One of my favorite pastimes in recent days has been watching the medical television show House, along with my 17 year old daughter, herself an optimistic and bright-eyed medical school aspirant.
Although there are some things about this show that are comical (if that be the appropriate term) from a medical standpoint, there is also a fair amount of learning and stimulation not only for the mind of an exceptionally bright soon to be physician but also for the somewhat fossilized brain of a longtime medical practitioner who has been in the business of making a diagnosis for a while.
The interesting parts of the show include the manner in which the characters, the elite diagnostic team of a community hospital that is renowned for its brilliant deductive skills, are led or rather goaded by their eponymous
chief, who is in turn satirical, vindictive and often downright sadistic. However, his cynical manner is effective in that it stimulates discussion and intellectual exercise and in that regard, brings out the best in the team. This is consistent with the method of postdoctoral and postgraduate training in the US, where one is constantly challenged and required to think on his/her feet with the goal of arriving at the correct specific diagnosis every single time.
This is a particularly satisfying goal in medicine which is at best an inexact science that deals with probabilities and statistics in no small measure, and where terms like ‘nonspecific’, or ‘not otherwise specified’ play no small role in day to day patient care.
In the TV show House though, the precise diagnosis, be it Fabry’s disease, Wiskott Aldrich syndrome, or the relatively trite lymphoma, is unfailingly arrived upon by a method of elimination and exclusion during a team discussion typically using a whiteboard and marker (although the lead physician’s savant-like qualities usually end up showing who’s the boss). The methodology is similar to Sherlock Holmes-ian deduction and the lead character of the show is to some extent based on that character.
The comical parts to me relate to such things as the medical team jumping from their chairs to perform every single procedure themselves, including (and not limited to) biopsies of all body parts, MRIs, endoscopies, and even angiograms (this is currently of slight concern to the radiologist community, battling as it is with turf and identity issues, and was even brought up in a recent radiology publication ****). Curiously, a radiologist is nowhere in sight anywhere during the show although there is plenty of radiology (occasionally radiologic images are displayed in reverse or upside down to my chagrin and to my daughter’s amusement, when I point it out to her). The convoluted interpersonal relationships in the show are also intriguing.
My own personal gain from watching the show has been an attempt to push myself beyond the vague “infectious/inflammatory” differential and try to add greater value in terms of specificity even in the ED setting in which I practice. As an example the other day I reviewed a chest radiograph which showed bilateral pulmonary alveolar opacities. When I called the ED physician, he informed me that the patient was in unexplained acute renal failure and had a tinge of hemoptysis. The thought that first crossed my mind was “Goodpasture’s syndrome” and the ED doc’s surprised appreciation when I proposed this diagnosis gave me the satisfaction that I had at the very least prompted a line of thinking that might benefit the patient sooner rather than later.
Art imitating life? Truly medicine is both an art and a science, and when entertainment is added to the mix, it can be heady and stimulating. And so 6 pm to me and my daughter is now increasingly being identified as ‘House time’, when diagnosis, deduction and drama combine to gratify both the mind and the spirit.