House vs Scrubs - The "real" diagnosis
December 12, 2008 9:21 PM   Subscribe

Can doctors really diagnose illnesses like they do on TV?

I'm a huge fan of the shows House and Scrubs. I've noticed that in Scrubs, when the doctors are faced with a tough case (including Dr. Cox) that they sometimes have to resort to medical books and journals to find a diagnosis. In House, it seems all the doctors have encyclopedic knowledge of every diseases there is, including defects that are caused from inhaling cat urine, to a particular chemincal in a perfume that causes kidney failure to acute dichemodysentrophicmystemia due to eating lettuce grown in Iowa on the 2nd to last week of the growing season.

My question, can doctors, even genius doctors, really be *that* good at diagnosising illnesses, or is that unlimited knowledge of medicine a Holloywood convenience?
posted by FireStyle to Media & Arts (25 answers total) 14 users marked this as a favorite
(Gross generalization based on small sample size but..) In my experience volunteering or shadowing at hospitals, I've seen the young residents (Scrubs age) using the mobile internet on their blackberry/iphones, and glued to computer terminals. The House generation are generally older, more established physicians with many books and articles in their offices. And they all frequently discuss the tough cases. Tough diagnoses are generally team efforts, and it's not cheating to look for more information.

If you like these shows, you should ask around to see if you can sit in on Grand Rounds at your local teaching hospital. It's like House: Real Life Edition.
posted by abirae at 9:33 PM on December 12, 2008 [1 favorite]

This article may be of interest to you. I think a lot of doctors specialize though, and if it's some crazy rare disease that's afflicting you, they probably would have to call up some of their buddies or something.
posted by Geppp at 9:38 PM on December 12, 2008 [1 favorite]

You can see here for detailed medical reviews (by a doctor) of House episodes, which often includes commentary on what they should and shouldn't have known.
posted by Zed_Lopez at 9:39 PM on December 12, 2008 [19 favorites]

No one knows everything. A similar case: My father is a District Attorney, and he often refers to his many law books while preparing for trials and everything else related to his job. Reference is there to help and I'd say every professional uses it daily.
posted by DMan at 9:43 PM on December 12, 2008

Just a data point, but my mother is a nurse and can't watch House because it's so unrealistic. Mostly, from what I understand, because they run so many unnecessary tests and because of the ridiculousness of the diagnoses they come up with.
posted by MadamM at 9:48 PM on December 12, 2008

It's worth noting that it's through the cumulative efforts of House's ducklings that they have all the knowledge you mention (although House himself knows a good chunk, if not all, of it). Doctors specialize, and House chose his team to get a good range of specialties - he's infectious disease/nephrology (kidneys), Foreman is neurology, Cameron was immunology, Chase was intensive care, Taub is plastic surgery, Kutner is sports and rehabilitative medicine, and Thirteen is internal medicine - and Wilson's oncology/cancer. Between the lot of them, that's a huge chunk of modern medicine right there.

It's also worth noting that by default, House knows that he only gets the weird cases, so that saves him a great deal of brain-space right there. We've seen references a few times to him keeping up with the latest research, but watching him sit there and peruse the latest medical journals wouldn't be very good television.

As a patient with a diagnosis of elimination (chronic fatigue syndrome - a whole bunch of other diagnoses to knock out first), I've run through a lot of other doctors, including a few with quite an arsenal of knowledge. One of the most impressive was an infectious disease (hmm, maybe it's that specialization?)/chronic fatigue/fibromyalgia doc who appeared in our several hours together to know something about everything - but he didn't seem much like House otherwise, mostly because he, you know, actually talked to me.

You may also be interested in this article.
posted by bettafish at 9:48 PM on December 12, 2008 [1 favorite]

Oops, I see Zed beat me to it.
posted by bettafish at 9:49 PM on December 12, 2008

It's almost a cliche in medicine that the more exotic tropical diseases go un- or mis-diagnosed expect by a small number of tropical disease experts.
posted by orthogonality at 9:57 PM on December 12, 2008

This is a bit of a tangent, but I find it interesting how we expect doctors, lawyers, and other experts in their fields to know everything. I do this often when consulting with people who I understand are leaders in their field. "Oh my god, you had to look it up, in a book?"

More to the point, though, for rare diseases I am 100% positive that doctors will need to refer to case studies and other documents in order to diagnose a problem. How do I know? Well, I don't, but I just can't see someone knowing everything the way that House M.D. knows everything.
posted by aloneinvietnam at 10:14 PM on December 12, 2008

Not all doctors are that good. I am occasionally accused of being a walking textbook by some of my colleagues, but I am nowhere near it. Some of the professors I had the honor to train under were true walking repositories of knowledge; they could quote 40 years of journal-based literature with the same ease that I can refer to a chapter in the latest edition of Victor and Adams (a neurology textbook.)

There was one professor of rheumatology at Columbia who was locally famous because he actually did seem to know everything; he had another amusing property, which was that his average work day was about 18 hours. When he was teaching he was a delight to be around; he had no personality to speak of, no life outside of medicine and if you did not share his joy in the pursuit of medical knowledge he could be quite abrasive and dismissive. In the four years that I knew him, he saved hundreds of lives by making diagnoses that other brilliant professors had missed. The utility of a man like this is hard to overstate.

The best docs I have known have had their nose in journals and conferences and books all the time. As abirae says, this is not considered cheating. I probably spend 3 or so hours a week on PubMed just based on cases that I've seen that week; I'm always poking around in books or journals or chatting up other docs trying to satisfy my curiosity to learn something new, and that's probably another 6 or so hours in my week. I enjoy this part of the job.
posted by ikkyu2 at 11:46 PM on December 12, 2008 [10 favorites]

Is there any way in which real life is like TV?

posted by the latin mouse at 1:21 AM on December 13, 2008 [4 favorites]

I went to physical therapy school at a med school where all the future MDs would get together in the dorms and watch House every week and laugh, and laugh, and laugh.
posted by jennyjenny at 5:44 AM on December 13, 2008

Data point:
My mom's an MD, and says that whenever you go in to the doctor and they leave the room, they're going to check their books, just so they can be sure.
Even when I was getting shots this fall, my doctor looked at his books just to be certain how long a Hep shot would last. In this regard, Scrubs is more realistic.
posted by dunkadunc at 6:04 AM on December 13, 2008

I had a weird skin condition on my foot and the doctor totally came back with a medical dictionary to confirm a few guesses. Obviously not as dramatic as House but still kind of funny.
posted by sararah at 6:51 AM on December 13, 2008

Very little on doctor shows is real. Very little on lawyer shows is real.

Sometimes I wonder what the medical or legal consultants actually do for their money. They certainly don't require realism.
posted by megatherium at 7:32 AM on December 13, 2008

Sometimes I wonder what the medical or legal consultants actually do for their money. They certainly don't require realism.

Regarding House, the cases tend to actually be based on real medical mysteries that have come up with other doctors (or so I've read; I'm obsessed with the show). That's what their medical consultant is paid to do- find random exotic diseases, and it's up to the staff writers to make the exotic disease sound interesting to us lay folk.

Also recall that during some of House's clinic hours, it is not all that uncommon for him to need a consult. Granted, there's always a nefarious purpose, but the willingness of other doctors coming to his aid imply that consults are not that unusual. Not that the rest of the show is usual or anything.
posted by jmd82 at 8:10 AM on December 13, 2008

My dad's a doctor, and thinks House is the stupidest show on television. He told me once that if you set out to make a show that was the exact opposite of what being a doctor is like, you'd end up making House.
posted by EarBucket at 8:35 AM on December 13, 2008

I can't speak for ER, but shows like House, Scrubs, and Grey's Anatomy are based on real-life cases. For instance, the Scrubs episode "My Musical" was based on a real-life case. From the link:
Long-time Scrubs writer Deb Fordham took the challenge, and contacted the show's medical consultant, Jonathan Doris, who provided her with several case studies,[4] one of which ("Musical hallucinations associated with seizures originating from an intracranial aneurysm," published in the Mayo Clinic Proceedings) became the basis for Ms. Miller's condition.
Also from Scrubs, one of the featurettes on the season 1 DVD is an interview with the medical consultants where they talk about an appendectomy scene having to be flipped in post-production because the surgeons were removing the appendix from the wrong side of the patient's body.
posted by phrayzee at 8:52 AM on December 13, 2008

The book Supercrunchers has an interesting chapter on the rise of "evidence-based medicine" and large diagnostic databases. It really made it sound like you can check off all the symptoms and then it'll spit out a list of possibilities based on documented cases -- essentially, the exercise that House and his staff go through every week around the whiteboard. (I have no idea how popular tools like that are in the real world, but it certainly sounded cool.)
posted by liet at 9:10 AM on December 13, 2008

There was one professor of rheumatology at Columbia who was locally famous because he actually did seem to know everything; he had another amusing property, which was that his average work day was about 18 hours.
Sounds like my rheumy. At age 76 he still spent most of his weekends attending medical conferences and lectures, and he never left the office at night without a stack of bulletins and trade magazines. On his last day of work he felt some chest pains, had a nurse give him an EKG, and discovered he was having a heart attack. He popped a nitro tablet and saw his last two patients before calling an ambulance. Sadly he passed away two days later. Over the years, during my appointments he'd often pull out a reference book (usually the PDR) to check or confirm something, such as is there a newer version of such-and-such pill.
posted by Oriole Adams at 9:45 AM on December 13, 2008 [1 favorite]

Response by poster: These are some interesting stories. It's funny you mention how doctors need to refer to their books... and that is exactly why I made this post. Scrubs, in all its humor, has been said to be one of the most realistically depicted med shows (minus the making out in front of the patients! lol) which isn't surprising because it was written by ex-med school students. But they hit the books in scrubs all the time. In house, as much as I love the show, I noticed they NEVER open a book during a case (even they I have seen them read after a case) so I found that kind of odd.

I am a musician with perfect pitch, and when I was studying with a professor who also had perfect pitch in some SERIOUS ear training, he had an encyclopedic knowledge of music theories and composers and could pick them out on the spot. He'd pause the music every few seconds or so and rattle off every single musical device there is. So I think one could really know a lot without resorting to books to confirm, but the human body is so complex, with impossible to pronounce latin terms, that i thought it would be superhuman to know as much as house!
posted by FireStyle at 10:16 AM on December 13, 2008

House is lame. Are there doctors out there with encyclopedic knowledge? Yes, and I'm jealous of all of them. The main thing that's true is that most of the time the diagnosis comes from the history, not the lab tests or the physical exam. Patients will reveal their disease to you most of the time, if you listen.
posted by gramcracker at 12:06 PM on December 13, 2008

I'm just throwing this here to complete the meta-circle of life by linking to Dr. Cox's (Scrubs) take on House (start at 2:10 and watch for about a minute. the rest of the episode is kinda meh).
posted by phrayzee at 12:38 PM on December 13, 2008

I once had a conversation with my doctor over having information on a PDA. I was reading a book on mine, and he said he stored medical books on his and found it really useful.
posted by stoneegg21 at 2:56 PM on December 13, 2008

I love House. Watching it as a doctor is the medical equivalent of imagining what it would be like to win the lottery. Everyone's got something weird and interesting (reality: most people have something you've seen a thousand times, or something that isn't anything, or something that *no one* is going to figure out). You have time to sit around and think about it (reality: you consider the first 3 things that pop immediately into your head because you have 10 other patients waiting to be seen). You formulate an hypothesis and start a treatment and within minutes you see the results (reality: well, it will be 24 hours before that treatment is approved, another 4 hours before the pharmacy fills it, and another 2 hours before the nurse administers it. 6 days later the patient shows some kind of response). You need to get a procedure done, you just do it yourself (reality: the MRI schedule is full for 3 days, you need to talk to the supervisor to bump someone). You *never* do paperwork (reality: paperwork is what I'm doing about 50% of the time). Patients always get better once you've figured things out and basically return to their normal, productive lives once they get out of the hospital (reality: usually when one is hospitalized for something serious, after discharge they face months of follow up care and rehabilitation, FMLA, financial crisis, and insurance hassles). Come to think of it, the most absurd thing about House is that he's grumpy all the time.

I've known a few docs that seem to just know things off the top of their head. My wife is one of them. In fact, about 50% of the time, she has the case of the week on House figured out half way through. The thing is though that she still reads and looks things up all the time, as all doctors do. You have to, even if it's just to confirm your suspicions or to see if any new treatments have been discovered. Gregory Houses aren't born that way, nor did they get that way by cramming like hell during med school alone. That got that way by spending years and years being curious, seeing lot of patients, going to lots of lectures, and doing lots of reading. So they may not need to run to the text book when they see a case of leishmaniasis (the way I do) but they are certainly spending a lot of their time edumacating themselves.
posted by Slarty Bartfast at 3:32 PM on December 13, 2008 [4 favorites]

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