For today’s blog post, I decided to watch an episode of the long running television series, Grey’s Anatomy. The show follows the surgical attendings, residents, and interns at Seattle Grace Hospital. I would describe Grey’s Anatomy as a relationship drama show first and medical show second. If anything, the hospital merely serves as a setting to incite the drama. Therefore, the communication between patients and medical staff is far from therapeutic most of the time. The episode I will be analyzing specifically is episode six from season one – If Tomorrow Never Comes. The primary patient we are introduced to is Annie, who was admitted to the hospital because of an excessively large abdominal tumor. The tumor was growing for over a year, but she refused to seek medical treatment, because she was afraid of dying.
The first intern to take her case is Dr. Alex Karev. He starts his communication very therapeutically by greeting Annie by her first name, smiling, maintaining eye contact, and keeping an open stance when he talks to her. His body language and tone are very friendly and probably quite comforting to the patient. Dr. Karev does bedside reporting to his attending, keeping the patient involved in her care, but the use of too much medical jargon seems like it would affect the patient’s understanding of her care. Dr. Karev takes Annie to her MRI, and before she goes in, he explains the procedure to her, reassures her that he will be there the whole time, and gives a therapeutic touch to her hands to calm her nerves. However, Dr. Karev ends his therapeutic communication shortly after. He talks to the MRI technician about how Annie is “sick” and “warped” saying he doesn’t “know how she lives with herself” (Rhimes et al, 2005). His judgement is overheard by Annie, and she later indicates that she doesn’t think she wants the surgery because she would rather die. Dr. Karev’s lack of empathy eventually lead to a non-therapeutic relationship, causing his patient to doubt going through with the surgery. Strike one.
Another intern, Christina Yang is assigned to the case, and she interviews the mother about the health history of Annie. The mother stated that she finally decided to call 911 when her daughter was having trouble breathing, because it “felt like the right thing” (Rhimes et al, 2005). Dr. Yang proceeded to say, “the right thing would have been to call a year ago” and then shakes her head and walks away (Rhimes et al, 2005). There is no room for Dr. Yang’s judgement in this situation and saying what the mother or patient should have done is not helpful when there is nothing to be done about it now. It only serves to make the patient and family feel guilty or bad, rather than comforted. Dr. Yang even goes on to tell her coworkers “it’s like she fatally lazy” (Rhimes et al, 2005). Her attitude fails to be empathetic to the patient’s condition, and spreading her judgement only serves to solidify her opinions and alienate the patient, which could fatally impact her care. Strike two.
The last intern to work on Annie’s case is George O’Malley. It seems like he has the most hope at a therapeutic interaction with the patient. He reassures her that Dr. Burke and Dr. Bailey, her lead surgeons, are great. He also validates and voices her concerns by saying “I know you’re probably scared. (Rhimes et al, 2005)” This opens up the lines of communication, and she begins to communicate how she has been feeling about everyone referring to her and thinking about her as “the fat, nasty tumor lady” (Rhimes et al, 2005). This is where Dr. O’Malley begins to stop his therapeutic communication. He asks her “why did you let it get this bad?” (Rhimes et al, 2005). Asking “why” questions comes across as very accusatory. In the show, the question was actually well received, and it opened up some of the patient’s underlying concerns and fears about hospitals and surgery. However, it would have been better to rephrase the question to sound less accusatory. The patient shares how she just kept putting it off and the longer she waited, the more afraid she was. Dr. O’Malley reassures her that she is not alone in this experience by stating “you’re not the only one to put things off” (Rhimes et al, 2005). This can help the patient to feel less alienated. However, Dr. O’Malley takes this opportunity to self-disclose, and while mild self-disclosure might have been helpful, he overshares. He talks about his unrequited feelings toward his coworker, which is a non-therapeutic boundary crossing. He loses sight of who is in need of the support, and this shifts the problems toward himself rather than the patient. This causes patients and providers to lose sight of their role in the situation, and it can be harmful to the patient’s well-being. And that’s strike three.
Unfortunately, it’s strike three and we’re out, and so is the patient. She ends up dying during surgery, and the doctor’s judgments throughout the episode were no help to her therapeutically. If anything, it seems like they destroyed her will to live, and her final day of life was spent feeling bad about herself. Not only was the lack of therapeutic communication harmful in the patient’s condition, but it also affected the doctors who were left feeling guilty about what they did and said now that she had died. There were definitely positive moments of therapeutic communication, but I would say the bad outweighed the good. Even though this television series is fictional drama about the lives of surgeons, the lessons on therapeutic communication can be applied to us – real life nursing students. I think it was important to see these non-therapeutic interactions occurring, because it reminds us to be mindful of what we think is acceptable.
Rhimes, S. & Vernoff, K. (Writers), & Brazil, S. (Director). (2005). If Tomorrow Never Come [Television series episode]. In S. Rhimes’, Grey’s Anatomy. Los Angeles, CA: American Broadcasting Channel.