Comments on: Is there a doctor in the House?

Question: Is there a doctor in the House?

tellurian — Sat, 04 Aug 2007 06:58:23 -0800

I know that House is a TV construct but I'm wondering, are there doctors that perform this role in real life?

For example, if I was to turn up in an emergency ward with some weird and unexplainable condition, do hospitals employ a Gregory House that would take on my case?

By: cocoagirl

cocoagirl — Sat, 04 Aug 2007 07:13:32 -0800

A recent article from Discover magazine profiles "The Real Doctor House". What I gathered from the article is that the key to his ability lies primarily in his deep and broad understanding of his patients' lives, not just cracking the code of their odd symptoms. The article mentions that other doctors do refer patients to him.

By: paddingtonb

paddingtonb — Sat, 04 Aug 2007 08:16:12 -0800

This article on Salon (written by a nurse) is critical of the show precisely because of the implausibility of having a crew of 4 doctors (House and his team) who have medical expertise in EVERYTHING and just handle all the weird cases. The author's other beef is that these 4 doctors seemingly have only one patient at a time to hover over, as a opposed to real life where a doctor would have dozens of patients (particular to his/her specialty) at a time.

By: tellurian

tellurian — Sat, 04 Aug 2007 08:29:52 -0800

Yes! Exactly what I was looking for, 'unusual symptoms investigator'. Thank you cocoagirl. That's a really interesting article. You'll be getting a tick a bit later because I don't want to muffle possible further input.

By: tellurian

tellurian — Sat, 04 Aug 2007 08:42:30 -0800

Hell. I've finished the article now. I'd like, but don't need any more examples. Brilliant.

By: thebrokedown

thebrokedown — Sat, 04 Aug 2007 09:03:48 -0800

semi-derail: If you like this sort of medical writing, Oliver Sacks' books are very interesting.

By: Turtles all the way down

Turtles all the way down — Sat, 04 Aug 2007 09:12:36 -0800

paddingtonb: Don't know if this is mentioned in the article but the other ridiculous thing in House (which I love) is that the hospital seems to have no ancillary staff: House's four docs run the MRI and CT machines and do all the lab tests using just a few test tubes and a microscope. Oh, and they also do ECT themselves when they need to therapeutically erase a fireman patient's memory when he's having trouble getting over a girl.

By: cocoagirl

cocoagirl — Sat, 04 Aug 2007 10:11:10 -0800

The New York Times Magazine also runs an essay/case study on diagnosis fairly frequently.

By: theora55

theora55 — Sat, 04 Aug 2007 10:28:17 -0800

House is implausible on such a multitude of levels that it would take all afternoon to make a list. But Hugh Laurie is fantastic, sometimes the writing is quite good, and the ensemble works.

By: dagnyscott

dagnyscott — Sat, 04 Aug 2007 11:09:07 -0800

House is more of a detective show than a medical show, and House seems to be based on Sherlock Holmes more than anything. I know most people who work in medicine HATE House, but I've always liked Hugh Laurie

By: TochterAusElysium

TochterAusElysium — Sat, 04 Aug 2007 11:37:05 -0800

Don't know if this is of interest, but I recently had to go to the ER (just needed stitches for a bad cut)...being a big Hugh Laurie/House fan, I asked the doctor and nurses if any of them watched the show. None did (and they all seemed to have a certain amount of disdain for it), but one nurse told me they were more a "Scrubs" type of hospital.

By: feloniousmonk

feloniousmonk — Sat, 04 Aug 2007 12:24:34 -0800

Medical professionals probably have the same reaction to the show that I do whenever I see an interpretation of computer programming on television, but that said, most of the things that are "implausible" are simply dramatic conceit. Of course there aren't dozens of extras performing menial tasks! Have you ever seen a play?

By: ikkyu2

ikkyu2 — Sat, 04 Aug 2007 13:22:03 -0800

Most of the top university hospitals I've worked at have a couple older docs on staff who are known for their ability to crack difficult cases.

When a diagnosis isn't immediately apparent the task is to form a "differential diagnosis," a list of possible diagnoses; and then acquire and analyze evidence for and against the diagnoses on that list. These experienced doctors are good at making sure that the right diagnosis is somewhere on the list, and then making sure that the right evidence is obtained and put in the proper context.

Often, but not always, this doc will be a rheumatologist, an endocrinologist, or a neurologist. Much more rarely it will be a cardiologist or a surgeon. I have known a couple academic dermatologists who were crack diagnosticians.

At many teaching hospitals, consults are routinely called to many specialty services on all interesting or unusual cases. At the hospital I trained at, 40% of inpatients were seen at some point by neurology. Obviously they did not all have primary neurologic disease, but as the consult resident, that was for me (or the other residents) to figure out.

By: ikkyu2

ikkyu2 — Sat, 04 Aug 2007 13:32:36 -0800

As far as House goes, like any TV show there are elements of truth and elements of pure Hollywood. The idea of a medical detective reflects, to my mind, the essence of difficult diagnosis. But House doesn't go about it the way my old canny profs do; he does it the opposite way. He thinks up one diagnosis, pursues it till he's proven wrong, then homes in on another diagnosis, rinse and repeat.

This is what is informally known as the third-year medical student way of practicing medicine. In difficult cases, you want to have an open mind so you don't exclude the correct diagnosis before you're sure. That way you won't do something dumb, like give treatment that might be right for disease A (your working diagnosis) but all wrong for disease B (the true diagnosis.)

House often commits errors like this - recommending craniotomy when there is no CNS involvement, for instance. He also does not appear to have a specialty, and performs difficult medical diagnosis and treatment, psychiatric "counseling", neurosurgery, thoracic surgery, abdominal surgery, orthopedic surgery, and other things.

In reality doctors do not practice out of their own area of expertise like this - if a neurologist makes a non-neurologic diagnosis, for instance heart disease, the patient gets referred to someone who's more expert in that area, for instance a cardiologist.

House's personality is an enjoyable TV fiction, but something strikes me as a little off about it. It is not that he is a malignant prick, or a drug addict - I've known docs who were worse in each regard, although to be honest these traits are quite rare in my experience, and never combined. Drug abusing docs I've known only got found out after they got caught; they were all trying to keep a low profile so as not to jeopardize their access.

The malignant pricks, on the other hand, simply exist, and they torment anyone they can get away with. They tend not to be truly good teachers, preferring instead to torment under the guise of teaching - unlike House, who seems to be a dedicated teacher.

I've found that docs who are like that seem to have little insight into their own behavior, unlike House who seems to ruminate over his own problems quite a lot.

By: MadamM

MadamM — Sat, 04 Aug 2007 16:22:09 -0800

My mother used to work as a nurse for an infectious disease specialist- he practiced at a private office mostly but IIRC he had and used hospital privileges from time to time. He was referred patients from other doctors when they gave up and couldn't figure out what their patient's problem was. He ended up prescribing a fair number of hardcore antibiotics and so forth. The doctor himself was a slightly crazy ADD South African guy... interesting guy all around.

By: BrotherCaine

BrotherCaine — Sun, 05 Aug 2007 05:05:34 -0800

Read Medical Detectives, it's not quite the same thing exactly, but it is fun. There is a lot of difficult diagnosis.

Also, in one of Tufte's books (visual display of quantitative information maybe) he talks about John Snow's isolation of the source of a cholera outbreak. Chart.

By: junesix

junesix — Sun, 05 Aug 2007 07:54:32 -0800

If you're really into the medicine, you should check out the episode-by-episode analysis by a family physician. He grades every episode on plot and medical accuracy.

Derail: Most of the top university hospitals I've worked at have a couple older docs on staff who are known for their ability to crack difficult cases.

ikkyu2, when you point out that it's the older docs who have this ability, is it simply because of their years of knowledge and experience or is it specifically the older docs due to differences in how medicine is taught and practiced for the younger generation in the age of HMO's?

By: ikkyu2

ikkyu2 — Sun, 05 Aug 2007 12:08:25 -0800

Well, I think it's the years of experience, mostly, junesix; maybe combined with the fact that these are docs who have chosen to keep learning and studying in a lifelong way. Also, it seems to me that these traits are the reason that these folks are still sticking around a university - they don't tend to have an interest in running a busy practice or in funding their massive NIH research projects.

By: mdn

mdn — Sun, 05 Aug 2007 12:26:46 -0800

My bf's brother is a resident and hates House/loves Scrubs for exactly the reasons mentioned above. It's obvious that someone who pitched/writes for Scrubs went to med school, whereas whoever came up with House just invented their own version of how a hospital works. No one ever dies, House is a doctor and a surgeon and a lab technician, etc.

It's like The West Wing compared with so many TV/movie versions of the the white house that just have a president and a couple random aides who act as the press secretary and the chief of staff and the head of congress - never really taking seriously the notion that one person "can't do it all on their own" - and that even when stuff gets done it's not that much and there's lots of failure.

I still adore hugh laurie, though, and House is really funny, even if I find the savior element a teeny bit annoying.

By: odi.et.amo

odi.et.amo — Sun, 05 Aug 2007 17:40:11 -0800

If you get TLC in Australia, you should watch "Diagnosis X". It airs on Wednesday evenings at 9pm Est in the states. These doctors aren't diagnosticians, per se... just regular doctors who happen to encounter really difficult cases and eventually solve them. The show interviews the real doctors and they perform in reenactments of the situations. I've found it pretty interesting so far.

By: ikkyu2

ikkyu2 — Sun, 05 Aug 2007 21:49:37 -0800

These doctors aren't diagnosticians, per se... just regular doctors

Ouch.