This blog was actually such a perfect assignment. I have been getting into the Good Doctor lately, a tv drama that follows a young doctor with autism named Sean. Sean is incredibly brilliant, virtually unbiased and incredibly resilient. However, he struggles with social awkwardness, sensory overload problems, and difficulty with communication.
I decided to pick a specific scene in the second episode. Sean walks in while the team is assessing a scan of the patient’s thoracic cavity. The team starts making guesses about possible diagnosis based on looking at the scan. Already, this is kind of unrealistic. I don’t think a doctor would start guessing diseases in the presence of a patient. I guess on one hand, it is good for the patient to be informed on the doctor’s thinking. We talk about how providing inform
ation can be an important part of therapeutic communication. However, we should only be providing relevant information; glancing at a scan and starting to guess diagnosis’ in front of the patient does not help the patient. Instead it can cause fear, anxiety, and even confusion. After thinking for a second, Sean decides (just based on the scan) that the patient has malignant lymphoma. Scared, the patient asks “that’s cancer- does that mean it’s killing me”. Sean immediately chirps back “yes”, leaving all the team and the patient in shock, and one of the other residents then tried to comf
ort the patient and reassure her she was not dying.
Several communication issues are at hand here as well. First of all, Sean does not practice empathy with the patient. Sean is also not practicing active listening. His autism prevents him from being able to read the non-verbal cues of the patient and talk to her in a way that is therapeutic and in the best interest of the patient. At the same time, falsely reassuring the patient she was okay was not exactly helpful either. Ideal therapeutic communication would have been perhaps to speculate cancer and explain that to her, wait for test result, and finally give the diagnosis sis to the patient while explaining all her options and listening to her feelings about the situation.
Despite these communication barriers Sean has, Sean’s unique communication offers him some advantages over other doctors. Sean does not give false reassurance. He does not lie to patients. He does not harbor secrets. Sean does not argue, get defensive, or cross patient relationship boundaries.