Friday, December 31, 2004


Scott at Polite Dissent has been writing about the mid (or so) season Fox replacement show House so I don’t have to. But I think I’ll mention it anyway. I agree with Scott about almost everything he says about the show, but I feel that I need to express my opinion that this is the best medical show in a long time. ER started somewhat strong (with a truly great pilot), but had already begun to succumb to its inherent problems by the end of season one (although the show has always been capable of the occasional really good episode). You really have to go back to St. Elsewhere to find a better show (the gold standard, of course, is Quincy M.E., a show that, thanks to strong identification with pathology, has made my job almost impossible to explain to people on airplanes).

Hugh Laurie (who I will parenthetically call Mr. Little just to be contrary to all the BBC watching snobs out there) is phenomenal, and the rest of the cast ain’t that bad, but he’s gotten so much attention for his paint peeling performance, that I have nothing to add. Omar Epps does a fine job, but has been singled out too much from the rest of the fine cast who all take a back seat to Mr. Little. But I’d rather talk about the medical aspects of the show, especially in comparison to the other major “medical detective” show on the air, Medical Investigations (MI), which I have written about before.

Let me start by admitting that House is not a perfect show. As in MI and other such shows, there is a tendency to up the ante on everything, so that any rare infection or drug with low percentage (but pretty bad) side effect comes off as ALMOST CERTAIN DEATH. Scattershot bizarre elements of the differential diagnoses are used to treat the patient, because much more likely explanations have been scratched off the erasable board because they don’t fit perfectly. Case in point, the woman in the recent episode who was very fatigued and was dying without a diagnosis was decided to have either tularemia (rabbit fever) or African sleeping sickness (both of which they admit didn’t quite fit) simply because they couldn’t think of anything else that it could be (I’m sure they could have come up with something a lot more common that didn’t perfectly fit - I don’t think that they even considered metabolic causes). I could follow this example out, talking about the other problem tendencies germane to this type of show (like when the doctors insist that the sleeping sickness had to be sexually-transmitted despite only one Portuguese report suggesting this could even happen, and proceed to rake the family over the coals about it till they caused the couple to separate, though the question of transmission was, at the very best, ancillary information… I could go on), but I’m here to say why the show is good, not to take pot shots at it.

The thing is, however the doctors take liberty with the execution of their medical knowledge, the whole show seems based on extremely solid medical understanding. The final diagnoses seem earned, and make sense. The differential diagnoses are thought out (apparently by someone who knows something), the tests chosen are generally correct, and many many moments seem piercingly true. The debunking of “if you hear hoof beats, think horses, not zebras” was edifying, the scrawling mnemonics on the erasable board and crossing through things conjured up memories of internal medicine rounds (aside – the leader of our internal medicine rounds, Dr. “Bo” Sanders, was so intuitive that he pegged me a future Pathologist - before I had decided to be one - after I uttered only 2 words to him – “Mallory bodies”), and the clinic scenes seem real even though the clinic set seems incredibly fake. And the odd mixture of high mindedness, contempt, the contentious relationship with political correctness, and the gallows camaraderie seems authentic when matched against my memories of academic medical training.

Scott isolates a very helpful point in one of his reviews, that I think all writers and producers for these shows should take note of. He coins the term “medical school disease” for those diseases that are talked about constantly in training, which you almost never see in practice. Just realizing that there are rare diseases that every doctor has heard about far out of proportion to the actual occurrence of the disease would prevent an entire type of error – the idiotic “a-ha, water is wet” moment - in all of these medical shows (I talked about this fact when I noted that everyone in MI was acting as if they had never heard of ontogenesis imperfecta when it is talked about constantly in med school - especially in ER rotations - and something like 2 questions a year about it show up on the step 2 boards).

The point is that even though House and MI are guilty of some of the same sins, MI feels utterly phony, and House feels authentic, despite specific lapses in reality (there is no way Dr. House could get away with acting the way he does – some other physician with an ax to grind would crucify him in front of a committee if he didn’t get thrown out over patient complaints first, unless he publishes a lot, which he doesn’t seem to – and they would never in this lawsuit shy environment force the guy to do a clinic). The show earns a pass in these areas. Right out of the gate, this is the third best new show of the year (after Lost and Veronica Mars).


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