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EducaciónMédica
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ORIGINAL ARTICLE
The Good Doctor and bioethical principles: A content
analysis
Irene Cambra-Badii a,b , Ariadna Pinar c , Josep-E. Baños b,d,∗
a
Bioethics Chair, Universitat de Vic --- Universitat Central de Catalunya, Spain
Research Group on Education in Health Sciences, Department of Experimental and Health Sciences, Universitat Pompeu Fabra,
Barcelona, Spain
c
Universitat Pompeu Fabra, Barcelona, Spain
d
School of Medicine, Universitat de Vic --- Universitat Central de Catalunya, Spain
b
Received 26 August 2019; accepted 11 December 2019
KEYWORDS
Television;
Medical drama;
Bioethics;
Medical teaching
∗
Abstract
Introduction: Since their inception, TV medical dramas have been popular with the general
public, and especially with medical students. Some educators in biomedical disciplines have
used these dramas to illustrate professionalism and bioethical dilemmas. The first season of
The Good Doctor, an American TV series, consisted of 18 episodes that showed the life of
a young autistic physician with savant syndrome who is starting his residency in surgery. His
personality gives rise to conflicts with colleagues and patients. It is hypothesised that The Good
Doctor might be useful for teaching bioethics to health sciences students.
Methods: We used content analysis for an exploratory and descriptive study of the first season
to determine whether the episodes had enough scenes involving bioethical dilemmas to justify
empirical studies of its teaching value. Two research questions were posed: What depictions
of bioethical conflicts can be useful? And, what characteristics of the representation of the
physician as an autistic with savant syndrome might be interesting for learning bioethics?
Results: It was found that many episodes of this TV medical drama deal with bioethical dilemmas in different scenarios. A total of 186 situations were identified in which a bioethical
principle was involved. The ethical principle most often represented was charity, followed
by non-maleficence (non-harming), autonomy and justice.
Conclusion: The results suggest that The Good Doctor might be useful for teaching bioethics to
health sciences students.
© 2020 Elsevier España, S.L.U. This is an open access article under the CC BY-NC-ND license
(http://creativecommons.org/licenses/by-nc-nd/4.0/).
Corresponding author.
E-mail address: josepeladi.banos@uvic.cat (J.-E. Baños).
https://doi.org/10.1016/j.edumed.2019.12.006
1575-1813/© 2020 Elsevier España, S.L.U. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/
licenses/by-nc-nd/4.0/).
Please cite this article in press as: Cambra-Badii I, et al. The Good Doctor and bioethical principles: A content analysis.
Educ Med. 2020. https://doi.org/10.1016/j.edumed.2019.12.006
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I. Cambra-Badii et al.
PALABRAS CLAVE
Televisión;
Serie médica;
Bioética;
Educación médica
The Good Doctor y los principios bioéticos: un análisis de contenido
Resumen
Introducción: Desde sus inicios, las series médicas han sido populares entre el público en general y especialmente entre los estudiantes de medicina. Algunos educadores en disciplinas
biomédicas han usado este formato para ilustrar el profesionalismo y los dilemas bioéticos. La
primera temporada de The Good Doctor, una serie de televisión estadounidense, comprende
18 episodios que muestran la vida de un joven médico autista con síndrome de Savant que
está comenzando su residencia en cirugía. Su personalidad da lugar a conflictos con colegas y
pacientes. Nuestra hipótesis indica que The Good Doctor podría ser útil para enseñar bioética
a estudiantes de ciencias de la salud.
Métodos: Utilizamos el análisis de contenido para un estudio exploratorio y descriptivo de la
primera temporada para determinar si los episodios tienen suficientes escenas que involucren
dilemas bioéticos para justificar los estudios empíricos de su valor docente. Se plantearon dos
preguntas de investigación: ¿Qué representaciones de conflictos bioéticos pueden analizarse?
Y, ¿qué características de las representaciones del médico como autista con síndrome de savant
podrían ser interesantes para aprender bioética?
Resultados: Descubrimos que muchos episodios de esta serie médica tratan con dilemas bioéticos en diferentes escenarios. Identificamos 186 situaciones en las que estaba involucrado un
principio bioético. El principio bioético representado con mayor frecuencia fue la beneficencia,
seguida de la no maleficencia, la autonomía y la justicia.
Conclusión: Los resultados sugieren que The Good Doctor puede ser útil para enseñar bioética
a estudiantes de ciencias de la salud.
© 2020 Elsevier España, S.L.U. Este es un artı́culo Open Access bajo la licencia CC BY-NC-ND
(http://creativecommons.org/licenses/by-nc-nd/4.0/).
Introduction
TV medical dramas have been very popular since their
inception.1,2 Many medical and nursing students follow these
TV series,3---5 and several authors have suggested that medical dramas are interesting as a tool for teaching students in
health sciences disciplines.6---9
Various factors argue in favour of using medical dramas as teaching tools. These depictions use visual language
that students easily understand and trigger their emotional
engagement10---16 and could increase students’ motivation
and interest in understanding the scenario.13,17,18 It could
also help students understand situations from the different
points of view19 and develop critical thinking skills through
deep analysis of the conflicts portrayed,20 especially in relation to the doctor-patient relationship.15
One of the subjects where TV medical dramas have often
been used to teach is bioethics or medical ethics4,13,21---23
and many scenes depict relevant issues that might help in
understanding bioethical principles.1
One of the most recent successful TV medical dramas is
The Good Doctor (ABC, 2018). The main character is Shaun
Murphy, a physician with autism and savant syndrome who
has just started his training as a resident in surgery. He is a
very special man. He is not only a young resident who learns
how to be a doctor but also a person with significant limitations, in particular due to the little empathic development
and the lack of communication skills with his patients and
colleagues.
We hypothesised that The Good Doctor might be useful
for teaching bioethics to health sciences students. We carried out a content analysis to identify plots and scenes that
portray events that might be useful for teaching purposes,
noting how they could be used to help students learn about
topics such as doctor---patient relationship, professionalism,
and ethical and bioethical dilemmas. This approach might
allow us to choose the best fragments and/or episodes in
terms of their pedagogical effectiveness, and to assess their
usefulness for teaching bioethics.
Two research questions were posed: What depictions of
bioethical conflicts can be useful? And, what characteristics
of the representation of the physician as an autistic with
savant syndrome might be interesting for learning bioethics?
Methods
Sample
The present study analyses the content of the 18 episodes
in the first season of The Good Doctor, broadcast between
September 25, 2017 and March 26, 2018.
Analytical procedure and variables of interest
The following variables were codified:
Ethical principle: We classified characters’ behaviour
according to the four ethical principles delineated by
Beauchamp and Childress:24 respect for autonomy, beneficence, non-maleficence, and justice.
Scenario: This variable describes the nature of the scene
illustrating bioethical principles as dealing with issues in
Please cite this article in press as: Cambra-Badii I, et al. The Good Doctor and bioethical principles: A content analysis.
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The Good Doctor and bioethical principles: a content analysis
medical practice such as institutional relationships, diagnostic processes, surgery, or patient discharge.
Assigning a connection between ethical principles and
scenarios enables a situational analysis of vignettes. This
consists of a brief description of the relevant aspects of the
scene that enable students to understand the link between
the bioethical principle and the scenario. We present a brief
example from episode 1×17: we analysed beneficence, nonmaleficence and autonomy principles in a surgical scenario.
In a meeting before surgery, where informed consent is
requested, Dr. Shaun Murphy questions the risk-benefit ratio
of the surgical procedure in front of the young patient to be
treated, her father and the surgeons. He asks what is the
need for an elective but risky surgery that only will allow
the patient to smile: is the possibility to smile more important than the risks of the surgery? The importance to talk
about the potential surgical risks --- and not only the good
outcomes of surgical procedure --- is then put into question.
Coding reliability
Two researchers trained in bioethics independently coded
the variables in the episodes under the supervision of a
third researcher. Coding was done episode by episode. The
third researcher sought a common delimitation for the scenarios in each situation. To harmonize the coding criteria,
we conducted a pilot study on the first six episodes and
three 2-h training sessions. The remaining 12 episodes were
analysed one-by-one: after each analysis of an episode, the
coding was checked, the coding scheme was discussed, and
a consensus was reached to facilitate understanding and
future work.
Analysis
We quantitatively analysed the data to determine the frequency of appearance of the bioethical principles and the
different scenarios considered in the episodes. This will
allow measuring and quantifying the value of The Good
Doctor for teaching bioethics to health sciences students.
We were also interested in knowing the variety of bioethical principles and scenarios, and understanding that, in a
greater variety, a more complex and rich look on bioethical
situations occurs.
To answer the question of what characteristics of the
representation of the physician, as an autistic with savant
syndrome, might be interesting for learning bioethics, we
used interpretive description25---27 to analyse the depiction
of situations that involve Dr. Murphy beyond the analysis of
the frequency of appearance of these vignettes.
Results
In the first season of the medical drama, 186 situations
were identified where a bioethical principle was involved.
Table 1 shows the distribution of the appearance of each
bioethical principle through the 18 episodes. The principle of beneficence is the most frequent (31.2%), followed
by non-maleficence (24.7%), autonomy (22%), and justice
(22%).
3
Table 1 Frequency of situations involving bioethical principles in episodes of the first season of The Good Doctor and
the mean number of these situations per episode.
Bioethical
principle
Number of situations
involving bioethical
principles
Mean
Beneficence
Non-maleficence
Autonomy
Justice
58
46
41
41
3.22
2.55
2.27
2.27
Table 2 summarises the distribution of situations involving bioethical principles in each episode. All four bioethical
principles were dealt with in two-thirds of the episodes,
often in more than one situation; three bioethical principles
were dealt with in the remaining third of the episodes.
We identified 18 scenarios dealing with issues in medical
practice that illustrate biomedical ethics (Table 3). Scenarios that were present in less than 5% of situations are
grouped in the Miscellaneous category.
The most frequent intersections between the bioethical
principles and the scenarios are: Autonomy and Informed
consent (n = 22; 12.6%), Justice and Institutional relations
(n = 20; 11.5%), Beneficence and Surgery (n = 15; 8.6%), and
Non-maleficence and Surgery (n = 10; 5.7%).
The premise of The Good Doctor centres on the main
character’s difficulties in interpersonal relationships and
communication, so it is interesting to analyse qualitatively
how these difficulties intersect with bioethical principles
and the doctor-patient relationship in the series. An example: in episode #17 (entitled Smile), the patient is a young
woman in her twenties who has Moebius syndrome, in which
paralysis of the sixth and seventh cranial nerves makes it
impossible to smile and express emotions facially. The similarities with Dr. Murphy’s expressionless face are obvious,
but the patient does have a sense of humour and makes
jokes about her condition. When Dr. Murphy evaluates the
patient in the preoperative appointment, he questions the
usefulness of the operation by asking ‘‘Do you want to be
a comedian?’’ This question is shocking in that it implies
that Dr. Murphy can only imagine the need to smile professionally, so he thinks that the risks of this elective surgery
might outweigh the benefits. When the patient changes her
mind about having surgery, the head of the department
reproaches Dr. Murphy for saying what he did. Dr. Murphy
reminds his chief that it is important to talk about the risks
of a procedure----not only the benefits. In this discussion of
beneficence and non-maleficence, Dr. Murphy’s inability to
empathize with his patient becomes a way to protect her,
because it restores the young woman’s autonomy.
Discussion
The present study found that The Good Doctor medical
drama is rich in bioethical conflicts. This series covers a wide
variety of situations in which bioethical themes can arise.
Our results confirm the potential interest of this medical
drama for teaching bioethics in health sciences.4,7,9
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Table 2
Distribution of situations dealing with bioethical principles in the episodes of the first season of The Good Doctor.
Episode
#1
#2
#3
#4
#5
#6
#7
#8
#9
#10
#11
#12
#13
#14
#15
#16
#17
#18
Bioethical principle
Beneficence
N = 58
Non-maleficence
N = 46
Autonomy
N = 41
Justice
N = 41
Yes
Yes
Yes
Yes
Yes
Yes
Yes
No
Yes
Yes
No
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
No
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
No
Yes
Yes
Yes
Yes
Yes
Yes
Yes
No
No
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
(n = 4)
(n = 3)
(n = 3)
(n = 4)
(n = 5)
(n = 3)
(n = 5)
(n = 2)
(n = 3)
(n = 6)
(n = 2)
(n = 5)
(n = 5)
(n = 4)
(n = 4)
(n = 3)
(n = 1)
(n = 3)
(n = 1)
(n = 3)
(n = 3)
(n = 3)
(n = 1)
(n = 3)
(n = 3)
(n = 5)
(n = 2)
(n = 5)
(n = 4)
(n = 2)
(n = 1)
(n = 1)
(n = 2)
(n = 3)
This study aimed to answer two research questions in
reference to the series. The first asked what depictions of
bioethical conflicts could be useful for teaching purposes.
The principles of beneficence and non-maleficence continue
to be the guiding principles of medical practice, and they are
represented in most of the vignettes. On the other hand, all
four principles are frequently depicted and none of them is
neglected; thus, the series provides a comprehensive view
of issues that arise in medical practice.
In addition to bioethical principles, we included the
scenario as a variable of analysis. Including this variable
enabled us to explore the resources from the series that
might be useful for teaching in various specific concrete
situations, and allowed us to expand the state of the art
on bioethics and TV series, since there are no bibliographical references on this subject. In fact, the use of TV medical
series for teaching purposes is quite unusual.1,2,9,14,15,17,18,22
Our second research question asked what characteristics
of the physician as an autistic person with savant syndrome
might be interesting for learning bioethics followed Ye and
Ward27 indispensable contributions to the content analysis
of medical dramas, although focused on the analysis of the
types of diseases portrayed and their treatments, rather
than on bioethical dilemmas as in our study. In analysing
the second research question, we placed special emphasis
on the effects of Dr. Murphy’s difficulties in communicating
with his patients and colleagues. His autism makes it difficult for him to relate others, which can obviously cause
problems in the doctor---patient relationship. However, his
autism also conditions him to have an enormous respect for
the rules and to do his job as best he can. His main problem is
in a lack of tact, coming off as brusque with the patients and
suggesting a lack of empathy. However, this representation
could help students identify the ethical conflicts that result
from this behaviour and its effects on patients and medical
Table 3
(n = 2)
(n = 1)
(n = 3)
(n = 4)
(n = 3)
(n = 2)
(n = 1)
(n = 1)
(n = 2)
(n = 2)
(n = 5)
(n = 5)
(n = 1)
(n = 3)
(n = 4)
(n = 2)
(n = 2)
(n = 3)
(n = 3)
(n = 2)
(n = 1)
(n = 5)
(n = 1)
(n = 5)
(n = 2)
(n = 2)
(n = 4)
(n = 5)
(n = 2)
(n = 1)
(n = 2)
(n = 1)
Scenarios and frequency of appearance.
Scenario
N (%)
Institutional relations
Communication with the patient
Surgery
Informed consent
Diagnostic process
Doctors’ personal problems
Miscellaneous (Risky medical
procedures, medical malpractice,
harassment at work, organ
transplantation, experimental
treatments, discrimination,
confidentiality, end-of-life care,
emergency medical care outside
the hospital, love affair between
doctor and patient, transsexual
patient, communication with the
patient’s relatives)
28 (16.1%)
24 (13.8%)
23 (13.2%)
22 (12.6%)
11 (6.32%)
9 (5.17%)
69 (37%)
colleagues. Thus, we consider that this character is especially relevant in showing the importance of empathising
with patients and colleagues.
This study has some limitations. Although measures were
taken to ensure a thorough evaluation of the content, only
three researchers took part in this task. Repeating this study
on a larger scale would increase its validity and reliability.
A final limitation comes from the production characteristics
of the series. Like most medical dramas, The Good Doctor
comes from the United States, so it is culture-bound to that
country and the structure of its health system, among other
features.
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The Good Doctor and bioethical principles: a content analysis
In conclusion, our results show that The Good Doctor contains much material related to bioethical issues in a wide
variety of scenarios. These findings suggest that this series
could be used to teach bioethics to students of health sciences. Empirical studies are necessary to determine the
theoretical and practical implications of using The Good
Doctor to analyse bioethical issues in specific scenarios of
practice and the pedagogical effectiveness of this approach.
Conflict of interest
No potential conflict of interest was reported by the authors.
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