If you are a regular reader of Medshadow, chances are you might be intrigued by the NBC hit show New Amsterdam, with its first four seasons on Netflix, and all five seasons on Peacock. The show follows Dr. Max Goodwin (Ryan Eggold), an idealistic patient-first go-getter in his new role as Medical Director at the oldest hospital in the United States, New Amsterdam. The work is inspired by real-life Medical Director Eric Manheimer’s memoir, Twelve Patients: Life and Death at Bellevue Hospital (2012).
New Amsterdam takes one health crisis after another by throwing itself into the frantic front lines of healthcare in the U.S., the not-so-good, to the bad, to the outright ugly, and yet somehow pulls itself out of the darkness with a feel-good drama. But first, in the opening episode, Dr. Goodwin introduces himself to the doctors, zeroes in on a cardiac surgical department that basically only performs high billing surgeries, asks them to show themselves and raise their hands, and then fires all of them.
New Amsterdam is a famous (fictitious) hospital that rests on its laurels and has lost its way. By asking over and over again throughout the series, “how can I help,” Dr. Goodwin’s mantra is the basis for this idea that when a system is so broken, doctors who put patients first will lead the way to change. It is, of course, a medical drama, so doctors and nurses will also fall in love with each other, wade their way through estrangement from wives or sons, and in general look good doing so.
Being the largest public hospital and with its New York City location, New Amsterdam is refreshingly diverse. Dr. Goodwin wakes up early to go running, arrives to work speaking Spanish to a locker room full of janitors, and asks them the same question he ends up asking everyone including the surgeons and the nurses for five seasons, “how can I help?” once again.
And most importantly, Dr. Goodwin follows through. The problem is, Dr. Goodwin asks a lot of questions about how to help, gets great ideas, then makes those ideas his own. Which, of course, a lot of fearless leaders do, but it makes the genuine intent of Dr. Goodwin have a sometimes questionable delivery, especially when, as viewers, you come to love New Amsterdam’s many characters (there are a lot), and maybe the least of which is Dr. Goodwin.
In the middle of an emergency that immediately follows his firing of an entire cardiac unit, another woman doctor points out how that was probably not a good idea, and Dr. Goodwin is forced to rehire a surgeon after prodding him about why he initially became a doctor. Her idea just becomes his, it is a pattern in the series that becomes annoying. Dr. Goodwin speaks with many inspirational quotes, one would hope he was as equitable with his source material as he is with his need to buck the system.
As revealed in the first episode, Dr. Goodwin has cancer, is estranged from his pregnant wife, and after being appointed Medical Director by the board of New Amsterdam is relentlessly foiled by its very board of directors. He is genial and likable, much like the more famous and puppy-dog-eye extraordinaire, Dr. Doug Ross (of ER, played by George Clooney), and rooted in patient-first change, so viewers will invariably root for him.
Real-world hospitals have relentless life and death decisions. This makes for good fodder for a high stakes drama. In the first episode, for example, we watch a young boy from Liberia leave the airport alone (if anyone has been through JFK’s passport control, we will suspend disbelief on how he got through it), clearly unwell, and makes his way to New Amsterdam only to wait forever in the ER, finally collapsing. He is quickly admitted, and the possibility of him having a highly contagious, airborne disease prompts Homeland Security to come barging in and declare him a terrorist.
Dr. Goodwin manages to talk them down, and the boy is left in quarantine for Ebola under the care of Dr. Lauren Bloom (Janet Montgomery), the head of the ER department. Spoiler alert: Dr. Bloom makes a decision to save the boy by entering the quarantined room without a full hazmat suit on. She saves his life by risking her own, and if that isn’t a solid dramatization of patient-first care, then I don’t know what is. Nevermind that she was told to push 10mg of epinephrine to save his life, a dangerous amount and not even recommended for Ebola treatment.While the overarching themes may be accurate, the medical technicalities are not.
Also in the opening episode, my personal medical nightmare unfolds. Dr. Bloom stops a patient from being rolled into the morgue after the EMTs declared her dead on arrival. The patient, Patricia (Rose Bianco), is diverted to the care of Head of Neurology, Dr. Vijay Kapoor (Anupam Kher), who confirms she is still very much alive.
Dr. Kapoor is told Patricia has Parkinson’s disease, but Dr. Kapoor senses this is a misdiagnosis. By using his experience, his instinct, and taking so much time to administer tests to try out his theories, to the point even Mr. Patient-First Dr. Goodwin, confronts Dr. Kapoor for not even addressing Patricia’s Parkinson’s to begin with, Dr. Kapoor gets to the root of Patricia’s misdiagnosis.
As we know too well, misdiagnosis can lead to prescriptions with unintended side effects, and a cascade of health issues occurring as prescription medicine chases its own imagined tail. Patricia originally was misdiagnosed for depression. She was given haloperidol for something she did not have, which has a known rare side effect of Parkinson’s. Patricia never had depression nor Parkinson’s, but she did have a tumor, called thymoma.
The misdiagnosis led to a treatment that made her tumor worse, and if she had been given the standard treatment for Parkinson’s when she entered New Amsterdam, she would have gone into cardiac arrest and died. This scene was one of the most compelling in the series, with great writing, acting, and a thought-provoking case of misdiagnosis, it shows what can happen when doctors get it right.
In the second episode, Leo, a 10-year-old boy, sits on the floor in front of his mother and Pediatric Psychiatrist Dr. Iggy Frome (Tyler Labine). His mother tells Dr. Frome that her son used to be energetic, and now refuses to speak and is listless and “out of it.” He was previously put on a powerful cocktail of antipsychotics after a school incident that followed the death of his father. MedShadow understands children prescribed antipsychotics should not be taken lightly.
Dr. Frome quickly, however, decides to stop all his meds, also an insanely risky proposition described as “rapid detox dialysis.” This is not deprescribing, which is a more thoughtful (i.e. time-consuming) approach with your doctor. What Dr. Frome proposes in this medical drama is more like a deprescribing freefall.
But Dr. Frome deems it necessary in order to enter Leo into a behavioral therapy trial. Dr. Frome meets the public school board in court, and questions are pointedly asked about labeling a child violent and difficult, elaborating on the side effects of an antipsychotic cocktail, especially for such a young patient. Spoiler alert again: Leo is released from his mental prison, returns to the energetic boy he used to be, and is ready to begin a recovery with conversational, behavioral therapy.
When New Amsterdam is great, it is an inspiration and easily bingeable. Dr. Goodwin genuinely wants to change the system, and it is a recognizably broken system, and as the oldest and largest public hospital in America, it is indeed a worthy system to fight for, especially with a patient-first mentality. He leads New Amsterdam’s staff, day-in and day-out, through this medical drama.
However, it is far too often simplistic. Granted, the show is originally a prime-time major network television show. There are storylines that run through several episodes and seasons, but the pacing has inherent timing constraints due to its one-hour time slot (around 42 minutes with commercial breaks), so of course it cannot exactly do a deep dive into the transformation of U.S. healthcare. However, a healthier balance of a manic, anti-bureaucratic, changemaker medical director coupled with the impact of his decisions would have elevated this series from “kind of binge-worthy,” to one of the greatest medical dramas hitting at the perfect moment in time for society.
Standing before the still-seated doctors in the opening episode, at least the ones Dr. Goodwin didn’t fire, he tells them, “You know, we all feel like the system is too big to change. But, guess what? We are the system. We need to change.” Viewers might stay for the promise and the medical drama’s fast-paced sprint, but in the end, especially those with a medical mindset, will be left wanting more.
