Wednesday, July 16, 2014

The Fallacies that House Built

First, a disclaimer: I am not a doctor and I am not giving medical advice. I'm more of a couch potato giving advice on how to watch TV.

What the hell does being a doctor, or watching TV, have to do with a caricature blog, you ask? Well, Hugh Laurie has an awesome face. I played around with it and did a quick digital doodle of him, but I'm not quite satisfied yet. I'll be drawing him at least a few times more. Rich features and bone structure there. You can see his young face (and native accent) on Laurie & Fry, an old British comedy also available on Netflix instant, for any of you who want something Monty Python flavored but who have memorized all of Flying Circus already.

House has long been on my list of things to check out. Dr. Gregory House is based on Sherlock Holmes, as Baker Street fans already know, which makes for some quirky dialogue and fun relationship friction . . . and every now and again a direct reference makes its way into the show. Doctor Wilson (who is the de facto Watson of the show) at one point talks about "hearing zebras instead of horses," and then in a later episode tells a group of doctors a lengthy lie about "Irene Adler," some woman whom he claimed House was infatuated with. And instead of a solution of cocaine, or the occasional bit of morphine that the original Holmes indulged in, Dr. House is hooked on vicodin and sometimes other, stronger pain-killers.

Netflix has all the seasons available on the instant download, and I found them perfect for what I needed. See, I recently took on a huge pile of commission work and it drives me bananas to not have something in the background as I draw. Some find that distracting, and I would never recommend it if one is doing something verbal-based (for instance, I can't watch TV and write, I need silence for that). But for repetitive actions like filling in swaths of color? I love me some podcasts, talk shows, or interesting-but-not-too-enthralling TV shows. I cannot work during really impressive shows like Game of Thrones or Walking Dead, because every frame is gold. House though? It's pithy, but for the most part predictable. While House has been trumpeted as a "skeptic" character and launched a thousand memes with snarky quotes from the show, I'm not exactly watching it with eyes glued to the screen . . . and if I really want to see the explosive bloody diarrhea that just coated the guest star's hospital bed, I can just pause and rewind.

I'm up to season 5 so far and have seen quite a bit of explosive bloody diarrhea.

The show introduces one or two medical mysteries that are resolved by the end of the episode (think Law & Order, but with doctors), and so it's no surprise the scripts are formulaic. But there's a sort of comfort to formula 42-minute dramas . . . Law & Order has eight hundred spinoffs for a reason. Not to mention the cool guest stars that sometimes have popped up. I got to see Jeremy Renner as a punk rocker who coughs up tons of blood, Felicia Day as an organ recipient, and Dave Matthews as a brain-damaged savant. That last episode is worth checking out just to see Hugh and Dave jam on the piano together.

But medically. Oh, ouch, medically. As I said above, I am not a doctor. But I am not a moron either.  This show gives me flashbacks to college, when I tried watching Chicago Hope with my roommate, who was working at a hospital and attending dental school. Between laughing fits, she would say "Uh, no, that doesn't happen," quite frequently. When one episode showed the transplant-harvest lab monkeys being brought down to the cancer ward so that sick kids could play with them, she near about had an aneurysm.

Paging Dr. House . . . it's 34 minutes into the episode!
House, indeed, has unrealistic medical things all over the place, and the very nature of the 42-minute-drama formula plays into the false medical information. The doctors (who should be used to seeing blood all the time, I mean, they're doctors) never seem to get really worried until that precise moment in the show, around minute 34, when a patient starts gushing blood from a particular orifice--or all of them. The writers use blood as a touchstone because of its visceral value to all human beings: most of us get panicked when we see it. So, like clockwork, the patient will become an Old Faithful of the red stuff whenever the story needs to signal viewers "okay, shit's getting real now!" Blood gushes from noses, or ears, or it gets vomited out, or comes out mouth, nose, and eyes simultaneously, or gets pooped all over the bed, or a catheter bag that should contain urine instead has--you guessed it--blood, and even once they had a doctor get wide-eyed and say "you're sweat . . . you're sweating blood!" as the camera zoomed in on little blood droplets and dramatic music crescendoed. The blood on this show has its own theme music, it's really one of the stars.

And then by minute 38, Dr. House, or his team, in conjunction with some teeny tiny clue they found while illegally breaking into the patient's home (when was the last time your doctor cared so much that he or she broke into your home?), figure out the diagnosis. And usually they save the patient. Not always, but usually. Not only that, but the out-on-a-limb nutty diagnosis is usually the right one, and House often dismisses previous doctors, who had made perfectly sound diagnoses based on the presenting symptoms, with "They're idiots." I wondered how doctors felt about the show . . . but then I remembered the internet! People post opinions on the internet! Indeed, some doctors had actually compiled a list of medical quibbles, dissecting every episode point-by-point. And you thought I was a skeptic busybody.
The Amazing Randi, who is a delight and generously gives
of his time to skeptically pose with many attendees at TAM.

Speaking of skepticism, this past weekend I was able to attend The Amazing Meeting, a yearly get-together of skeptics, science educators, and activists who seek to spread rationality and combat bunk. And, oddly enough, House came up. This year's theme was the brain, and Dr. Steven Novella, a neurologist who runs my favorite weekly podcast, The Skeptic's Guide to the Universe, mentioned the show and how it has changed the assumptions of some patients who come to see him. Dr. Novella told the crowd about a patient that had presented with a laundry list of what are typically referred to as "non-specific symptoms." Fatigue, headaches, soreness, and so on. She had been to some other specialists but none had found anything wrong, so she was now getting an MRI. When he went over the results with her and said there was nothing abnormal in the MRI, she started crying. Not crying in relief, just crying, agonized that there was nothing visibly wrong.

He said he's been seeing more and more of this type of reaction, and he has termed it the "Dr. House Effect." Patients have taken the House formula to heart: on that show, they run test after test, and the victorious moment comes when the really smart doctors finally make a successful diagnosis and treat the patient, who then gets better. If they cannot beat the clock and diagnose something, well then, that patient dies. No specific diagnosis = death. That's what this poor woman was internalizing; she thought that having a normal MRI was actually bad news. Dr. Novella had to reassure her that the "normal MRI club" was definitely where she wanted to be. Having a confirmed brain tumor or neurologic defect is way worse than having some symptoms that seem mysterious because they're unexplained. And, in actuality, not every set of non-specific symptoms gets diagnosed. Nor should we expect doctors to ever be able to do that. Human bodies are terribly complex, we aren't just walking sudoku puzzles that have a specific answer if you just connect all the right numbers. In cases like this patient's, Novella said, you just prescribe some lifestyle changes (exercise, better diet), see if you can mitigate the symptoms (try some headache drugs or muscle relaxers), and clinically keep an eye on things (see them for future appointments, see if anything gets worse).

So bear this in mind the next time you get frustrated at doctors for not having a cut-and-dry explanation for exactly what might be your health issue. Many popular TV shows have contributed to reductionist thinking in America, and I think House is a good example of that. Watch enough of that type of medical drama and you start to expect that doctors are all either idiots or geniuses, and lack of diagnosis means you'll be dead by the end of the episode.

But knowing all that, I'm still anxious to see the next episode. Drs. House and Cutty are coming dangerously close to a liaison, and, even if the hospital shennanigans are pumped with bunk, they are also fun to watch. Plus I have a few more angles I want to try with a Hugh Laurie drawing.


  1. The zebra/horse thing is a saying that gets trained in medical school right?

    1. Right you are Aaron! I had thought it originated with Sherlock but was then adopted by med schools. Wikipedia says otherwise though. Good catch!