This week’s episode of The Good Doctor is titled “Mount Rushmore.” It delves into issues of autism, honesty, and bedside manner. And to be honest, this week Dr. Murphy’s writing unfortunately tilted him more towards being a DSM checklist than a person. I hope next week’s episode does better.
I am intentionally only referring to Dr. Murphy as Dr. Murphy in this article instead of “Sean.” Because he is a doctor. He went to medical school. He got good grades. He passed his board examinations. He is just as qualified as the other two surgical residents, if somewhat less experienced.
Watching Dr. Murphy being repeatedly abused and bullied without him even understanding that he is being abused and bullied was painful for me. Like many autistic adults, I’ve been in similar situations, and when you find out what people actually thought of you, it is soul-crushingly awful. It made the episode hard to watch.
‘I’m a surgical resident. Today is my first full day!’
We kick off with Dr. Sean Murphy (Freddie Highmore) lying on the floor of his new apartment in San Jose. Bizarrely, it is devoid of furniture. I know medical residents don’t get paid very well, but the man should at least be able to afford an IKEA dresser to put his carefully folded shirts in. Sean’s morning is dictated by a series of alarms that appear to help him transition from one task to another. There is an alarm to get up. There is an alarm to exercise. There is an alarm to take a shower. There is an alarm to brush his teeth. In some ways, I really enjoyed this scene — It’s cool to show how something as simple as a cell phone alarm can help someone live independently.
In other ways, I was a little frustrated. He didn’t use the alarms during his morning routine in last week’s episode. As a result, it felt like ticking off a box on a diagnostic checklist. “Has difficulty transitioning from one task to another.” Is he going to do the same thing next episode, or is this just a signifier of Dr. Sean Murphy’s strangeness that we will never see again? I also question the choice of music. Is inspirational, rising orchestral music really necessary for a scene where a man is just brushing his teeth?
In his building’s elevator, a man asks Dr. Murphy “where to?” Dr. Murphy responds, ” San Jose St. Bonaventure Hospital. I’m a surgical resident. Today is my first full day!” the man dryly responds, “I meant floor.” Dr. Murphy then replies, “oh, I meant ground floor. I’m taking the bus!” This moment in the elevator basically made a cartoonish exageration of Dr. Murphy’s autism the punchline. I’m a little disappointed, since the writers mostly avoided doing that during the pilot.
‘It’s called bedside manner, Claire, not outside the door manner.’
‘I’m using the word ‘fart’ in front of the patient to be more casual.’
We are treated to a montage of Dr. Murphy doing things that nobody else wants to do, while a nurse stares scornfully at him in the background. Dr. Glassman, the hospital president, finds Sean literally waiting for a patient to fart. Dr. Murphy gleefully tells Dr. Glassman that he is doing all of the scut work. He still seems to believe what he is doing is important. Instead of explaining to Dr. Murphy that he is being treated poorly, Dr. Glassman sarcastically welcomes Dr. Murphy to his surgical residency.
In another room, Dr. Browne is having a serious conversation with the woman who has the malignant tumor. She actually tells the patient that she won’t need to reschedule anything and recovery will be easy. She doesn’t answer the question about whether the woman could die during this surgery. In fact, she later goes on to tell the patient that she isn’t going to die. It is an outright lie. Of course death is a risk during a complicated cancer surgery near the heart. Ironically, Dr. Browne is the malpractice suit waiting to happen, not Dr. Murphy.
What follows is a heavy-handed conversation between Dr. Browne and Dr. Balu about lying to patients in order to make oneself feel better. The underlying message is that Dr. Murphy’s autistic over-honesty might be a good thing in comparison. We get it. The writing on this show is not subtle. The conversation ends with Dr. Balu getting salty about the fact that Dr. Browne isn’t interested in a romantic relationship with him. At this point in the program, I may or may not have screamed, “dude, she owes you NOTHING,” at the screen.
Dr. Andrews, the mean board member we’re all supposed to not like, tells Dr. Melendez that Dr. Murphy ordered an MRI on a healthy patient. Dr. Melendez then responds essentially by making his nurse into his baby sitter. I think if it was possible for me to hate this character more, he would instantly, spontaneously combust on the screen.
Dr. Murphy checks on a little girl, and believes she may have a serious issue requiring surgery. Nobody believes him. The other doctors dismiss her pain as stress, since her parents are fighting.
‘This year, we’re not going to Mt. Rushmore.’
Dr. Glassman confronts Dr. Melendez about excluding Dr. Murphy from doing anything useful or educational. Dr. Melendez explicitly tells Dr. Glassman that he is teaching Dr. Murphy that he doesn’t belong at the hospital. Dr. Glassman decides he is going to “pull rank.” It isn’t clear what that means.
Dr. Murphy has a conversation with Dr. Browne about sarcasm. Specifically, isn’t it just like lying? This would be excellent and realistic dialogue if Dr. Murphy was a child instead of an adult man with a medical degree. How has he never had a conversation about the purpose of sarcasm before in his entire life?
We flash back to when Sean was actually a child. His brother is lying about an imaginary classmate who is dealing with imaginary cancer in order to get a stranger to give them money for an imaginary party. They need the money to survive since they have run away from home and are living in a bus. Sean’s brother seems to be the only person who has ever been straightforward with him about anything, which is bizarre. “Is any of that true?” Sean ask after his brother lies. “Yeah, we’re not going to Mt. Rushmore.”
In the present, Dr. Browne tells Dr. Murphy that the point of being a surgeon isn’t to save people’s lives. It’s to do whatever Dr. Melendez tells them to do. She also tells him not to talk to the hospital president about how he is being treated, since he is not realizing that he is being mistreated.
In a flashback, Sean tries to learn how to lie from his brother. He does it poorly. In the present, he once again lies poorly to a patient who asks if he’s going to be OK. Since Sean isn’t 100% sure, he doesn’t sound 100% sure. This frightens the patient, who goes on to complain to the president of the hospital. It is unclear why “scut work” seems to mean “things emergency room doctors usually do.” None of these patients seem to have complaints remotely related to anything surgical.
‘It’s past midnight which means it’s tomorrow which means you’re no longer my boss.’
In surgery, it turns out the tumor is more complicated and larger than originally thought. Dr. Melendez calls Sean to surgery, only to send him on yet another pointless errand, because of course he did. Sean goes on the errand and does his best to complete it — He tries to get the test results rushed for the woman who is being operated on. The woman at the lab tells him that all of the tests are important. Sean offers to give an honest assessment of which tests are most to least him important. Unsurprisingly, his suggestion is not well received.
In flashback, a man calls Sean a moron. Sean’s brother throws a rock through the man’s window and they run away.
In the present, Sean threatens to throw a rock through the lab window if they don’t do Dr. Melendez’s test right away. For some reason, this isn’t perceived as a violent threat by the lab staff and they don what he asks. The entire interaction makes no sense.
Dr. Melendez clutches his pearls when his wife points out that he is being prejudiced against Dr. Murphy. “I don’t have a problem with an autistic doctor,” he insists, despite every single thing he’s done this episode indicating the opposite of that. I’m not sure if he’s lying or if he is just a master at cognitive dissonance.
Outside the OR, Dr. Murphy comes up with a novel way to conduct the surgery and possibly save the woman’s life. Dr. Balu steals the idea, passes it off as his own, and takes all of the credit. Dr. Browne says nothing and lets him. Dr. Balu rightly points out that it’s because she didn’t want to stick her neck out. They’re both awful people, although I appreciate that they are written as people. I wish Dr. Murphy got to be a person, too.
Sean decides to run tests on the little girl he sent home. It turns out she does have a serious health issue. He goes to her house at 1 AM and knocks incessantly until her parents let him into the house. For some reason, they don’t call the police. If Sean was black, this entire scene would have gone way differently. Dr. Murphy then delivers my least favorite line of the entire episode. Yes, that includes the boner and fart jokes. “You’re right, I’m weird. Part of my weirdness is that I perseverate. That means I keep thinking about things. That means I will keep knocking on your door until I know [the sick little girl] is OK.” Thanks for the DSM definition. I can honestly say I have never told anyone other than my psychiatrist I’m “perseverating.” The girl is very sick. Sean’s theory is vindicated and they rush to the hospital.
He schedules a surgery, despite being told he is not allowed by his nurse/babysitter. Even though he is a medical doctor. Sean gets around her in a way that admittedly had me snorting my drink out of my nose. Since Dr. Melendez specified “today” when he gave the instructions to the nurse, Dr. Murphy retorts, “it’s past midnight which means it’s tomorrow which means you’re no longer my boss.” He schedules the surgery. As soon as he’s about to perform the surgery, Dr. Melendez arrives and makes sure Sean doesn’t get any practice, learning, or knowledge.
Dr. Andrews, the mean board member we’re not supposed to like, intervenes and orders Dr. Melendez to like Dr. Murphy stay. In the bathroom, Dr. Glassman confronts Dr. Andrews about helping Sean. Sean points out, “if [Sean] succeeds, I’m the guy that just backed him. If he fails, I’m the president.” Touche.
Dr. Balu tells Dr. Browne that he will confess the surgery on the woman with the tumor was Dr. Murphy’s idea and that he will apologize to the whole team, if Dr. Browne admits she would have sent the woman home to die. She doesn’t because she doesn’t want to upset the woman. She wants to stay comfortable.
What worked
- Actress Eve Gordon had some good lines and an even better deadpan. Unfortunately, this appears to be her only episode.
- Dr. Balu and Dr. Browne seem like they just stepped off the set of House as his new team. I liked House. I dislike Dr. Balu and Dr. Browne, but it’s because they have well written flaws. I look forward to seeing them develop.
- “Why does it matter who gets the credit?” “It matters because the person who gets the credit doesn’t have to do scut work.” Dr. Glassman gives Sean useful advice.
What didn’t
- Based on the behavior of basically all of Dr. Murphy’s colleagues, I can only assume that the show is set in some alternate dimension where the Americans with Disabilities Act doesn’t exist.
- ls waiting for someone to fart actually something a doctor or any other health professional would do after facial surgery? Really?
- There is no adult human with a medical degree as naive as Dr. Sean Murphy. It’s ridiculously bad writing. Sean Murphy is not written like an autistic man, he’s written two autistic children standing on each other’s shoulders.
- This episode, everything Sean did was because of his autism. It was infuriating. I hope next week’s episode is better.
- Sheldon-esque door knocking is annoying enough when Sheldon does it. I guess “autistic people who knock on doors weirdly” is a trope now.
Neurotypical Bullshit (NTBS)-O-Meter
- Basically everything Dr. Melendez did this episode.
- Basically everything Dr. Browne did this episode.
- Basically everything Dr. Balu did this episode — You may be sensing a pattern.
- Autistic adults are not children. Autistic adults are not children. A grown ass man with a medical degree is not a child. Stop writing him like one.
So what did you think? Good, bad, or just indifferent? Weigh in on the comments below.
I wish the show were a quarter as entertaining as this review. You nailed everything that was wrong, and I laughed reading it. I’m looking forward to your next review.
My only thought is on the “perseveration” line. That word wasn’t in my lexicon before diagnosis and it’s one that explained so much about my life. Prior to my diagnosis, I actually had a specific instance where it interfered with my ability to do my job. It still feels ridiculous to me but they added an instant messaging application for people to use in addition to email (which is my primary communication tool). I found questions popping up from sometimes random people in our very large organization incredibly disruptive. People would say just ignore it if it’s not somebody you need to respond to, but I couldn’t. I set it to show I was away, but even if I didn’t respond, I would keep looking at and thinking about the message. I would look up the person’s directory information to see where in the organization they worked. Even when I closed it, it would take me a long time to recover my thought process. And it kept getting worse, to the point that I could hardly think about anything other than whether and when another unsolicited question would pop up and getting very little else done except outside normal working hours when nobody would contact me anyway. I recognize now I was perseverating in an unhelpful way, but had no word at the time. I overcame my feeling that it was ridiculous and negotiated with my manager to turn off the application and only start it if I specifically needed to join a conversation, share a screen, or something similar. That restored equilibrium and worked for everyone. It matters enough to me that I’ve included it in a formal reasonable accommodation request along with the other major things I’ve informally negotiated over the past decades so I don’t have to go through the process yet again the next time my manager changes. I didn’t use perseveration in the formal request, but am prepared to do so (and get documentation from my therapist) if I need to. So while I probably wouldn’t use it the way Dr. Shaun Murphy did or in a similar context or setting, I kinda appreciated hearing it.
But yeah, this episode was a mess. The pilot and the third episode were both much better.
I left a similar comment over at the Crippled Scholar review so apologies if you see this more than once
I’m an autistic doctor
I am dividing my criticism of The Good Doctor into two categories, roughly “autism doesn’t work that way!” and “medicine and residency don’t work that way!”
The glaring problem with this episode (and the pilot) is that Medicine and Residency don’t work that way. And then they are blaming “autism” for all the problems caused by the inaccuracies.
Scut work is real work that has to be done, that few people like doing, and yes it typically “rolls down hill” to the more junior members of the team, medical students and interns. This is things like checking labs, nagging the pathologist and completing discharges. It’s not busywork that is made up.
However, when discharging surgical patients, they are first seen in the morning by a member of the team, then presented to the team as a whole on rounds, and the senior people on the team decide who is ready for discharge. The junior person might have to hand over paperwork and explain medication or other care instructions, but the whole idea of an exit exam done this way doesn’t exist at any hospital I’ve ever encountered. So they made this thing up, and then use it to blame autism when it goes badly.
Another major thing that Doesn’t Work That Way is the board involvement on specific residency hiring decisions. There are residency committees with multiple faculty members, and interview processes, and all sorts of procedures. The Board typically is not part of this process at all. They don’t meet to determine treatment decisions, either. It would be realistic for a residency review committee to meet and discuss concerns about a disabled applicant or current resident’s abilities. Perhaps illegal, but realistic. I was asked about my mobility device on residency interviews, illegally. A discussion about actual ability to perform actual essential job functions would be legal. But it would be the actual senior surgeons involved in the training program, not the board.
This is the editor/mod. I just want to thank your writing such an interesting and insightful comment.