HERO WORSHIP of the curmudgeon
A "crusty and ill-tempered" person is what the dictionary tells us a curmudgeon is. I have been accused of being a little curmudgeonly myself. So I am intrigued that the latest TV hero, Dr. Greg House of the Fox show "House," is the archcurmudgeon.
The TV doctor has evolved. From the dashing hunk (Dr. Kildare) to the genial, fatherly (Marcus Welby) to the bumbling and laughable (Frazier and Dr. Huxtable), we now have the drug-addicted, sarcastic Dr. Greg House.
My patients are loving this anti-hero. God knows why. His personality is epitomized by a quote from one episode: "Treating illness is why we became doctors. Treating patients is actually what makes most doctors miserable."
I have been pilloried for such politically incorrect sentiments. But this hard-hitting, in-your-face infectious disease specialist played by Hugh Laurie (in stark contrast to his former role as the upper-class English toff Bertie Wooster) has captured our hearts it seems. One blogger I read says, "The show is brilliant, and he is my new hero."
Nurses down on 'House'"House" has not captured the heart of the profession. The Center for Nursing Advocacy
Playing off House's premise that "everybody lies," the Center says, "The show itself is a damaging lie: that a team composed entirely of physicians would rove the hospital providing all significant care to desperately ill patients as the few nurses and other professionals stand silently in the background or simply disappear."
Each episode is centered around some desperately sick patient that no one can diagnose--until Dr. House reluctantly gives his dyspeptic attention, that is.
Like Sherlock Holmes--who, apparently, the character is modeled after--he does not tolerate fools gladly and is usually much too preoccupied with his higher cerebrations to be bothered. That is, until some fascinoma catches his interest.
Then, it's no-holds-barred until he diagnoses the arcane disease. In one episode, the patient is dying, but finally, after much brilliant sleuthing, House shows that the patient has cysticercosis (tape worm larvae) in the brain.
In real life, says the center for Nursing Advocacy, the diagnosis would have been made by some savvy nurse seeing tape worm segments in the stool as she emptied the bedpan. Not so romantic.
In another episode, a high diver contracts some obscure illness. And despite massive numbers of blood tests, imaging studies, endoscopies and bone marrow samplings (incidentally all done not by the relevant specialist or technician, as would really be the case, but by House's team of young roving debonair doctors), no one can diagnose the problem.
That is, of course, until House gets in on the act and observes how the male dive team members avoid her, apparently frightened off by the fact that they know she is pregnant. Her mystery disease is an obscure complication of pregnancy.
It's good drama, but it's not reality. The first test any woman entering an emergency room gets is a pregnancy test. It's an automatic, imperative part of the work-up, based on the somewhat chauvinistic assumption that all women are pregnant until proven otherwise.
So, in the real world, the diagnosis would have been made immediately, and the crotchety, limping, pill-popping Dr. House could have gone and sat in the doctors' lounge and had a cup of coffee.
Poetic license?Is it unfair to expect such a show to be realistic, accurate and lifelike? Should we allow the producers/writers some poetic license? Again, the medical press is critical.
In an editorial in Postgraduate Medicine, Y Pritham Raj, M.D., an associate professor of psychiatry at Duke University, goes so far as to blame the media for what he witnessed after a shooting at a
His explanation: Deaths portrayed in the media are "accompanied by the customary reaction of grief or horror, but there is complete omission of basic life saving steps. Help is rarely summoned. Instead the heroes or villains are left to die of gunshot wounds."
I guess the challenge is writing a show that will grip the public's imagination more than the humdrum cases we "grunts" of primary care see.
In another episode of the series, House is implored by his ex-lover to diagnose the abdominal pains of her mortally ill husband. It's an emotionally loaded business, as House obviously still has the hots for this old flame.
After the now-routine cliffhanger investigation, as the patient nears death, House sticks him in the bladder to collect a urine sample--which he then uses to diagnose the cove with porphyria.
Porphyria is one of those incredibly rare causes of abdominal pains that only the much-hated nerds in medical school would ever come up with.
I have never seen a case of porphyria--nor a case of cysticercosis come to think of it.
When I was a resident at S.U.N.Y. at Stony Brooke, I did do a rotation with a dermatologist whose patients all seemed to love him, even though he used to abuse them by telling them "here's someone who's worn out their welcome," for example.
On the whole, I always thought patients wanted the Marcus Welby type rather than Greg House. Am I wrong? Has this "anti-Marcus Welby," as he's been dubbed, really taken over as the type of doctor the public wants?
If you come to see me in the office, and I'm particularly gruff and don't seem to want to see you--I'm just doing a Dr House.
DR. PATRICK NEUSTATTER can be reached at pneustatter@prattmed.com.