It all started with the notebooks.
When Eric Manheimer, MD, arrived at Bellevue Hospital in New York City in 1997 as its new chief medical officer (CMO), "one of the things I did was I started walking around with a notebook and taking notes on everything I saw," Manheimer explained during a phone interview at which a public relations person was present. "I still do it to this day. I was very interested in the patients that came there and their stories -- why they were in the hospital and what was driving it."
Outside the hospital, a lot of political things were going on; for instance, the Sept. 11, 2001 attack on the World Trade Center happened a few years after Manheimer arrived. "So I combined in the notebooks the patients I saw, the political issues with City Hall, and what was going on internationally ... I ended up with 150 notebooks when I sat down to write a book in 2011."
In the book, Manheimer said, "I wanted to tell the story of the social and political things festering in this country, but I wanted to tell the patients' stories that could narrate it ... So I went through the notebooks and chose 12 patients that illustrated 12 important themes."
Twelve was a sort of arbitrary number, continued Manheimer, who left Bellevue in 2012 and is now a clinical professor at New York University. "Twenty seemed like too many and five was too small." He wanted to discuss issues like drug addiction, incarceration, and the obesity epidemic more in-depth. "I chose patients that I could approach, go to their homes, get to know them. I found people who were extremely cooperative, and that enabled me to get into in-depth discussions with them."
Patients' Backgrounds are Important
Manheimer's book, , was published in 2012, a few years before discussions of the "social determinants of health" became popular. "To understand patients and where they're coming from, you need a broader lens than just seeing them in a clinical office," he said. "You need to know more about where they're from and what's going on [in their lives]; the context is missing. It's too narrow, too thin, too airless. So my interest in those topics really aided me in getting a much more profound telescope to understand patients."
In the average consultation room, "with just you and the patient, you don't see their family, where they live, their relatives, their friends ... and you're missing a lot of vital information about what drove the patient to the office," Manheimer continued. "A very substantial amount of hospitalizations are related to social determinants [which are] not part of the interview. So I found it really unsatisfactory trying to understand the patient and their environment."
Manheimer had no idea about what was coming next -- interest from TV networks. "I got a call one day from my literary agent, who said, "Eric, there's some interest in one of the networks in buying the book.' So the first thing we did was get a Hollywood agent" to work with the literary agent.
Eventually, four networks were interested in making the book into a TV show, "but I chose NBC because I felt they had the best appreciation of the kind of story that I wanted to tell, which included the social determinants as well as interesting medical stories," he said. "Living in this country every day [means] living with the issue of immigration, and a massive opioid epidemic [as well as] significant problems in the delivery system [with] runaway costs that are not sustainable ... This is affecting our entire society in a very serious way." The show that NBC developed — as well as the hospital where it is set — is called “New Amsterdam,†a reference to New York City’s original name.
Putting the Caring Back In
The show's protagonist, Max Goodwin, "is bringing caring back into medicine. What has been leeched out of medicine -- as it becomes a marketized business and a commoditized business -- is the caring part ... That is universally understood by patients and physicians. The profession is suffering tremendously because of this, so what he's changing is bringing physicians and patients in the front and [making it a place] where caring comes first."
In the first episode, which airs at 10 p.m. Eastern time on Tuesday (Sept. 25, 2018), Goodwin is himself diagnosed with cancer. "I was diagnosed with [squamous cell throat] cancer a number of years ago, and went through a rigorous, difficult treatment; I had a difficult course [of illness] with lots of complications and it changed me tremendously," said Manheimer. A year after he recovered from the throat cancer, he diagnosed himself with melanoma and was treated for that as well. "There will be a lot of similarities [with my own situation]."
"Essentially, I downloaded my experiences as a physician administrator, a leader, and a CMO in this environment to the writer team," added Manheimer, who is also a writer on the series. NBC has a team of 10 writers for the show in California, with one principal writer for an episode usually on the set in New York, "so there is a lot of flying back and forth from Los Angeles to New York," he said.
Will it Resonate?
Manheimer had just returned from filming part of an episode at Kings County Hospital in Brooklyn, one of three filming locations for the series. "We filmed a wonderful scene and there were about 180 people there, from actors to experts," he said. "It was a beehive of activity, with directors, producers, and cameramen. It takes an enormous effort to make this happen and bring it to life."
Bellevue is the oldest hospital in the country, dating back to 1736. Although it's mostly known for its psychiatric ward -- which includes patients with many native languages as well as prisoners from Rikers Island -- it also has an obstetrics ward, a pediatric ward, and other hospital services (Manheimer noted that two of his own grandchildren were born at Bellevue). However, because it's such a busy hospital, the crew can only film scenes at Bellevue on the weekends, so the series producers also use some formerly "mothballed" inpatient units at Kings County as well as two soundstages in Westchester County, where they can reproduce specialized sets such as an ICU.
The goal is for people "to see [the show] and have it resonate with them, and to understand that these are big social issues," he said. "We don't have the solutions to these issues but we want to put them on the table. It's not a 'Sherlock Holmes' about a tricky case [or a] doctor with a psychiatric illness who is able to pull rabbits out of a hat. It's about dealing with complicated social situations and taking care of people in that environment."
Manheimer said he hopes his fellow physicians will be interested in watching the series. "I think a lot of it will resonate with them, and I would love to hear what their thoughts are," he said. "There are much bigger issues facing medicine than any one particular doctor is going to deal with, and I want to get those out on the table ... I'm curious to see how it resonates with them."