I don’t mean the acting or the characterization or the plot details. I mean how hard it always is for all these doctors, supposedly the best of the best, with the latest equipment and techniques at their fingertips, and working under the tutelage of a genius, to diagnose an ailment. They never hit on what’s really going on until they’ve considered and discarded half a dozen wildly different theories to explain the one set of symptoms.
I know it’s only a TV show . . . but it still instills doubts in me as to whether my GP really knows what he’s doing . . .
I start to think about it that way (well, the three times I’ve seen House)…
but then I remember that these shows are trying hard to make it seem professional. I think that they try hard to have a variety of things it could be. It seems like a good plot device.
Would it be better to watch a show where the doc comes in, hears the symptoms, then tells the person exactly what is wrong, or where the doc hears the symptoms, goes through a bunch of theories, has some personal revelation about himself, and saves the patient just in time.
I also could be completely misunderstanding what you are asking…but that’s ok, I’m trying…
Well, that’s the idea. House gets the most difficult cases, the ones that leave other doctors befuddled. A lot of the time, patients have multiple illnesses that help to hide each other, and many of them also have very rare diseases that nobody thinks of. Also, keep the clinic in mind, where House (and other doctors as well) easily diagnoses the people who walk in. It’s not that doctors are incompetent, it’s that he deals with incredibly hard patients.
The phrase taught to doctors in real life is, “If you hear hoof beats, it’s probably a horse, not a zebra.”
It means: look for the most common disease that fits the symptoms.
Well, I’m a zebra and I’ve been writing about a couple of rare diseases for 10 years.
Our patients get misdiagnosed routinely and with an incredible list of incorrect guesses. By the time the doctor has gotten down the list of maladies to our 30-in-a-million disease, years may have passed.
It’s not uncommon–even with the NIH researchers on whom I report–for the situation to be tricky in any number of ways–and this is a TV show, right? No conflict, no show.
Heck, my aunt went to the hospital with the “stomach flu” a few weeks ago, and it took them 4 days before they let her go, saying “yeah it was really just the stomach flu.”
Diagnosis isn’t always quick and easy. House likes to point out, too, that people lie and it makes it harder for doctors to come up with the absolute correct diagnosis without a lot of tests.
I honestly think that a lot of diagnosis is based on guesswork in order to hopefully get the best results the quickest. I’d be willing to bet this works 90% of the time. Good “guesswork” diagnosis comes with practice and experience.
When I was a kid I went to the doctor complaining of serious, persistent headaches. I got sent home with sinus infection medication. I ended up in the hospital a few days later with something that definitely wasn’t a sinus infection in the least bit. Most of the time the doctor would have been right and I would have felt better. But he wasn’t and I got passed up the chain of diagnoses until someone figured it out.
IIRC, when my son was about 2 years old, he got sick and was running a fever. Our Pediatrician gave us something for it and sent us back home. His temperature spiked and we were sponging him to try to cool him down. This went on for about 12 hours and about 3 PM of the second day, my Mother came by about 18 hrs after the last time she had seen him, took pone look and said to get him to the hospital ASAP. He was bright red and it had come so gradual that we had not noticed how bad it was.
The iced him down and called everybody and one doc said, “Scalded Child syndrome” or some such. My son was only the second case in Oklahoma history at that time.
You start with a really healthy kid and let him catch a bad flu or cold. Then before you get that knocked, he comes down with a staph infection and if he fights that long enough that it gets away from you before it is diagnosed, he turns bright red and soon dies.
Lucky for us, one of the docs had seen it in a different state before moving to Oklahoma and he recognized what was going on. We had almost lost him. That was in about 1970.
It was not “Staphylococcal scalded skin syndrome” but it was similar in that Staph was involved.
My point being that we were lucky in that we had an observant and knowledgeable doc that figured it out in time to save him. He was our “House” and we are thankful for him.
I have a stomach pain that comes and goes. You’d think that would be an easy diagnosis, but it has never been definitively diagnosed (it’s not an ulcer, it’s not likely cancer, it’s not the usual things that stomach pain is). It comes, I eat bland food for a week, it goes away. The human body is a very complicated piece of organic machinery, and it can be very tricky. I wouldn’t base my distrust of my GP on what I see on “House;” I would distrust him based on how he actually treats me (if I need to distrust him at all).
I thought this thread was going to be about how disturbed House is, and the things he does and the way he acts. Yeah, he is pretty disturbed (and disturbing).
I went to hospital some years ago, with what appeared to be all the symptoms of a coronary and came under the care of a cardiologist. They checked out a whole lot of stuff and decided I was clear. The cardiologist sent me for an exercise stress test after my discharge and when I went to see him about the results he told me I was fine. I told him that my father had been complaining of pains and intermittent shortness of breath for years and had been repeatedly cleared until only months before when it was apparent that he needed quadruple bypass surgery. The cardiologist said in that case he would have a precautionary thallium scan done because “after all the stress test is wrong 50% of the time.”
I asked him whether the thallium scan would produce a result more accurate than tossing a coin and he was taken aback by my attitude. I asked him how long he thought mechanics would be in business if their attempts to work out what was wrong with your car were only right half the time.
My mother also has a long history of deteriorating health that was not correctly diagnosed for years. Again it seemed to boil down to test results seemed to simply clear her of one thing at a time.
I heard some doctors add an addendum to the effect of, “… but keep your eye out for unicorns just in case.” In other words, you’re more likely to see common diseases rather than exotic ones, but don’t allow that thinking to cloud your judgement completely.
I was watching Dr G, Medical Examiner last night and she had on her table a perfectly healthy child who died at a theme park. Everyone wanted to know if the them park was to blame. It had to be, right? The kid had never been sick. Dr. G did her exam and couldn’t come up with a cause of death. She sent away all the samples for labwork, tox screens, etc. Everything came back fine. She’d had a very slighty elevated temp (99.something). Dr. G was very nearly in the place where, weeks after the death, every test done and she was going to have to tell the mother and the media there was no definable cause of death. Then she got out every single sample of hert tissue, not just those eamine. There, on a few of them, was the evidence for myocarditis (I think). A virus similar to a clod caused minor cellular changes to her heart which set up a deadly arrythmia.
People die for unknown reasons all the time. Not everyone is diagnosed in time, not eveyone is helped. House doesn’t bother me. At least they’re curious enough to make an effort.
I don’t watch ER or House or Grey’s Anatomy because I usually end up screaming at the tv “Yeah, right”. Our residents eat and sleep and work hard and joke and seemingly indulge in little romance and don’t say “Boo” without the attending right there. They are seldom arrogant or sarcastic or very decisive. They learn. They are working. Their instructors want to make good doctors. Most of what goes by is ordinary. Not good tv material.
Your GP probably knows what he’s doing or he would have been sued out of exisitence by now. He’s not an actor, just a doc who’s learned a lot and is transferring this to helping people live more comfortable lives every day.
Cyn OB/GYN RN–we delivered 10,000 babies in 2006 and none were on tv.
I am deeply disturbed by House’s complete lack of medical ethics and occasionally things like “Oh, there’s an experimental drug that’s in pre-clinical testing in dogs, let’s try that.” ( :smack: ) But I find it extremely of entertaining in a “oh geez, what now?” way. But that’s television for you. Can’t be bothered consenting patients properly? You’re my hero! But the diagnostic run-around doesn’t really bother me because you’d have a ten minute show if they kept getting it right the first or second time!
(Should I have been worried that my orthopedic surgeon told me House was her favourite show? Heh.)
Couldn,t computers be used to diagnose. Plug in the symptoms and you get whittled down to a tiny list of options. There must be programs to do it by now.
Heh, indeed. My priest says *House * is his favorite show. I think it’s because House gets to say all the things real-life doctors and preists want to.
Seems that more and more doctors are using Google to help in their diagnosis. Mind you, Google is a garbage-in-garbage out machine, you have to know what you’re looking for if you want to find it, so this method of diagnosis isn’t recommended for people who haven’t had training in what highly involved field they’re using Google to research.
But there’s all sorts of things that can cause the same symptons. Sore throat, runny nose, headache, and lots of coughing and/or sneezing? Why, that’s the Common Cold, except that the Common Cold is apparantly some rediculous number of minor virii with similar symptoms. I’m sure you get similar symptoms from a number of more serious diseases too, just that some of them are far more common than others.
Oh, and another thought on computers for medical diagnosis: Computers can fly airplanes and the space shuttle rather efficiently too. If my ass is strapped into a 747, the plane WILL be flown by another human with his ass strapped into the same plane. Just saying.
They might, IF humans had more single-disease only symptoms. Seriously, the doctor barely hears you when you say “headache” or “shortness of breath”, because EVERYTHING under the sun causes those. If something would be nice and simple like “Cooties varr., and nothing else, causes your index finger to become purple”, then any idiot could diagnose Cooties varr.
But IRL, you have people reporting SOB, chest congestion, wheezing and coughing. It is a chest cold (treat symptomatically), chronic asthma (treat with steroids), bronchitis, bacterial (treat with antibiotics), bronchitis, viral (treat symptomatically), or congestive heart failure (get in the hospital bed now)?
Even worse, people suck at giving their medical history. Even if they aren’t outright trying to lie to cover something up, they just suck at it. 9 times out of 10, when I take a health history, I ask, “Ever been hospitalized?” “No.” “Any major illnesses?” “No.” Then I get to the section on childhood illnesses: “Ever had tonsilitis?” “Oh, yeah, all the time! I missed school like twice a month for it every year until they took them out when I was 12.” Excuse me? You had your tonsils removed NOT in a hospital? Someone just scooped 'em out in your bathroom, maybe? When they’re missing large data points like this, you just know they’re missing small important ones, as well. Hell, denial being what it is, half the time they ignore symptoms and forget about them, or won’t report them for fear of sounding like a hypochondriac and being dismissed.
A good doctor knows what questions to ask to get as much of the real story out of a patient as possible. He’ll rephrase things and ask the same things three different ways to get to the truth of the matter. While it’s theoretically possible a computer could do that, I’ve stumped that online 20 Questions game plenty. I don’t want something that can’t guess “baby bottle” in 25 tries being in charge of my diagnosis and treatment.
) But I find it extremely of entertaining in a “oh geez, what now?” way. But that’s television for you. Can’t be bothered consenting patients properly? You’re my hero! But the diagnostic run-around doesn’t really bother me because you’d have a ten minute show if they kept getting it right the first or second time!