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flux
Remember when Bailey tried to resuscitate Jeremiah, the Cystic Fibrosis patient even though he was DNR? And the time when the organ donation team tried to obtain organs from a patient that is not brain dead? Here's a thread for all you ethical people to talk about what is right and what is wrong.
Triteia
This seems like the thread for the medical sins of Grey's Anatomy.
lamadeleine
Okay, perhaps someone who follows this thread can discuss the ethics of allowing drunk interns/residents/whatever they are to stay at work and hang out in the trauma room while they sober up. I'm not in the medical field, but that seemed so not right that it totally distracted me from the episode. I know they gave some lame explanation for why Meh wasn't being sent home- "oh, you can give yourself a 'banana bag' until you're sober enough to work". Would a hospital really do that?? Wouldn't they be ethically bound to send that person home, or at least send them somewhere out of the way to sober up?
sarah1225
I'll admit before I say anything that I know zero about practicing medicine. But..this thread is what bugs me most about the show. The medical stories are good but the ethics kinda piss me off. Last year when Cristina and Izzy gave that guy an autopsy and Bailey caught them? Wouldn't that kick them out of the program? I'd think that and sleeping with an attending is more likely to get Cristina kicked out than not being able to find a leg.

Also, last week when the girl had to find her soul with the ceremony? There were flames. Are flames allowed in hospitals if porn isnt?
netful
Twice now we've seen doctors involved in talking to patient's families about organ donation. Don't they have people specially trained to do that?

The whole amputated leg thing with Christina really bothered me too. Would an intern really go searching for the missing limb. Aren't there people for that as well? Actually, that whole storyline bothered me. Christina paging a surgeon to help her look for the leg? C'mon, boyfriend or not, she would know better than to page a surgeon, especially in the middle of the crisis going on around them. Wouldn't she? I don't buy that as part of her neurotic worrying that she was done as an intern if she didn't find the leg. I'm getting into nitpicks now, so I'll shut up. :)
beastie
This might be the place to link some blog posts by Moreena, whose five-year-old daughter has had two liver transplants. Moreena is annoyed by GA's protrayal of organ donation. She thinks that it spreads misinformation, and that in turn might make people reluctant to donate organs.
Babsonite

Okay, perhaps someone who follows this thread can discuss the ethics of allowing drunk interns/residents/whatever they are to stay at work and hang out in the trauma room while they sober up. . Would a hospital really do that?? Wouldn't they be ethically bound to send that person home, or at least send them somewhere out of the way to sober up? [/quote]
I thought it was understandable given the situation, and they needed all the help they could get.
lamadeleine

I thought it was understandable given the situation, and they needed all the help they could get.
[/quote]

Yeah, I guess I just don't buy it. I would have cut that little plot point some slack if I felt like there had been a great payoff for it. But, having Meh sobering up at work really didn't add anything to the story or to her character except more disbelief and more dislikability.
I think I may just be secretly terrified that I may have to go to the hospital someday and find out that some boozo the clown was my doctor....yikes!
PenguinJen

Remember when Bailey tried to resuscitate Jeremiah, the Cystic Fibrosis patient even though he was DNR?[/quote]

They never specifically mentioned it in that episode, but most hospitals (all of the ones that I've worked at) have a policy that makes DNR orders invalid during surgery. That would have applied to the DNR CF guy, so not particularly unethical. It would be somewhat lengthy to discuss all of the reasons why, but it's mostly because during surgery so many events can take place that are more easily correctable than on the floor.

I thought what was way more disturbing was having George run that forever non-ending code on that guy who was clearly dead. You're supposed to stop when you know there's no hope for survival, not proceed to mutilate bodies for education purposes.
jandj
This is not specifically an ethical issue but I have a really hard time with how insensitive and unprofessional these doctors are around their patients. Izzie with the incessant judging. The way they gawked at the "pregant guy". The smirking, joking, and open disgust at the broken penis. Cristina telling the quints' mom that her baby's organs were outside her body but they could shove 'em back and it would all be good.

What the hell? I know they're just interns but it's not like you don't get extensive exposure to patients in medical school.

I know that there are many many things that are just flat out wrong about how they portray medicine but this one just grabs my attention all the time. Don't they pay consultants for this kind of thing?
mellybean
I was also deeply disturbed by the scenario with George and the patient who had died but was still being worked on. If that were my loved one I didn't think I'd want anyone to be cutting into them unnecessarily. But then at the same time, if they're already dead... there's no pain, no suffering, that persons not really there. I guess what I'm saying is that it isn't really hurting anyone. It's a controversial issue and I do see both sides. But George had to learn somehow. And I think at some point someone told George that most of the patients he was going to be seeing that day wouldn't have much hope anyhow.

I do also have to say that while I was initially deeply disturbed by that scene, I was also moved by the scene where George is talking to someone (I want to say it was Olivia for some reason, I really don't remember) and says that he figured out why they do the work if the person is dead and then says that it's because that way they can tell the family they did EVERYTHING they could. And that's what I would want to hear!

In regards to the interns being insensitive, they are! A lot of the time! At the risk of sounding insensitive myself, that's one of those things my husband and I would chalk up to the fact that it is just TV after all! That's how we keep ourselves from thinking too much about those sorts of things!
Excuses
Regarding Izzie and judging.
When is it right for a doctor to say - "Whoa there, slow down a bit. That's a big step."? When should a doctor educate the patient about ethical choices - or even just caring for someone's psychological well-being?

After reading the re-cap I am reminded that Izzie got snarky basically as an introduction to Dory, but with Savvy - Izzie was right on target - it sure didn't feel like Addison was going to go deeper until right before the surgery.

With Dory, Izzie would have been okay if it had been a lot earlier in the pregnancy or pre-conception. I agree that here she just let herself be completely judgemental. At the same time, I wonder if any other doctor talked Dory through the possibilities of having the 5 girls and what it could mean regarding their health.

In some ways this just adds to the entire consumeristic nature of our society. (I say as I just got back from spending loads of $$ on myself and presents). And also the idea that if you're broke the doctor can fix you - no matter what.

When is it the doctor's job to say - "Ma'am, don't fix what ain't broke" and when does the doctor just go along with what the patient wants done?
beastie

After reading the re-cap I am reminded that Izzie got snarky basically as an introduction to Dory, but with Savvy - Izzie was right on target - it sure didn't feel like Addison was going to go deeper until right before the surgery.[/quote]

It seems to me that Addison was more qualified, in every possible respect, than Izzie to make that call. Addison is a much more experienced doctor who has dealt with many, many more patients than Izzie has. Addison knows Savvy well enough to know whether she generally makes impulsive decisions that she regrets.


At the same time, I wonder if any other doctor talked Dory through the possibilities of having the 5 girls and what it could mean regarding their health.[/quote]

I am positive that, had this been real life, someone would have discussed this with Dory and her husband. I don't think they just stick a bunch of embryos in you without talking about the possible outcomes. And had this been real life, the person who had that discussion with Dory would have been more qualified than Izzie and would have done it in a more appropriate time, in a more appropriate setting, and in a more appropriate manner.


In some ways this just adds to the entire consumeristic nature of our society. (I say as I just got back from spending loads of $$ on myself and presents). And also the idea that if you're broke the doctor can fix you - no matter what.[/quote]

I don't think it's about consumerism, or not just about consumerism. It works the other way around, too: I've had a doctor judge me because I didn't want the aggressive, invasive treatment that he thought I should have.
Rudywill
Since this seems like the thread for it, it has been bugging me that Nurse Olivia would put her license on the line and give 3% saline at such a high rate. 3% Saline is a solution that isn't just thrown in with all the IV bags on the floor, the order has to be entered officially and has to be verified by the pharmacy and signed out by 2 RNs before it is given. Just so something like Alex's screw up doesn't happen in real life. I know it was just something to show Alex messing up - again and leading him to Olivia, but the fact that this show doesn't show nurses as having brains is distracting me from the good, fun soapiness.

No intern or resident helps with a code brown - let alone gets sent to one like the nurse who was trying to illustrate a point to Christina - no matter how rotten they are to the nurse. They learn, eventually - but unfortunately it isn't that way! Though I did have an attending doc help us hold a patient still to clean and change his linen while the intern and resident ran out of the room - asshats. LOL
Excuses

Addison knows Savvy well enough to know whether she generally makes impulsive decisions that she regrets. [/quote]

I actually think the dual relationship of friends/doctor-patient between Addison and Savvy was a problem. I don't think it's a good idea for a good or best friend to be someone's doctor (or counselor or pastor or financial advisor). You become friendly with people who help you, sure, but even the most professional people can develop clouded judgement when it turns to a friend's situation. I suppose there could likely have been a long back story about how Savvy came to this decision and it just wasn't good tv to include it. Who knows?

I don't think that in either the Dory or Savvy cases Izzie lacked qualifications. Tact and timing, yes - IMO she failed with Dory there. Personally, as I have moved and changed insurance companies a number of times in the last 10 years, I have always sought a new doctor or a resident - because they seem to be more willing to question with me, to listen and are less arrogant in their belief that they actually know what is going on. The residents take their time with me and ask good questions.


I don't think it's about consumerism, or not just about consumerism. It works the other way around, too: I've had a doctor judge me because I didn't want the aggressive, invasive treatment that he thought I should have. [/quote]

Oh sure - no denying it. And that's horrible to feel judged by your doctor! What I was trying to say was that it seems to me that our culture thinks we can buy our way to health and happiness - and I would agree that doctors do that too. I just wonder who's job it is to remind us that we are mortal...that it's not a matter of "deserving" to live or die...that maybe those resources can be better used in a different manner.

I feel I must add that I appreciate the extra 10 years my grandpa got late in life from medical intervention. I appreciate that my other grandfather is getting good medical treatment now - and he is having to wrestle with his course of action should the biopsy reveal the tumor on his lung is cancer. It's not easy - and I don't think one way works for all people.
katydid13
It seemed like Addison crossed a line with Izzy's quint. It seemed like they put that baby through an awful lot when they knew it wouldn't work. Why was no one talking about making the baby DNR? It seemed cruel and pointless.
DrCher
Totally cruel and pointless. If it were my daughter used like that, there would be hell to pay.
anwen
That really seemed to me to be an abuse of the teaching system. If they absolutely knew Emily couldn't survive, they should have let her parents spend those last hours with her, not kept flogging her little body to teach Izzy a lesson. The questions about what, if anything, they told the parents bothered me so much that I ended up liking Addison a hell of a lot less than I did before.
Rosa Lynn
Re: the interns being judgmental and all that...

I agree that it was really annoying to watch Izzie talking down to her patient last week, and then again we sort of saw it last night with Cristina, but I kind of like that these characters have such horrible, sometimes even ugly sides to them because it makes them more real. Maybe it's because I'm a cynic, or maybe it's because I've just spent the last few months doing psychology research for my honours on prejudice and how next to impossible it is for anyone to avoid been judgmental 100% of the time no matter how aware they are of it, or maybe I just don't know anything about how real life surgeons are, but I think the way Izzie and Cristina were totally unable to keep themselves from judging their patients made them seem more like real, messed-up, flawed human beings...as opposed to a bunch of actors pretending to be real.

I'm sure that they were exposed to all kinds of patients in med school, and they were definitely taught that it's completely unethical to judge them, but that kind of thing is so much easier said than done, and it's so much easier for me to watch the show and think "God, Izzie is such a judgmental bitch!" I think that, with time and experience, they should learn how to distance themselves from the situations they're in, but they're new to this and I think it's only natural for them to forget their boundaries sometimes.

(Of course, the whole male pregnancy thing was crossing the line and seemed totally unrealistic and ridiculous to me.)

YMMV.
Lila82

It seemed like Addison crossed a line with Izzy's quint. It seemed like they put that baby through an awful lot when they knew it wouldn't work. Why was no one talking about making the baby DNR? It seemed cruel and pointless. [/quote]

I guess I'm the only one who didn't think Addison crossed an ethical line. Assuming the babies didn't have DNR, Addison didn't do anything wrong. As the on-call doctor, wouldn't Izzie be required to try and keep the baby alive as long as possible and do everything in her power to do so? Izzie should have figured out during surgery that Emily wouldn't survive, but was too caught up in her own emotions. If there's an ethical question, I think it would Addison guilt-tripping and lying to Izzie, rather than Izzie working her ass off to save Emily. But then again, if Izzie could be objective and think with her head and not her heart, she would have figured out what most of the audience probably figured out during surgery, that Emily wasn't going to make it.
mialoubug

I guess I'm the only one who didn't think Addison crossed an ethical line. Assuming the babies didn't have DNR, Addison didn't do anything wrong. As the on-call doctor, wouldn't Izzie be required to try and keep the baby alive as long as possible and do everything in her power to do so? Izzie should have figured out during surgery that Emily wouldn't survive, but was too caught up in her own emotions. If there's an ethical question, I think it would Addison guilt-tripping and lying to Izzie, rather than Izzie working her ass off to save Emily. But then again, if Izzie could be objective and think with her head and not her heart, she would have figured out what most of the audience probably figured out during surgery, that Emily wasn't going to make it. [/quote]

No, I agree with you. Addison had spoken to Dory BEFORE she left Izzy with Emily. (Remember when Meredith was with her quint and saw Addison speaking with Dory?) So Dorey knew that Emily would not make it through the night. Izzy was caught up in her own emotions, both with the baby and her relationship with Alex. You just CAN'T be half involved with your case; you need to be there 100 percent. Izzy was distracted and distractions as a physician are not acceptable. Addison needed her to focus; Izzy did and worked very hard. Some of that may have been the guilt she felt at judging Dory. But you're right, she should have realized that given the baby's situation during surgery -- and Izzy's outburst in the operating room -- that Emily was destined to not survive. Not all patients do. No matter how hard everyone tries.
Aunty Mib
I can't remember the chief's name but wasn't Addison directly ORDERED to put Izzy through that ordeal? Hadn't Addison been put through the same ordeal herself?
flux

wasn't Addison directly ORDERED to put Izzy through that ordeal? Hadn't Addison been put through the same ordeal herself?[/quote]

No one ordered her to do anything. This isn't the military you know. She asked the Chief for advice and Chief said she did the same thing to her and it made her a better doctor. What she did to Izzie, she decided for herself.
BostonsKrissy
I was just wondering, for all the wonderful doctors/nurses, what are the procedures that the hospital takes in the unfortunate event somebody (like Christina) has a miscarriage? Is the body of the baby given to the mother, to be buried by their family, or does the hospital take it and um.. despose of it? Wow... that sounded awful. Is the mother required to go under psych analysis?

I was just wondering because I have seen an episode of ER and from another medical show where the outcomes of a miscarriage were carried out differently. Thanks in advance!
Brigid134

I was just wondering, for all the wonderful doctors/nurses, what are the procedures that the hospital takes in the unfortunate event somebody (like Christina) has a miscarriage?[/quote]

I'm not a doctor or a nurse but I do work in a hospital (as a secretary at the moment but I'm going to school to be an x-ray tech), so I wouldn't take my word as gospel, but I'll answer as far as I know.


Is the body of the baby given to the mother, to be buried by their family, or does the hospital take it and um.. despose of it? Wow... that sounded awful.[/quote]

Christina was, I believe, only seven weeks pregnant. There wouldn't be all that much to give to the family. I far as I know ectopic pregnancies are simply disposed of like any other medical waste.


I was just wondering because I have seen an episode of ER and from another medical show where the outcomes of a miscarriage were carried out differently.[/quote]

I assume you're talking about Carter's son. That pregnancy was much further along than Christina was, so that's why it was different. Really in that case it was more of a still birth, rather than a miscarriage.
Love
I know that it's tv but I am really surprised that George was able to get away with telling off the ulcer lady's mother like he did. Especially after she already threatened to sue. I am a nurse and if anyone at my hospital (nurses or docs) had spoken to a family member that way- trouble would be sure to follow. Having said that, I can totally relate to George. I have had many a family member (and patient) that I have wanted to say that too.
Want2Sleep

I am a nurse and if anyone at my hospital (nurses or docs) had spoken to a family member that way- trouble would be sure to follow[/quote]

But would you let a family act that way in the first place?
Love

But would you let a family act that way in the first place? [/quote]

No, but sometimes they do anyway. We've had to get hospital security involved many a time to help control things.
phillica
there were lots of problems with the ulcer storyline. first of all, you never do elective surgery on ulcers. treatment is purely medical until perforation and then you have emergency surgery. second, with insurance companies as they are today, they would NEVER have allowed for a patient to sit for three days just awaiting surgery. most elective cases are same day admissions...ie you show up the morning of your surgery. and if you are getting bumped, you get called and sent home. so most of that family silliness wouldn't happen by that regard. and there are rules about visitors in terms of numbers etc, and no you wouldn't get away with that behavior in most hospitals. but no, an intern wouldn't tell you off either.
BostonsKrissy
Now whenever I've been inside a hospital, I always see signs that say "Cellphones are banned inside the hospital" or something like that, and the only explanation for that I've heard was that it had to do with the radiation and the machines. But, we saw in this last episode Meredith with a sidekick and Bailey with his own phone. So, what's up?
youdidntseeme23
So far George has had to deal with some wacky patients, all the interns have. Bex though, last night, was probably one of George's toughest. I'm putting this in this thread because of George's indirectly forcing Bex's parents to tell her she was a hermaphrodite.

George may have known the girl was going to be happier if she knew, but in the end, in the words of Bob Kelso, "it's not [his] job to care." It's George's job to care for the patients, but their personal decisions, which this was, are left to the patient, and the patient's family.

I just felt George was completely out-of-line.
jewlmc
Edit.
meredithand

I just felt George was completely out-of-line. [/quote]


I don't think he was completely out-of-line. Sometimes I think the legalities are carried out to an extreme.

George knew that Becks was suicidal so he was acting in her best interest. It wasn't just a matter of letting this play itself out - parents not saying anything, Becks finding out (maybe when she tries for a baby?), Becks succeeding at that wrist-slashing. He was, quite possibly, saving her life by forcing them to tell her. And far better to do it then, with a doctor she was starting to bond with, then at home where she won't have a resource to turn to.

If Becks was younger, I see your point. But a teenager does start to have control of her body. And trust & mutual respect become so important for parent-teen relations at that stage, that any violation of that could have a disasterous outcome.
youdidntseeme23
I guess when you think of it in that way, it wasn't that bad of George. I assumed that Bex wasn't suicidal, but simply slashing her wrists.
RandomRanter
I just want to clarify that Becks was/is an intersexual - rather than a hermaphrodite. Hermaphroditism really doesn't occur in humans.

But I agreed with George. And it is sort an interesting ethical question, in some states, if Becks had been pregnant, that would have made her an emancipated minor for the purposes of medical decisions. But her parents were willing to try and not just make her medical decision for her, but not even tell her there was a decision.
Merreh
I don't disagree with what George did. If he was trying to tell her that she should decided to live her life as one gender or another, that would be crossing the line. But he wasn't: he merely wanted to tell her the truth.
celestial904

I just want to clarify that Becks was/is an intersexual - rather than a hermaphrodite. Hermaphroditism really doesn't occur in humans.[/quote]

Yeah. Last night I was so dissapointed because GA could have used the storyline to educate us a bit about intersex individuals.

Although it it occured at a speed I doubt it would in reality, I love the fact that Becks' reaction was so different than what her parents expected. I think the hard thing about parents being the gateway of information (or permission) for minors is that their own denial can cause them to make choices that are easier for them, not the child.

I'm curious, if a child or teen had cancer and the parents didn't want to tell the child, what would most doctors do?
Chaos nCrackers
Dunno, celestial, that's a good question. I would almost think they'd have to tell the child in that case, simply because it's a condition that affects the child's immediate health.
BostonsKrissy
I don't know about children, but when my grandmother was diagnosed with brain cancer, among a long list of other illneses, my family decided not to tell her. They thought she'd be more at ease and in retrospect, she really was blissfully ignorant.
celestial904

I don't know about children, but when my grandmother was diagnosed with brain cancer, among a long list of other illneses, my family decided not to tell her. They thought she'd be more at ease and in retrospect, she really was blissfully ignorant.[/quote]

Thanks for sharing your experience. I've never been confronted with an ethical dilemma around medical information. It's such an interesting situation to think about...

I have heard stories (I'm not sure if they are true or not) about doctors, years ago, not even informing parents that their newborn was intersex before surgically "correcting" the problem. The idea being, I guess, that the parents would be better off not knowing and the baby would be less traumatized as it grew. When I think about this being true it just sends shivers through my body. Gender identity is such a complex issue... I'm so glad it seems that we, as a society, are becoming more thoughtful about it.
snuffles

I'm curious, if a child or teen had cancer and the parents didn't want to tell the child, what would most doctors do?[/quote]
Depends on their age and their mental age. If over (approximately) 13years old, then most of the time we ask the patient if it is OK to give all info-diagnosis, prognosis, etc. to their parents and let the parents decide what to tell them.
Same holds true for elderly patients, esp in cultures where it is universally accepted the person dying is not told they are dying. (However, most of the time, people know when they are dying). By law, we would have to ask the patient's permission first, to only tell their designated loved or DPA (durable power of attonery) their diagnosis, etc. If the patient refused to give persmission, then by law (re: patient autonomy) we are required to tell them.
LittleRed
This dates back to an earlier post, but I'm really glad that someone mentioned the quint. I remember being horrified while watching the episode that that poor baby was being put through hell. Though I realize that doctors are required to do all that they can for a patient, even when it is hopeless, I think that part of my reaction was based on Izzy's ignorance of the futility of it. She hated the idea of not being able to save Emily's life but also was loath to put the baby through so much trauma, without realizing that no matter what she did she would fail. (I was a little surprised that kind-hearted Izzy didn't bring that point up in her fury at Addison, actually.) My older brother was born prematurely and died after almost two months in an ICU incubator, and I know that it tore my parents apart to see their son go through that. I was disheartened to see that Addison didn't let Emily go in peace with her parents, instead of using her as a teaching tool.
Spaz Cadet
Any medically knowledgable people out there know what it is that causes spontaneous orgasms and what, exactly, the surgery is that stops them? Is it a nerve somewhere getting undue pressure? Where? What is going on?
dybryd
I don't know much about spontaneous orgasms, but I do know that it's a neurological problem--it sometimes occurs in conjunction with epilepsy.

So, even if Addison is an all-purpose gynecologist/ob-gyn/neonatal/anything to do with va-jay-jays doctor, it still makes no sense that she took the patient. She should have seen a neurological specialist.
Billifan
SpazCadet, I found this link that may answer your question.

I thought it is neat that they put this information on the web site - whether or not it is true, not sure (I'm not a doctor and I don't play on on tv or at home). So, if someone has any medical background to uphold or dispute this information, let them speak their piece.

Hope it helps!

Did You Know?
mediabrain
Can any of the medical experts tell me more about fellowships?

According to a 2003 newspaper article in the character bios section of the ABC web site, Dr. Webber came back to Seattle Grace from New York in March 2003 when he accepted the position of Chief of Surgery. The article also states that Richard and Ellis were interns together at SGH nearly 3 decades ago and that "after fulfilling his residency at Seattle Grace Dr. Webber moved to New York where he has been training residents while practicing cutting edge surgery ever since."

I take this to mean that Webber has been away from Seattle for 20+ years yet in the Season 2 finale just before Bailey told him that Denny had died, Webber said "did my internship here, my residency,... came back here the minute my fellowship was done. The day they told me I would be chief I was standing right there in that OR. Spent my whole career at this hospital. My whole life."

The discussion we are having on the Bitter Medicine: Gripes/Complaints/Rants thread is if these two statements are inconsistent or contradictory. What is the length of a typical fellowship? I'm guessing that it is less defined than that of an intern or resident. If Richard spent so much time in New York, why would he still consider that he spent his whole career at SGH?

Instead of just assuming that Shonda and Co. screwed up I'm trying to find a justification for these two statements to both be correct. Any thoughts?
3chords
In our department (don't want to specify, but it is not surgical), fellowships are typically 3 years long.

Sometimes they are straight medical fellowships, and sometimes they are medical-research fellowships which dump the fellows in research labs. Most teaching hospitals have research institutes inside or affiliated with them. Here, they commonly rotate on a 6 month basis from research to clinical work, and the research is related to their field. Usually they don't have much interest in research unless they have a combined MD/PhD, but they do it to get their names on papers. This is actually a huge failing of the show - today's climate is publish or perish and most of the staff here seems uninterested which is odd. McDreamy, Burke, Bailey and Addison would all most certainly be chasing JAMA papers like chickens without a head.
HotButteredRum
This is actually a huge failing of the show - today's climate is publish or perish and most of the staff here seems uninterested which is odd. McDreamy, Burke, Bailey and Addison would all most certainly be chasing JAMA papers like chickens without a head.


In the S2 Mark episode, Derek accused Mark of only wanting to work on the boy with elephantitis so that Mark could then write a JAMA paper on it, get published and cover himself in professional glory. So it has come up, only it has come up in a negative way, as a selfishly negative, self serving thing thing for the shows 'bad boys' to do, as opposed to working on medical cases for the purely altruistic reasons of helping sick people get better.

I don't know about Dr Bailey, but is it possible that Burke, Addison and Derek, all of them acknowledged world class incredibly brilliant surgeons, all of them Head of SGH Departments, 2 of them in line for the position of Chief of Surgery, have already gone down the JAMA road and it is the resulting professional glory that they are basking in from their JAMA papers, that leads them to being in such positions of success and authority now? Maybe they have done the JAMA thing, have prospered from it, but are now kinda over it and are just back to the basics of just practicing medicine for no other reason than for the love of it.
YourMom
I work in medical publishing (including research publications), and I think it's doubtful that any of the surgeons would have a "been there, done that" attitude toward publishing. It IS publish or perish. Especially for Derek and Burke, who are trying to move up to a very high-ranking position. And Bailey, who is still working to establish herself. The only time you can afford to have a meh attitude toward publishing is if you're someone like the chief: already advanced as high as you want to go, already very well-known, and likely near the end of your career.

But watching them write and research papers is extremely boring compared to the excitement of watching McD and his magic hands at work. So it's either suspend disbelief on this relatively minor point in the interest of having an exciting show, or go for ultra-realism and risk being bored out of our minds. I pick #1, so this doesn't bother me at all.
3chords
No way.

The Chiefs of the Departments are even more psychotic about publishing than the underlings.

For one, it's a well known phenomenon that they poach patients from the residents when they are "interesting" or "rare." Lately, particularly if somebody presents with a possible novel gene mutation - the Chief will swoop in so they can be first author.

The higher you go, the greater the stakes. If you look at the citation index (in short, how many other papers referred to your paper), you will see that the more senior and prestigious the staff member, the more publishing they have and the higher their citation index is.

Derek and Burke would definitely be publishing regularly, we are talking several times a year.

And JAMA is a piece of crap when it comes to research anyway, NEJM is a bit better, but the golden calf are Science, Cell and Nature. None of them would get published there based solely on clinical observations, however. But it is seen as the ultimate in research publishing success.
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