What I’d like to know is the continuing fascination with this minuscule bit of classic TV trivia…in particular, how everyone not only feels compelled to take it so, so, SO seriously (I’ve not seen one “geez, get a life, you guys” comment anywhere), but to map out each and every thread with the last least tiniest bit of possible relevance. I mean, I understand the desire to get worked up into a foaming-at-the-mouth overanalytical lather over certain subjects (case in point…well, me 
), but I’ve seen a hundred screwball twists like this on TV. TV has pretty much always been weird. I see something like KITT jumping 15 feet into the air with no visible means of propulsion or Sarah McKenzie getting psychic visions, and I’m like “whoa…okay, then”. Making this big Tommy Westphall list strikes me as a massive, endless treasure hunt with no prize at the end. It just doesn’t strike me as rewarding.
And honestly, I think there’s a really simple explanation for the ending. St. Elsewhere is, in fact, fictional, but the vast majority of the events happening in it weren’t some little boy’s delusions. When the dad says “who knows what’s going on in his mind”, the implication is that nobody knows. I mean, think about it: what would an autistic boy know about medical terminology in the first place? The stories are works of fiction created by a talented writing staff, unrelated to whatever this kid’s been dreaming.
Here, I’ll put it another way: Suppose one day this boy, who’s a big boxing fan, writes out a fantasy about an unknown, spurred on by the recent death of a family member, getting the shot of his life against the world heavyweight champion who’s this terrifying force of nature believed by many to be utterly unbeatable. And the unknown gets pounded early, even getting knocked down, but manages to pull it together and score an unbelievable knockout and score the upset of the decade. Couple months later, Buster Douglas knocks out Mike Tyson. Wow, that must mean that the entire sport of boxing is a fantasy! Er…no. The underdog prevailing over the invincible champ is a common fantasy, an incredibly common trope, in fact. That a young boxing fan would come up with it is nothing special, and that real life would more or less follow suit at some unspecified point in the future is just a happy coincidence. (None other than Sports Illustrated had the headline “Rocky Lives”.) In fact, this wouldn’t even qualify as a neat coincidence since Tyson was clearly overconfident and unprepared, allowing Douglas to frustrate him for most of the fight; he wasn’t in any particular trouble prior to that knockdown.
Bottom line, every TV show exists in someone’s imagination. That’s part of what makes it so appealing. And I think getting all up in arms over one random little boy’s imagination is giving him way too much credit.
Oh, as for Newhart…in hindsight, and especially given how completely universally adored that ending was, I think the truth is nobody ever truly bought the show. I didn’t see the original Bob Newhart Show, but from what I’ve heard it was quite popular…so much so, in fact, that his fans flat-out refused to ever accept him in any other role. Typecasting, FanDumb, whichever. The final episode effectively stated that this was his one and only role, this was all he was and all he would ever be forever and ever, and anything you see to the contrary is just a crazy dream. That he never had any really major TV role after Newhart (yeah, I checked) supports this assessment.