Medical Diagnoses in The Good Doctor: A Comprehensive Review of Medical Conditions in Season 1
- 5 days ago
- 9 min read
The first season of The Good Doctor introduces us to Dr. Shaun Murphy, a surgical resident with autism and savant syndrome, whose unique perspective allows him to visualize medical problems in ways others cannot. The season balances high-stakes trauma cases with incredibly rare congenital defects, often requiring experimental surgical solutions.
Below is a detailed medical review of the diagnoses, treatments, and surgical interventions featured in Season 1.
Episode 1
Traumatic Pneumothorax and Pericardial Effusion
The series opens with Adam, an eight-year-old boy critically injured by falling glass at an airport. Dr. Murphy intervenes, identifying a traumatic pneumothorax (collapsed lung) by noting the paradoxical movement of the chest. He improvises a one-way valve using a soda machine tube and a water bottle to allow air to escape the chest cavity. Diagnosis and Progression: At the hospital, Murphy insists on an echocardiogram after noting a drop in ECG amplitude. While the initial echo appears normal, Murphy identifies a subtle deformity in the right atrium. He correctly deduces that glass shards traveled through the jugular vein, puncturing the superior vena cava and causing a pericardial effusion (fluid buildup around the heart). Treatment: The team, led by Dr. Melendez, performs surgery to repair the SVC and stabilize the patient.
Mediastinal Abscess
Callum, an adult patient requiring bypass surgery, is found to have a white mass under the left atrium during the operation. Diagnosis and Treatment: The mass is identified as pus from a mediastinal abscess, likely caused by past exposure to Tuberculosis (TB). The discovery causes a crash in blood pressure, requiring immediate suction, aggressive fluid resuscitation, and Levophed to maintain a mean arterial pressure (MAP) of 60.
Other Medical Diagnoses and Conditions Discussed
Severed Jugular Vein: A critical injury to the primary neck vein requiring immediate pressure to prevent exsanguination.
Tracheal Compression: Airway obstruction caused by misapplied pressure to the windpipe.
Autism: A neurodevelopmental condition characterized by social communication challenges.
Savant Syndrome: A condition where individuals with developmental disorders exhibit island of genius-level ability, such as spatial recall.
Numerous Lacerations: Multiple deep cuts requiring suturing, sustained from shattered glass.
Episode 2
Leiomyosarcoma
Stephanie Willis presents with abdominal pain and bloating. Imaging reveals a large mass abutting the aorta and kidney. Diagnosis and Treatment: Dr. Murphy identifies the mass as a malignant leiomyosarcoma. The tumor has encased the abdominal arteries, making excision difficult. The team opts for a radical approach: removing the healthy left kidney to create a plane of dissection, allowing Dr. Melendez to peel the tumor off the arterial walls safely.
Intestinal Malrotation with Volvulus
Martine, a 10-year-old girl, is initially dismissed with a "tummy ache." Murphy suspects a deeper issue based on slightly elevated D-dimer and lactate levels. Diagnosis and Treatment: Murphy diagnoses intestinal malrotation, a congenital anomaly that leads to a volvulus (twisting of the intestine). Martine eventually collapses from hypovolemic shock. Emergency surgery is performed to untwist the bowel and prevent necrosis.
Other Medical Diagnoses and Conditions Discussed
Renal Angiomyolipoma: A benign kidney tumor considered in the differential diagnosis.
Lymphoma: A cancer of the immune system initially suspected.
Neurogenic Tumor: A tumor arising from nervous system cells.
Hypovolemic Shock: A life-threatening condition caused by severe blood or fluid loss.
Post-operative Ileus: Temporary paralysis of intestinal contraction after surgery.
Episode 3
End-Stage Liver Disease
Chuck, a patient with severe cirrhosis, requires a liver transplant. A routine test finds alcohol in his system, jeopardizing his eligibility. Diagnosis and Treatment: Using algebra based on clearance rates, Murphy proves Chuck only had one glass of champagne. However, due to strict registry rules regarding six-month sobriety, the organ is redirected, leaving Chuck with a terminal prognosis.
Oral Tumor Reconstruction
Wannamaker requires a "Free-Flap" procedure to repair a cheek defect after tumor removal. Diagnosis and Treatment: A post-operative hematoma begins compressing the carotid artery. The team performs an invasive rescue by cutting through the mandible to access Zone Three of the neck, locating the bleed and preventing a stroke.
Other Medical Diagnoses and Conditions Discussed
Hepatitis B: A viral liver infection affecting transplant eligibility.
Intra-organ Vascular Clotting: Thrombosis within a donor organ due to improper flushing.
Autism Spectrum Disorder: Discussed regarding sensitivity to environmental stimuli.
Episode 4
Fetal Tailbone Tumor
Barbara Allen, 22 weeks pregnant, has a fetus with a massive tumor monopolizing blood supply. The mother also suffers from Antiphospholipid Syndrome (APS). Treatment: The team stops Barbara’s heart and places her on bypass to perform a C-section. They partially remove the fetus, excise the tumor, and return the fetus to the uterus. Both survive.
Bartholin Gland Abscess and Perineal Myoma
Olivia presents with a painful Bartholin gland abscess. Diagnosis and Treatment: Surgeons discover a perineal myoma (fibroid) beneath the gland engulfing the pudendal nerve. To save genital sensation, Murphy proposes a nerve graft, reconnecting the pudendal nerve to a femoral cutaneous nerve branch.
Other Medical Diagnoses and Conditions Discussed
Necrotizing Fasciitis: Flesh-eating bacteria initially suspected due to disproportionate pain.
Chlamydia: STI considered as a cause for the abscess.
Myocardial Infarction: Complication suffered by the mother during surgery.
Episode 5
Echinococcus (Hydatid Disease)
Merrill Wilks collapses from anaphylaxis. A biopsy of a pancreatic lesion triggers a second reaction. Diagnosis: The "lesions" are Echinococcus cysts (tapeworms). Rupturing them releases toxins causing anaphylaxis. Dr. Glassman surgically removes a cyst from the brain using saline to gently displace it.
Stage IV Osteosarcoma
Evan, a young boy resembling Shaun's brother, has a fractured arm and nystagmus. Diagnosis: While parents claim it is terminal osteosarcoma, Shaun argues for Langerhans cell histiocytosis. However, during surgery for a saddle embolism, the team finds metastatic cancer in the chest, confirming the terminal osteosarcoma diagnosis.
Other Medical Diagnoses and Conditions Discussed
Alcohol-induced Pancreatitis: Initial misdiagnosis for the pancreatic swelling.
Langerhans Cell Histiocytosis: A treatable condition involving osteolytic lesions.
Hypochondriasis: Irrational fear of disease.
Episode 6
Shattered Femur (3D Printing)
Marco presents with a shattered femur and severed femoral artery after a bus crash. Treatment: Instead of amputation, the team implants a 3D-printed titanium femur. Despite legal battles over consent and clotting in the temporary shunt, the procedure succeeds.
Burns and Tilapia Skin Graft
Celez suffers severe burns. Circumferential neck burns constrict her airway, requiring an escharotomy. Treatment: Dr. Kalu applies medical-grade tilapia skins to the burns. Rich in collagen, the fish skins accelerate healing and reduce infection risk, leading to a successful recovery.
Other Medical Diagnoses and Conditions Discussed
Subdural Hematoma: Brain bleed managed via emergency burr hole in the field.
Hypoxia: Caused by improper intubation (tube in the right main stem bronchus).
Cardiac Tamponade: Compression of the heart by fluid.
Episode 7
Hypereosinophilic Gastroenteritis
Liam, an autistic patient, presents with jaundice and abdominal clenching. Stimming prevents an MRI. Diagnosis: After ruling out cancer and cholangitis, Murphy diagnoses hypereosinophilic gastroenteritis linked to Kava root supplements, indicated by uveitis (red eyes). Treatment: The bowel perforates, causing septic shock. The team removes necrotic bowel segments to save his life.
Other Medical Diagnoses and Conditions Discussed
Ascending Cholangitis: Infection of the bile ducts initially suspected.
Sepsis: Systemic reaction to infection.
End-Stage Heart Failure: Treated in a parallel case (Glen) who eventually opts for DNR.
Episode 8
SIRS and Internal Hemorrhage
Avery suffers a gunshot wound, leading to a ruptured spleen and Systemic Inflammatory Response Syndrome (SIRS). Diagnosis: As organs fail, Murphy realizes she is bleeding from a missed source. He deduces the bullet nicked the left supreme intercostal artery. Treatment: Emergency surgery to clip the arterial bleed stops the multi-organ failure.
Other Medical Diagnoses and Conditions Discussed
Cervical Hematoma: Post-operative swelling compressing the airway of the shooter.
Subcutaneous Emphysema: Air trapped under the skin.
Transverse Colon Rupture: Injury caused by the bullet trajectory.
Episode 9
Hypertrophic Obstructive Cardiomyopathy (HOCM)
Gabriel, a boy from the Congo, presents with severe HOCM, an Atrial Septal Defect, and a Mitral Valve anomaly. Treatment: Using a 3D-printed heart for simulation, the team performs a septal myectomy. They shave the septum down to 13mm to find a hidden anchor point for re-implanting the mitral valve.
Other Medical Diagnoses and Conditions Discussed
Benign Laryngeal Nodule: A vocal cord growth initially feared to be cancer.
Endocarditis: Inflammation of the heart lining ruled out by blood cultures.
Episode 10
Malignant Schwannoma
Bobby, an e-sports athlete, has ligament tears but also a paradoxical loss of grip strength. Diagnosis: An MRI reveals a malignant schwannoma encasing the brachial plexus and a secondary mass on the brain stem. Treatment: High-risk excision requires sacrificing part of the red nucleus, causing partial paralysis, followed by chemo/radiation.
Other Medical Diagnoses and Conditions Discussed
Compartment Syndrome: Muscle pressure build-up treated with fasciotomy.
Reperfusion Injury: Lung distress caused by the sudden return of blood flow to limbs.
Multiple Sclerosis: Initial differential diagnosis.
Episode 11
Craniopagus Conjoined Twins
Jenny and Katie. Twins joined at the skull shared a sagittal sinus vein. Diagnosis and Treatment: Jenny suffered heart failure after a kidney transplant rupture. The separation surgery was expedited, utilizing a cavitron to separate brain tissue and grafting a new vein for Katie.
Other Medical Diagnoses and Conditions Discussed
Renal-Vascular Interdependence: Connected circulatory systems.
Ventricular Tachycardia: Life-threatening arrhythmia.
Episode 12
Cerebral Artery Narrowing and Heart Failure
Jenny and Katie (Post-Separation). Post-surgery, Katie remained in a coma due to a narrowed middle cerebral artery, while Jenny went into heart failure. Outcome: The twins were temporarily re-conjoined at the femoral vessels to support circulation. Katie woke up, but Jenny’s heart failed, leading to her death.
Other Medical Diagnoses and Conditions Discussed
Circle of Willis Malformation: Vascular abnormality in the brain.
Ventricular Fibrillation: The terminal rhythm for Jenny.
Episode 13
Dimethyl Sulfate Toxicity
Naja presents with burns and respiratory distress. Diagnosis: Murphy diagnoses dimethyl sulfate poisoning (a chemical weapon component) after noting bronchial wall thinning and methanol presence. Naja was using it to make perfume. Treatment: Methylprednisolone to reduce inflammation.
Other Medical Diagnoses and Conditions Discussed
Cerebral Aneurysm: Rupture in the anterior communicating artery.
Mucosal Edema: Swelling caused by chemical inhalation.
Episode 14
Testicular Cancer and Torsion
Quinn, a transgender girl, presents with abdominal pain. Diagnosis: Imaging reveals testicular cancer and osteopenia (from puberty blockers). The tumor weight causes testicular torsion. Treatment: During orchiectomy, a retroperitoneal hemorrhage occurs. An exploratory laparotomy is required to stop the internal bleeding.
Other Medical Diagnoses and Conditions Discussed
C. Diff Infection: Antibiotic-resistant infection treated with a Fecal Microbiota Transplant (FMT).
Gender Dysphoria: Distress due to mismatch between gender identity and biological sex.
Episode 15
Ectopia Cordis
Spirit is born with her heart outside the thoracic cavity. Treatment: Dr. Lim uses a "bionic sternum" made of resorbable material to expand the rib cage and house the heart.
Acute Cellular Rejection
Eric rejects a liver transplant. Treatment: A new liver is procured from a convict who commits suicide to ensure donation.
Other Medical Diagnoses and Conditions Discussed
Pulmonary Hypertension: High blood pressure in lung arteries.
Anesthesia Allergy: Severe reaction causing hypoxia in the donor.
Episode 16
Spinal Arachnoid Meningioma
Hunter, a paraplegic, feels neck pain. Diagnosis: A tumor is compressing the spinal cord, which had actually healed from the original injury. Treatment: Surgical removal carries a risk of death due to brainstem adherence but is successful.
Other Medical Diagnoses and Conditions Discussed
Septic Cosmetic Implant: Infection spreading from facial implants, leading to fatal septic embolism.
Varicocele: Enlarged veins in the scrotum causing infertility.
Episode 17
Moebius Syndrome
Gretchen cannot smile due to paralysis of the 6th and 7th cranial nerves. Treatment: "Smile surgery" involving muscle transfer from the thigh. Complication: She fails to wake up. Diagnosis is Plasma Cholinesterase Deficiency, preventing the breakdown of anesthesia. She wakes up once the drug clears naturally.
Other Medical Diagnoses and Conditions Discussed
Post-herpetic Neuralgia: Chronic nerve pain after shingles.
Septic Shock: Treated with broad-spectrum antibiotics.
Episode 18
Low-Grade Glioma
Dr. Glassman was initially diagnosed with an inoperable glioma, then aggressive Glioblastoma Multiforme (GBM). Diagnosis and Treatment: Dr. Murphy pushed for a biopsy via the nasal cribriform plate, which revealed a treatable low-grade glioma.
Disseminated Intravascular Coagulation (DIC)
Caden Hauley, a student with an ankle fracture developed DIC. Diagnosis and Treatment: The condition was caused by a pseudo-aneurysm in the aorta created by a surgical error. An endovascular graft repaired the vessel.
Other Medical Diagnoses and Conditions Discussed
Bimalleolar Fracture: Severe ankle break.
Pulmonary Artery Thrombosis: Clot requiring immediate dissolution.
🔖 Key Takeaways
🗝️ Diverse Pathology: Season 1 covers a vast array of conditions ranging from common trauma (pneumothorax, fractures) to extremely rare congenital defects like Ectopia Cordis and Craniopagus twins.
🗝️ Surgical Innovation: The show highlights cutting-edge and experimental procedures, including 3D-printed bones, tilapia skin grafts for burns, and fetal surgery on bypass.
🗝️ Diagnostic Persistence: A recurring theme is the value of questioning initial diagnoses; Dr. Murphy often identifies overlooked details (e.g., Kava root usage, faint ECG dips) that alter the treatment plan.
🗝️ Complex Ethics: Cases frequently intertwine with ethical dilemmas, such as organ transplant eligibility for alcoholics, parental rights in transgender care, and the risks of elective cosmetic surgeries.
🗝️ Anatomical Accuracy: The series places heavy emphasis on vascular anatomy (Circle of Willis, superior vena cava) and the physiological consequences of surgical errors.
Keywords: Medical Diagnoses The Good Doctor Season 1
Medical Diagnoses The Good Doctor Season 1
