In an early episode of NBC’s medical drama New Amsterdam, viewers see a 10-year-old boy named Leo sitting on a hospital floor, listless and unspeaking. “He used to be energetic. Silly,” his mother laments. She explains to a doctor that for several years, Leo has been taking a powerful cocktail of antipsychotic medications following a series of violent outbursts at school. “Who needs breakfast, am I right? Fistful of pills like that every morning,” the child psychiatrist Dr. Iggy Frome (played by Tyler Labine) quips as he reviews Leo’s list of prescriptions.
Within minutes of meeting Leo, Frome decides to take him off his meds, later exposing the boy to the absurdly risky process of “rapid-detox dialysis” to remove the medications from his system as quickly as possible. This detox, viewers are told, is intended to allow a trial course of behavioral therapy. But by the end of the episode, therapy is largely unnecessary. Freed from his psychotropic prison, Leo is restored to his old self: He smiles, hugs his mother, and articulates the guilt he’s been feeling over his father’s death. It’s a story line that caters to nebulous fears and conspiracy theories about health care and pharmaceuticals. It’s also one of many times on New Amsterdam when complex medical problems evaporate as soon as anyone cares enough to address them.
Medicine is approaching a moment of reckoning in the United States. Costs are skyrocketing, physician burnout is rampant, and the health-care system is plagued by inadequate staffing, rushed appointments, and byzantine insurance rules as the population continues to grow sicker. Addressing these challenges is the raison d’être of Dr. Max Goodwin (Ryan Eggold), the new medical director of America’s oldest public hospital in New Amsterdam, which aired its fall finale Tuesday. The current state of medicine is a topic ripe for incisive critique and could offer fodder for meaningful TV drama. Unfortunately, the NBC series grossly oversimplifies the issues it portrays and leans into hero worship, which may lead viewers to troubling—even dangerous—conclusions about health care.
Since debuting in September, the show has followed Goodwin as he tries to overhaul New Amsterdam Hospital, a fictional behemoth based on the real-life Bellevue Hospital in New York, where I’m a resident physician. (The series was inspired by the 2012 memoir Twelve Patients: Life and Death at Bellevue Hospital.) Goodwin’s character is a familiar archetype: a maverick Man of Principle who jogs to work every morning, delivers self-righteous diatribes, and shows cynical onlookers the error of their ways.
Soon after taking charge, Goodwin fires every cardiac surgeon (for placing “billing over care”), eliminates “untrained residents” from the hospital workforce, and does away with the emergency-department waiting room. In a recent episode, he encourages physicians to defraud the hospital through downcoding—providing expensive and time-consuming care to patients, then lying about it in the medical record. In doing all this, Goodwin claims to be putting patients first, defying the nebulous higher-ups of the hospital who, despite having only recently hired him, now seem bent on thwarting his efforts. That Goodwin also has cancer, which is revealed in the first episode, only adds to his zeal. “Let’s get into some trouble. Let’s be doctors again,” Goodwin tells the hospital staff his first day on the job, implying that health-care providers today are, somehow, something else.
New Amsterdam, which was the first new show of the fall to receive a full-season order, has proved popular with audiences, despite widespread critical consensus that it is simplistic and patronizing. I took a personal interest in the series ever since its television crew first appeared in the Bellevue lobby a few months ago. At the time, it was easy for me to separate the telegenic TV doctors from the overworked, under-hydrated real ones, and the disparity between onscreen and real-life medicine is equally vast. But while accuracy has never been a requisite of prime-time programming, skewed medical dramas such as New Amsterdam can have a more insidious effect, poisoning how the public views the health-care system and physicians.
Television doctors can hold powerful sway over how people perceive medicine. Research has found that programs depicting physicians in an unflattering light correlate with negative and distrustful feelings toward doctors in the real world. Meanwhile, frequent viewers of courageous doctors on shows such as Grey’s Anatomy tend to have positive beliefs about physicians, as well as higher satisfaction with their own medical care.
This is worrying because over the past 50 years, TV doctors have devolved from caring, honest, and authoritative figures—as in the 1954 drama Medic, for example—into the arrogant and unethical characters we often see today. The hit series E.R. was among the first to depict hospitals as cold, inhumane environments staffed with callous and overworked (yet sympathetic) physicians, paving the way for the eponymous Dr. Gregory House, a pompous, rude, and drug-addicted (yet brilliant) diagnostician. Recently, Fox’s The Resident has taken the notion of bad doctors to the extreme, portraying physicians who routinely kill patients through medical error and then cover up the deaths as accidents, all while belittling and abusing their patients and one another. Against this backdrop, distrust in physicians is rising, with only 34 percent of Americans now expressing confidence in medical leaders, down from 73 percent in 1966. Crucially, this decline has occurred despite the fact that most people still trust and admire their own physicians; it’s the medical profession at large that many see as more suspect.
New Amsterdam is a throwback to the old-school, superhuman TV doctor, with a notable twist. While Goodwin and his apostles are unflinchingly noble, they’re also clearly intended to be exceptions to the rule. Other doctors, the audience is told, are the problem: They are “corrupt and lazy,” performing unnecessary procedures to inflate billing and prioritizing golf over patient care. Even the lone surgeon who escapes the chopping block scoffs at Goodwin, saying, “You do know the whole system is rigged, don’t you? I mean, they’re not going to let you come in here and just … help people.” In another episode, Goodwin meets a homeless woman who is “skeptical” of doctors. “So am I,” he tells a colleague.
Working with patients, I’ve come face-to-face with the end result of this distrust, which often manifests as a deep reluctance to accept evidence-based treatments such as vaccines, antibiotics, and needed medications and procedures. Frequently, patients and their families mention seeing something on TV, online, or in the news that scared them, though they often can’t express more than a dark, nagging suspicion that something nefarious is lurking behind the scenes. Once, a woman told me that The Resident had lifted the veil for her on how medicine really works. Other patients, perhaps bolstered by fictional story lines like Leo’s, have told me that they believe doctors will only make them sicker. It can sometimes be impossible to assuage my patients’ fears, to the real detriment of their health.
There are, unfortunately, doctors who game the system, and who care more about money than about helping people, though they are outliers. There are also patients who are rightfully frustrated and angry due to negative or harmful encounters with these doctors. But in New Amsterdam, valid critiques of the incentives that allow bad actors to enter (and flourish in) medicine are supplanted by vague fearmongering and outlandish claims; scapegoating all doctors means overlooking the real, serious flaws in the health-care system.
If New Amsterdam has erred in identifying depraved doctors as the single biggest problem with American health care, the solutions the show proposes are equally disturbing. Never mind that banning residents from patient care, as Goodwin suggests, would dismantle the pipeline for training new doctors, exacerbating the impending physician shortage. Or that removing the emergency-department waiting room would mean filling beds on a first-come, first-served basis rather than by medical need. Or that hiring 50 new attendings and an unspecified number of nurses, as Goodwin does in the first few episodes, would strain any hospital’s budget. In the only episode thus far to directly address the hospital’s finances, Goodwin offers a rare glimpse into his ostrichlike mindset, declaring, “The fiscal thing is really not my strong suit. I prefer to talk about the patients.” The absurdity of this statement, coming from the director of a hospital, confirms that Goodwin lives in a world without consequence. There are no trade-offs in this medical fantasy.
At the forefront of the show is Goodwin’s haphazard, manic leadership style, apparently inspired by Jim Carrey’s character from Yes Man. Goodwin’s colleagues repeatedly note that the medical director previously ran, and turned around, a failing clinic in Chinatown. Yet viewers are left with no sense of how he accomplished that—unless it was by uncritically accepting every offhand suggestion from the people around him. Attention spans, like cardiac surgeons, seem to have no place at New Amsterdam. Whims become policy, facing only token, if any, objections from the quietly skeptical administrator who tails Goodwin through the hospital, the business-minded dean of medicine, or the comically mute board of directors. The audience is meant to admire Goodwin’s fast-moving, shoot-from-the-hip reforms (he’s the anti-bureaucrat!), but the reality is that in medicine, pure intuition has fallen out of favor. With evidence-based medicine still in its relative infancy, many doctors are only now coming to terms with how frequently our gut instincts can be wrong.
Part of the problem with New Amsterdam is format. If the medium is the message, prime-time procedural dramas venerate the quick fix at the expense of substance. They rely, by necessity, on simplified, stylized versions of difficult medical problems. Surgical and medical “cures” abound. Ideas invariably work—if not on the first try, then certainly on the second or third. Story lines wrap up neatly by the end of each episode. Relative to real-world medicine, which is often messy and uncertain, TV medicine can be intensely satisfying and comforting to watch, tapping into an ever-growing societal obsession with instant gratification. The danger is that an inability to delay gratification, and to weigh nuance, is what brought about much of the dysfunction in the health-care system in the first place. Good medicine, and effective reform, takes patience.
Max Goodwin’s obvious redeeming feature is that he does seem to genuinely care about his patients. The fatal error of the show is assuming that other doctors don’t. Without Goodwin, physicians in the New Amsterdam universe are apathetic and inert, waiting to be inspired into action. At the real Bellevue, I have yet to meet a doctor who doesn’t care deeply about their patients’ well-being. Medicine is also teeming with people who are passionately working to reform health care through advocacy and research. If good intentions alone were enough to improve American health care, the problems facing Bellevue—and so many other hospitals—would have been solved long ago. Addressing medicine’s many ills requires acknowledging their complexity; New Amsterdam does the opposite, leaving only frustration and fear in its wake. For a show about healing the system, it may do real harm.