"Fortunately for these patients, I am programmed with the Hippocratic Oath."
The Doctor's program is stolen from Voyager and is taken to a world where all health care takes place within a facility that determines who gets the best care and who doesn't. Meanwhile, Voyager tracks down his kidnapper, a shifty man named Gar who has left a trail of victims throughout the area.This episode provides examples of:
- The Alleged Expert: Chellick was hired to administrate the planet's bureaucracy to relieve a crippling lack of resources. He does this by setting up an algorithm to allocate medical care which is obviously wildly inadequate to the task.
- In response to there being only limited supplies of a critical drug, that drug is withheld from critical patients and diverted to non-critical patients for what's essentially off-label use based on the algorithm valuing those individuals more highly.
- Quite aside from the horrifying humanitarian implications, the system promotes all kinds of perverse incentives. For instance, doctors who use fewer resources risk having their rations cut, making them less effective at their jobs, and risking their positions and careers. It's therefore in their best interest to requisition more supplies than they actually need (remember, the system is supposed to address a lack of resources).
- Badass Bureaucrat: Chellick is surprisingly astute. He catches on to the Doctor's attempts to subvert the system very quickly. This seems to be his species' hat, as they are known for their talent in administration.
- Beleaguered Bureaucrat: The doctors on the planet of the episode are forced to work in the unhelpful and obtrusive healthcare system put in place by Chellick. All important decisions about patient care, from who gets what medicine to what ward the patients are sent to, to where the doctors themselves will be working, is decided for them by a non-sentient artificial intelligence that decides everything by a vaguely defined algorithm. Interestingly, both doctors we see on the planet are less than happy with the bureaucratic system they're forced to operate in despite doing so at different levels, and both are very receptive when the EMH provides insight in how to exploit loopholes.
- Beware the Nice Ones: The Doctor demonstrates what happens when you put a healer in a situation where he has to cause harm to save lives.
- Beware the Silly Ones: Neelix, of all people, is the one to get Gar to talk, by giving him food chock full of Talaxian spices, much to the surprise of Tuvok who was threatening Gar with a Mind Meld.
- Bittersweet Ending: The Doctor's plan to poison Chellick and put the proverbial shoe on the other foot goes off without a hitch. But afterward, all the Doctor can think about is the fact that he just poisoned a man. It goes against everything he was made for, and he's deflated to find that this decision was not a malfunction, but his own free will.
- Borrowed Biometric Bypass: The Doctor uses this in reverse on Chellick, poisoning him in such a way that the computer reads him as the deceased Tebbis, disease included. Stripped of his authority, Chellick has little choice but to comply with the Doctor's demands if he wants to be treated, much less have the Doctor undo his sabotage.
- Boyfriend Bluff: Captain Janeway and Lt. Cmdr. Tuvok pretend to be romantically involved as they talk to one of the people that Gar came in contact with.
- Chekhov's Gun: Neelix remembered about the spices that gave Gar indigestion and decided to use them again.
- Cold Equation: Chellick sees this as the essence of his job. He was hired to make the hard decisions others can't or won't.
- Colour-Coded for Your Convenience: Each level of the facility has a different color designation depending on T.C. score. In descending order: blue, green, yellow, red, white. The highest T.C. scores are at Level Blue with the best care, while the lowest T.C. scores get Level Red which is strapped for resources. White is the morgue.
- Con Man: Gar is a serial huckster. As Voyager tries to retrace his steps, each person they talk to gives a different tale of being swindled. His lover's request that they ask him to come home implies that he probably ran out on her too.
- Continuity Nod: The Doctor mentions the algorithms Seven promised to create to secure his Morality Chip in "Equinox".
- Crisis Point Hospital: Level Red, which is for the common rabble, fits the trope description — overcrowded, insufficient resources, people dying left and right. Level Green is implied to be even worse, and Level White is a euphemism for the morgue.
- Doctor Jerk: Chellick is a medical administrator, rather than a doctor, but otherwise fulfills this trope. His entire job is denying medical care to those who he deems unworthy of it, and shows zero concern for how it impacts anyone. Chellick eventually gets his comeuppance when the Doctor decides to poison him with Tebbis's illness, putting Chellick in the Level Red and forcing him to change his thinking.
- Does This Remind You of Anything?: People with treatable illnesses going without vital medicine because they aren't "valuable" to society. Dinaali society just makes the denial of care official rather than letting it happen by economic default.
- Dramatic Pause: In The Doctor's Catchphrase when he realizes that he is no longer on board Voyager."Please state the nature...of the medical emergency?"
- Foreshadowing: The back of the elevator in the care facility shows the different levels by color. Given Level Blue with the best medical care is at the top and Level Red with the worst medical care is second from the bottom, it's easy to infer that Level White, the very bottom level, would be the morgue.
- From a Certain Point of View: The Doctor assumes that Level Blue is the critical care unit. Chellick says that it's critical that these patients get the best care.
- Get Out!: For the nurses on Level Blue, a simple "You may go" is sufficient.
- Good Cop/Bad Cop: Subverted with Tuvok and Neelix. Tuvok threatens a Mind Meld while Neelix brings a homecooked meal to Gar. Neelix turns out to be the bad cop in this scenario.
- He Had a Name: The Doctor is pissed at Chellick for referring to the deceased Tebbis as "Patient R-12", since he sees all patients as worthy of care, not statistics.
- Hoist by His Own Petard: After spending the entire episode trying to get the Doctor to follow the rules, Chellick is not happy when Dysek does exactly that.Dysek: I don't want to break the rules.Chellick: I MAKE THE RULES!
- Hope Spot: Tebbis starts recovering nicely with the help of cytoglobin injections—and then he dies when his medicine is cut off and his infection worsens.
- Hospital Paradiso: Level Blue. The Doctor rejects it in favor of Level Red, where he feels he's more needed.
- Human Aliens: The Dinaali have no alien makeup whatsoever. The only difference demonstrated between them and humans are internal scans.
- Hyperspeed Ambush: Voyager pulls one on Gar to keep him from escaping, downwarping right above his ship and grabbing it with a Tractor Beam.
- Hypocrite: When Tuvok tells Neelix that poisoning a prisoner is a violation of Starfleet rules regarding the treatment of prisoners, Neelix points out that Tuvok threatened to use the mind meld on Gar, which is also a violation of those same rules.
- I'm a Doctor, Not a Placeholder:Chellick: We're healers, not killers.
- Inconvenient Hippocratic Oath: Subverted in one instance where the Doctor purposely poisons the man in charge of the medical facility in order to get better health coverage to those of a lower societal status.
- Jerkass Has a Point: While Chellick's system is deeply flawed, and his total lack of empathy is disturbing, he points out that he's been hired to fill a difficult but necessary function. In a society with insufficient medical resources, someone has to decide who gets treatment and who doesn't. He was hired to make those hard choices because none of the locals are willing to do so. Both Dysek and Voje tell the Doctor that conditions on their world improved significantly after Chellick’s people took over administrative functions. The Doctor forces him to learn some empathy, but it's not like the circumstances on the planet are really going to change.
- Laser-Guided Karma: After purposely letting Tebbis die, Chellick is injected with Tebbis's illness by the Doctor in a fit of desperation, and he is sent to Level Red, where he is left to die. This forces Chellick to reconsider his ethics and move all surviving Level Red patients to Level Blue so they can live.
- Lethal Chef: Neelix purposely poisons Gar's food with indigestible spices so that he could get his cooperation in retrieving the Doctor's program. He succeeds.
- Medical Drama: An episode that focuses on the Doctor as he struggles to deal with the finicky ethics of the facility he ends up working for (against his will) while trying to heal the patients there.
- Mind Meld: Tuvok was about to attempt doing this to Gar to extract information from him when Neelix shows up with an alternative form of interrogation.
- Misapplied Phlebotinum: The treatment for a deadly disease is also effective as a more mundane wellness medication, and is being predominantly prescribed for the latter use. The Doctor finds this appalling, as they're letting a treatable disease run rampant just so already-healthy people can live a bit longer.
- Mood Whiplash: The episode's A-plot is the Doctor's attempts to treat dying patients, culminating in the death of a boy he'd befriended and deciding to take drastic measures. The B-plot is Voyager trying to find him by giving a man indigestion, arguing with other outraged traders, and Janeway becoming hilariously more exasperated with each passing interview.
- Moral Pragmatist: Dysek accepts a system that allows level red patients to die while the medicine that could save them is used to help level blue patients live slightly longer. The Doctor convinces him to rebel against the system by pointing out that the Allocator will "reward" his efficiency by reducing his resources until he doesn't have enough, at which point his cure rate will go down and the Allocator will downgrade him.
- My God, What Have I Done?: Afterwards, the Doctor is seriously disturbed that he deliberately infected someone with a deadly disease, and can't simply blame it on a malfunction.
- The Needs of the Many: Seven says that the Doctor was merely sacrificing an individual to help the collective. The Doctor doesn't find the Borg philosophy comforting, especially since that was close to the explanation that Chellick gave for denying patients life-saving care.
- No Good Deed Goes Unpunished: The Doctor manipulates the system to requisition medicine for Tebbis, but the system recognizes that Tebbis has been given said medication and thus refuses to approve treatment for a secondary infection he contracted, leading to his death.
- This is the flaw in the Allocator's system that convinces Dysek to turn. If a doctor is too efficient, the Allocator will give them fewer resources, and continue to do so until their cure rate goes down, at which point the Allocator will downgrade the doctor.
- No Time to Explain: The Doctor says this when asking Voje to smuggle him back to Level Red, as he's going to be deactivated in less than a minute.
- Oh, Crap!: Gar gets pretty unnerved when Tuvok threatens him with a Mind Meld, and again when the Talaxian spices in his meal start to wreak havoc with his digestive system.
- Reasonable Authority Figure: Dr. Dysek. It's hinted that he's no less unhappy with how the Level Red patients are callously treated, and aids the Doctor's efforts on several occasions, either by turning a blind eye and congratulating the Doctor on how he learns to game the system to benefit them both, and later refusing to treat Chellick while giving the Doc a "consult."
- Screw the Rules, I'm Doing What's Right!: Pretty much everything the Doctor does on the planet, bending or breaking every rule to care for Level Red patients. Even poisoning Chellick with a deadly disease was for the purpose of getting better treatment for the Level Red patients and forcing Chellick to learn more empathy.
- Socially Scored Society: The Doctor has to deal with an alien world where each citizen receives a "T.C." or treatment coefficient from the Allocator, which ruled how useful a person was to society. The higher the T.C., the better healthcare they get.
- Surrounded by Idiots:Tebbis: I've never met a doctor like you.
Doctor: Well, it's not hard to stand out when the general level of competence is so low. - Swiss-Cheese Security: One of the most egregious examples in the series, as the Doctor is stolen from Sickbay. Justified by the fact that the EMH was intended to act as a short-term emergency replacement, and since mobile emitters weren't invented yet, they could only function in a holographic environment. There was really no reason to design an EMH to be difficult to steal.
- Triage Tyrant: Administrator Chellick, whose policies decide who's socially important enough to receive better treatment while leaving the Level Red patients to die.
- Ugly Guy, Hot Wife: The fat schlub and the Ms. Fanservice wife who left him for Gar.
- Wham Line: Voje telling the Doctor that Tebbis has been moved to Level White and what that means:"It's the morgue."
- What the Hell, Hero?: Voje is appalled that the Doctor infected Chellick after having given Voje several lectures on medical ethics and where a doctor's duty lies. The Doctor isn't blind to the hypocrisy, but feels he's been backed into a corner and has no other option.
