A doctor reviews the science of "House"

Earlier this week at The Conference on World Affairs, I watched a panel about science in the movies. During the panel, physicist and science writer Sidney Perkowitz said that, out of all the people writing about science and medicine in Hollywood, the writers of House are some of the people who care the most about accuracy.

After I tweeted that, reader Jay Rishel pointed me toward Polite Dissent, a blog written by a doctor that periodically reviews the medical science presented on episodes of House.

It's a nice reminder that even the writers who care the most about getting science right, don't always succeed. That said, I am pretty impressed that, for the most part, the complaints the doctor-blogger has are usually closer to the nit-pick end of the spectrum. For a show that is so densely packed with medical information, that's pretty good. Some of the complaints about Season 2, Episode 1:

I’m surprised the inmate didn’t have a severely elevated blood pressure with the pheochromocytoma, and I’m equally surprised that his abdominal surgery went so well since pressure on the abdomen is enough to cause the tumor to release a large amount of adrenalin. This sends the blood pressure rocketing dangerously high.

The patient got over his respiratory depression remarkably quickly — one minute he’s sick enough to require intubation, and the rest of the time he’s fine. (And why wasn’t the endotracheal tube taped in place?)

It takes a great deal more alcohol than a few shots to clear that much methanol from the body, and that’s why IV ethanol is generally used.

Check out all of Polite Dissent's House-related posts.

Via Jay Rishel

Maggie Koerth-Baker is the science editor at BoingBoing.net. She writes a monthly column for The New York Times Magazine and is the author of Before the Lights Go Out, a book about electricity, infrastructure, and the future of energy. You can find Maggie on Twitter and Facebook.

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MORE: blogs • great moments in pedantry • medicine • Science

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http://evilbobdayjob.blogspot.com/ Deidzoeb

As it turns out, every diagnosis really should have been Lupus. ;(
mypalmike

The main thing they get wrong in House is that the doctors actually spend time trying to diagnose the problems their patients have. That conflicts with the primary objective of billing that exists in real doctors’ offices.
- DeeAnAy
  
  As a physician, I pretty offended by that statement.
  - Antinous / Moderator
    
    I worked at a major teaching hospital, and residents, students and attendings were in a non-stop frenzy of diagnostic activity. And that was on the surgical floor. In fact, there was quite a bit of joking about some far-fetched hypotheses. I don’t know if doctors in non-teaching hospitals really discover malignant hyperthermia or diabetes insipidus when it sneaks in.
    - Ashen Victor
      
      Diabetes insipidus is when a diabetic urine doesn’t taste sweet?
      - Antinous / Moderator
        
        Kind of. It’s unrelated to d mellitus, but the symptoms are similar.
  - mypalmike
    
    If you spend the time and resources on each patient that House does, I’ll switch to you as my PCP in a heartbeat. Even your broken sentence structure would not deter me.
    - twianto
      
      That’s not what you said. You said that doctors don’t “actually spend time trying to diagnose the problems their patients have” and that doctors’ “primary objective” is billing patients.
      
      If making money is all you care about you don’t go to (and probably won’t make it through) med school. There are easier ways to accomplish that.
      - AnthonyC
        
        Non sequitor. It could just as easily have been a commentary about what a ridiculous fraction of a doctor’s time is taken up by arbitrary paperwork required my insurance companies. That, too, diminishes a doctor’s ability to actually spend time with patients.
  - http://twitter.com/ethicalcannibal Ethical Cannibal
    
    As a nurse, I have seen 10 minute appointments in some offices, and pressure from above to get docs to move ‘em out to make room for more office visit income. I temped at an office where a doc started making us check cholesterol on every patient that came in to get the additional fee. I could go on and on.
  - 666beast1
    
    As a long term patient I find your offense comical. If the doctors I saw were any less engaged they would have been asleep.
steveboyett

Discussing the accuracy of diagnostics and treatment on House kind of misses the forest for the trees. I like watching House, but as it has progressed, it is increasingly taking place on some Bizarro world where clinics have unlimited budget and resources, no wait times, no protocols, no multi-patient multitasking, and no fear of liability. Any clinic or doctor that operated as this does would be out of business in minutes.

I don’t fault it that because I don’t think that’s House’s aim. But discussing aspects of realism on the show seem kind of moot, considering.
- koko szanel
  
  >taking place on some Bizarro world where clinics have unlimited budget and
  >resources, no wait times, no protocols, no multi-patient multitasking, and no
  >fear of liability
  
  sounds like every single cop show
Preston Sturges

I don’t think Dr. House would last more than a day or so in any real work place before he would send some administrator off on a screaming unhinged vendetta. In real life he’d be working in a warehouse and yelling at Alex Trebek from his Barcalounger.
- Uthor
  
  I think you’ve just described every episode that featured Cutty…
yrogerg

My recollection, from playing the “compare and contrast” game, was that one doctor show that tended to do even better than House did as far as getting the medicine right was, oddly enough, Scrubs, which presented itself as much more of a straight-up comedy show.

Working in health care administration, I have to admit that I also appreciated that they tended to spend a fair bit more time filling out paperwork/dealing with insurance/getting sued or suspended for their misbehavior, as well; it came a damned sight closer to realistic portrayal of what being a doctor actually entails.
- Daneel
  
  IIRC the BBC series Cardiac Arrest was meant to be pretty accurate, but it got canned for not presenting a positive enough image of the NHS.
Don

The thing that makes me nuts about House is this: there are no nurses in that hospital. None. No lab techs, no radiologists or Xray techs—pretty much any ancillary services are done by the doctors themselves. About as believable as the U.S. President answering the phones at the White House. Good thing there’s only two patients in the hospital at a time.
- Antinous / Moderator
  
  The one thing that always struck me as unrealistic in doctor shows is the idea that doctors marry nurses. In real life, doctors marry doctors. Occasionally lawyers.
- evanplus
  
  There are plenty of nurses, see any scene in the clinic. House’s staff doing all of the tests is explained in-universe by House not trusting the nurses. In real life it’s because it would be boring if the main characters just sent away for tests and then did nothing for 12 hours.
  - Don
    
    I get that they don’t want to clutter up the story with lots of other characters, it’s just impossible to suspend my disbelief that far. We have to believe he doesn’t trust radiologists or pathologists either, AND that his staff are proficient at everything.
    - Cefeida
      
      And that they have sufficient clearance to operate almost every machine and lab in the hospital…is that a normal thing?
soapdish

What the hell is wrong with Cuddy’s foot in that picture?
- Paul Renault
  
  It’s that she’s an intelligent, well-trained, powerful woman, and no one will take her seriously unless she wears shoes that were pulled from Bettie Page’s wardrobe.
  
  Ditto for Alicia Florrick, who wears shoes with heels longer than her knee-to-ankle distance.
  
  Yep, they’ve come a long way, baby…
  
  /Seriously, grab and enlarge the photo. There’s nothing wrong with her feet.
  - Antinous / Moderator
    
    It’s that she’s an intelligent, well-trained, powerful woman, and no one will take her seriously unless she wears shoes that were pulled from Bettie Page’s wardrobe.
    
    Ah, yes. Like the Bajoran freedom fighter, fresh from the Caves of Mascara in Lipliner Province.
  - soapdish
    
    Or it could be a photoshop disaster. I’ve seen quite a few shops in my time, you know.
- DrDave
  
  It’s the shadow of House’s cane.
  - Antinous / Moderator
    
    Is that a Roger Corman film?
AviSolomon

The show would have done a lot better if it had stuck more closely for medical content to the Berton Roueché stories that were it’s original inspiration:
http://en.wikipedia.org/wiki/Berton_Rouech%C3%A9
http://www.facebook.com/people/Peter-Dickson/1280707658 Peter Dickson

As a scientist I always object to calling the typical practice of medicine a science. Most MDs are not doing experiments (and I’m quite ok with that). They are doing the usual things in response to the usual inputs. That is not science. It is a valuable service, which I want to be done by a skilled practitioner.
- MandoZink
  
  My old girlfriend, now a PhD Microbial Geneticist, used to tell that medical doctors are really just technicians. They match symptoms to remedies. The real doctors are researchers, she asserted. Now I have to protest that assumption. My last physician did a lot of research – “Lets see, what useless test will his health plan pay for next?”
pjcamp

Linked to from the Wikipedia article for years. But it’s still a good site. I rather enjoy watching House with my stepson, the orthopedic resident.

The one thing we know its not is pheochromocytoma. It’s never pheochromocytoma. But they always suggest it is.
- Paul Renault
  
  Yeah, and in the CSI-type cop shows, it’s never petechial hemorrhaging.
  
  http://www.wisegeek.com/what-is-a-petechial-hemorrhage.htm
  
  /And in one ST:TNG episode, they flooded the nacelles with ‘deionized deuterium’….
Cynical

Intravenous ethanol?? That’s actually a thing? Where do I sign up?
- Antinous / Moderator
  
  In the emergency room. Maybe in the ambulance if you’re already seizing.
sadiej

My father is a physician and hates to watch House. He can’t bear to watch such a poorly run hospital. Coincidentally, I can’t bear to watch it with him because he almost always makes the correct diagnosis within the first five minutes.
marilove

Lupus? Nah, it’s never lupus (except that one time it actually was!).

I used to LOVE this show, but by the end of the 3rd season, I just couldn’t do it anymore. It was just … too much. It was too outrageous while taking itself way too seriously at the same time.
MandoZink

I could never accept House as even remotely realistic.
mr_mediocre

The reason Scrubs did well with the medicine is twofold, I think. First, the writers apparently got a great deal of material from actual doctors, who enjoy the “you think that’s screwed up? This one time…” type of story as much as any sysadmin. Second, the show wasn’t built around mystery maladies, so they could make use of perfectly normal anginas and blastomas and diabetic ulcers and prostate cancers. Things that House wouldn’t turn down the volume on his soap opera for.

(Ok, now I have this mental mashup of House and Scrubs going on. I want to see Hugh Laurie sing barbershop quartet with The Blanks.)