I admit it — I watch medical television shows, and have recently been binge-watching the "House, M.D." series. My wife cannot understand because, as she says, "You live it all day long, and then you want to watch it on TV?" Maybe it's because I like to appear smart by pointing out the ways in which the writers got a medical term or concept wrong. Maybe it's because I want to imagine my practice as dramatic as those on TV, saving lives in a thrilling and effective manner. Or maybe I just find it entertaining. Regardless of the reason, I have found that I actually learned some things from the curmudgeonly brilliant diagnostician Gregory House, MD, that have actually made me a better physician.
The history and physical (H&P) is paramount
Dr. House runs the lone department of diagnostics (in the country) because of being so gifted at diagnosing patients that no other physician could. He is also the epitome of a jerk. He has the tactless habit of not lowering himself to actually seeing his patients, but instead relies on his carefully chosen team to do the "dirty work." In many of the episodes, he ends up finding that diagnosis by hearing something about the patient's condition that his team failed to mention initially, creating a great epiphany. It will then frequently follow that he will go into the patient's room and point out an anticipated physical exam finding that his team missed, confirming his suspected diagnosis and saving the patient. The importance of the H&P continues to slip as more and newer technology gains wider use, but if you listen closely enough, the patient really will tell you what the problem is.
Even physicians have problems
The first noticeable thing about Dr. House is that he has a considerable limp and walks with a cane due to a prior major surgery on his leg. He is also addicted to narcotic pain medication. This occasionally leads to questionable decisions made in his patient care.
This obviously brings up very relevant and significant issues in physician mental health, substance abuse, and even suicide. There has been more press about these issues in recent months and years, but there are likely thousands of physicians with mental illness and/or substance abuse that have yet to seek help. The show raises these substantial concerns in the personage of Dr. House, who is visibly miserable and whose life appears in shambles due to his chosen profession and substance abuse. Help is eventually sought, but only after years of heartache to himself and those close to him.
Think outside the box, but play the percentages
Dr. House does not play the percentages when it comes to diagnosis. Being the best at recognizing unusual diagnoses, he can often fail to see more likely (and thus boring) conditions at the expense of the patient. A large differential diagnosis is crucial to make sure that something is not missed, but understanding the odds of the most likely diagnosis and successful treatment should be focused on first. It's exciting to make diagnoses that your colleagues have forgotten about or never heard of, but the reason they are referred to as rare is because, well, they are. One of the best ways to counteract this is to not be confined by the diagnoses specific to your specialty. Think outside the box, but act within the odds of what the problem most likely is.
Advocate for your patient
For all of Dr. House's faults and eccentricities, he will fight tooth and nail for his patients. He will buck all administrators, colleagues, and standard practices to ensure that his patient gets the utmost care to save or improve their lives. Patients obviously come to us at their sickest and most vulnerable, at a time when they most need an advocate against any barriers they may be facing. Patients may not have a way to recognize the extent of your medical knowledge, but they will never turn on someone who fights fiercely for them.
While "House, M.D." is a dramatic television show with multiple inaccuracies and stretches of reality, it can provide some directions and reminders for physicians on how to improve ourselves in a challenging profession. In the end however, you don't need to be brilliant or have your own television show to be a good physician.