I feel like there are a lot of benefits to pathology, but if Shaun doesn’t want to do it then he doesn’t want to do it. I don’t know how feasible it would be in a reality, but this isn’t reality. This is a story of one character in one reality. As far as autism representation, it is an acceptable story.

So let’s talk about the autism representation. Mostly the episode seemed to focus on the need for routine. This is fair under the circumstances, and I don’t know about everyone else, but when something big changes in my life I find myself falling back to relying on routine more in order to cope with the change better. So that’s pretty good representation.

Dr Han took away a lot of the redeemable factors in his argument this week. He immediately goes towards the future and says that Shaun won’t be able to work independently. This is really naff reasoning and is inappropriate. For starters, he doesn’t know what will happen in the future and if you need to develop his practical skills for working then there are medical communication support teams that can support (professional studies units, ect.). So therefore, while you don’t know if they will work, there is a chance that he can improve his skills in this environment. If his argument was about making sure Shaun was ok, or talking about patient safety today, then that would be a different matter. But it isn’t and so it’s a bit of a naff thing to work with. Also the flu reasoning is bad reasoning due to the nature that the flu would go away after a period of time whereas autism doesn’t just go away. In this way it isn’t equivalent so is a bit of a bad set of reasoning.

But Shaun is equally naff and ends up trying to go through the patient’s handbag to try and find her phone, which gives Dr Han very good support for his thoughts. Shaun is insistent on rules to the point that he is…not insistent on rules? I imagine that’s fitting for his character, but it is still a bit irritating. It’s a common theme in autism representation that bugs me, that autistic people will do crime if they are trying to follow another rule. I don’t know about everyone else, but I consider the law kinda important and try to follow it the best I can as an overarching rule set in society. Therefore, I limit my actions within that and don’t commit crimes because that would potentially hurt others and is just a bad thing to do. I imagine this is the case with a lot of autistic people. Sadly, in an aim to get more drama into a show, media representations often portray this idea that autistic people are ok with this. It’s not really ok. Just focussing on Shaun as a character, this may be an option he would take (though again, really backs up Dr Han’s point), but sadly due to other people using the trope a lot it comes across as another excuse to insert in drama. However, Shaun and the cans was a good moment. I can relate to that moment of wanting to organise the house to deal with how things aren’t working. That felt really human and so that’s really nice.

My overarching feeling is that there should be a way to enable Shaun to have some patient contact and to follow cases through while working as a pathologist. Generally, at least in this country, there is more of a movement for pathologists to be involved in outpatient clinics and other services so they can have more of a patient connection. In this way they can bring their specialist knowledge and explain that to patients. Also the involvement of pathologists in MDTs is massive and substantial. Shaun may not do surgery in this role, but he could basically be involved in every other part of the work of a surgical speciality. There should be a business case for Shaun to do that as you can argue the huge benefits to patients that this would offer (as Shaun’s skills, yet again, were extremely helpful in this case). But seeing as though medical systems aren’t always the most adaptive with roles, I can understand this not being offered.

Looking at the medical representation, it goes a bit more downhill after last episode. We have two medical cases: one of a patient with medically unexplained symptoms and the other with shrinking tumours. They are ultimately not the most memorable cases and add to my feeling of deflation after last week’s episode being really good.

For a note before we discuss the cases – pathology labs are not that small. Pathology labs, especially for a hospital that big, are huge with lots more people and machines. That lab was tiny. End of lab size rant.

The first thing I want to say is that medically unexplained symptoms should not be met with testing in order to make the patient go away. Medically unexplained symptoms is an area of a lot of discussion in medicine as there is generally a large prevalence of a condition called ‘somatisation’ across the population. To put it simply, this is when you’re mind causes you to start experiencing symptoms of some sort and this can vary in presentation by whatever you think. Theoretically, your mind is capable of a lot of different symptoms. Headaches, nausea, acid reflux, constipation, diarrhoea, chest pain, joint pains, palpitations, shortness of breath, dizziness, and so much more. I was taught at medical school that a really significant number of the patients presenting to their GP were probably presenting with this.

It should be noted that your mind producing symptoms is not abnormal and it doesn’t mean that the symptoms are being made up. The symptoms are real. It is just that the cause of them is not physical that the person needs to have support in order to find the alternative cause and work around that (ex. Stress at work, busy lifestyles, problems at home).

You shouldn’t go about testing people without a good reason. In the UK, tests cost money for the taxpayer (in the US, it’s insurance covered, so this matters a bit less). This means that if you do MRI’s on everyone then you are going to have a bad time where the NHS ends up in tons of debt…oh wait. Where the NHS ends up in even more debt? That might be the better way to put it. But also, tests have risks to them. An MRI has minimal risks, but still takes time and produces anxiety while waiting for the scan results to be obtained. Whereas, if you listen to someone carefully and explain their symptoms and the likely cause to them, then this can be reassuring and help.

Of course, in this case they had an underlying medical problem. But this is really for drama reasons. The chance of this presentation correlating with this cause in this way, without them finding out more from clinical history taking is incredibly slim.

The other reason not to go testing people who have somatisation is that you end up creating a cycle where the person feels worried, sees a doctor, has a test, feels reassured. This then repeats leading to them dealing with their anxieties about other parts of their life through using the health service and tests. Over the long term this can lead to lots more anxiety and potential iatrogenic damage from tests, which is an issue.

So based on headache, a bit of weakness (that were both explained by other problems she was having) and a sense of impending doom – no, you shouldn’t order an MRI. If the weakness was persistent, then probably you should. So likely I would recommend seeing their GP if the symptoms are persisting. But hey, that’s just a theory. A GAME THEO- no.

The other case with tumour shrinkage is more of a dialogue on religious beliefs, which has been done by a lot of shows and brings nothing unique into the picture. It just felt like filler to try and give Claire another storyline. Claire is a character that it just feels like they don’t know what to do with her. In one episode she is an absolutely lovely extremely ethical character who is very empathic. In another episode she is proving she is edgy and being extremely unethical. She is a strong person from her actions (ex. Standing up to her bosses), which is really respectable. But she currently is flipping between the different roles and doesn’t feel like she has a cohesive story line, which is sad.

The final part to mention were the doctor’s and their ways of responding to patient cues. At multiple times in the tumour shrinkage case the patient mentions a comment like that they needed the pain, or that they were scared. The doctors then respond by talking about the procedure or pain management. This is something people do, so fine, but at the same time my instinct would be to ask ‘what is leading you to feel that?’ and to try and understand why they are feeling what they are feeling.

So yeah, overall this episode left me feeling a bit deflated after last week. However, filler is important and we are approaching the end of the season, which will be good. Also I think next week’s episode is called ‘Breakdown’ and so sounds like it should be a bit more interesting. Thanks for reading through this!

Rating for medical accuracy: C

Rating for autism representation: C

References:

ABC Studios. The Good Doctor. Season 2, Episode 16 “Believe”.

Image from The Good Doctor instagram page – does not belong to me. All rights reserved.

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