by Craig Klugman, Ph.D.

Summer is a slow time for television and especially for the medical drama. One show that has been filling this warm weather slot is The Night Shift, a fairly uninteresting and poorly done drama. Frankly, I only started watching it because of its setting in a fictitious hospital in my former home of San Antonio. However, this week’s episode (Season 3, Episode 5: Get Busy Livin’) raised several ethical issues and resolved them poorly.

First, a patient is in the final stages of cancer. She has accepted her death and even has plans for one final vacation, but she runs into a physician who is not willing to let her go. The patient has agreed to a DNR and is firm in her decision that she’s done enough to fight her disease. She watched her mother die of breast cancer just a few years and does not want that kind of suffering. The physician actually colludes with a pharmaceutical rep who lies about the patient’s recent medical record in order to qualify for an experimental clinical trial. Perhaps this physician was absent on the day that clinical trials were taught in medical school, but in most trials there is no guarantee that the patient will be helped by the new drug. Some trials exist just to determine the side effects or whether there is any help. And what the physician also clearly did not know is that being in a randomized clinical trial does not mean the patient will receive the experimental agent—the patient could end up with placebo (which in some cases is better since placebo has fewer side effects). This patient turns out to be a counselor and asks the physician “why can’t you let your patients go?” A heartfelt counseling session ends with the patient dying. As the physician is calling for a crash cart, a colleague pulls her back, saying the patient is DNR and she needs to the patient go.

Second, a pharmaceutical rep has nearly free range of the hospital. She is a young, attractive woman ostensibly there to evaluate whether the hospital should be chosen as one of four sites for a clinical trial of a new heart valve replacement. Being part of the trial would significantly raise the status of the hospital. While there, she also tries to convince the ER to switch over to her company’s pharmacy and to exclusively use her company’s drugs. Apparently all of the doctors were absent during the medical school lectures on putting the patient’s best interest first and on conflicts of interest. The chief of surgery, who wants the trial in his hospital, colludes with the drug rep and tells her what each physician who gets a vote on the formulary would want to choose her company. In other words, a senior physicians tells her how to manipulate the medical staff to get what they both want (he to be a trial site; her to make a big sale). To the exhausted chief of the ER she offers an all expenses paid trip to a medical conference in Hawaii. Even though there are continuing education sessions, she tells him outright that he can skip them all and just have a vacation with his wife. Tying in to the first story line, a physician is promised a slot in a clinical trial for her patient (even though the patient does not want it, and it takes a lie to get the patient enrolled). The advice on winning over another physician is basically to seduce him, which she does. Watching, one assumes that a responsible show will end with her boorish behavior called out. But no one does. As she admits in the final minutes, the hospital had already been chosen as a study site, but she wanted to see if she could get something more out of them. It appears that she was successful, which is not surprising when a recent study found that doctors prescribing habits can be influenced by as little as a $15 gift. Although most medical schools now forbid pharmaceutical reps on campus or giving out free gifts, fewer hospitals have made the same pledge.

The only lesson The Night Shift seems to offer is one does not have to hide, nor feel regret, about unethical behavior under the cloak of darkness. This does align with a study that shows people who are tired tend to be less ethical. Maybe the Night Shift should transfer to the daytime.