13 Departs House, Leaving Lessons About Genetic Testing

One of the central features of the Olivia Wilde's character "Thirteen" was her struggle with the memory of what a terrible genetic disorder did to her mother... and her tremulous approach to confronting the answers that genetic testing might reveal to her. As Wilde makes her final regular appearance on House, it's a good time to look back at a bit of that history.

"Stranger Danger" & Obesity

It happens, but very rarely. 

A U.S. Department of Justice report* estimates that about 115 children a year are abducted by a stranger and taken far away or overnight or held for ransom or killed. It's a calamity for each family. But by comparison more than 1,500 children under age 15 are killed and almost 600,000 are injured in car crashes in the US each year according to CDC statistics.

Yet parents are scolded and shamed (or worse) if they let their kids play in the neighborhood without a minder shadowing their every move. And parents load their kids into the car and drive them to school (remember the leading cause of death of children in the US is car crashes) because they are afraid to let them walk there or even wait for the school bus without a parent posse on hand.

The "stranger danger" hype on TV has real consequences.

How does it relate to obesity? Think about it. Free outdoor play is discouraged. Walking or bicycling to school forbidden. Kids are kept inside or in the car. While fear of abduction by strangers is not the only reason that children today aren't as active as earlier generations, it certainly plays a role... and the toll of rising childhood obesity may be shorter lives.

So should we really spend so much time worrying about strangers? Or maybe a little more time worrying about the effects of the familiar TV set.

Read the full discussion in “House, M.D. vs. Reality”

*Note: The Second National Incidence Studies of Missing, Abducted, Runaway, and Thrownaway Children (NISMART–2) is currently being updated with research that will go into NISMART-3.

Scary TV Makes the Real World Look Scarier

A half-century ago, communication researcher George Gerbner developed the "Mean World Index." Survey questions measure how trusting or fearful people are. What’s interesting is that fear of crime, for example, appears to correlate more closely with the level of crime on TV than it does to actual rates of crime reported by law enforcement agencies...

Influence of TV Medical Shows Adds Up

The influence of fictional TV shows is a drip, drip, drip effect.

“It’s not a conscious process, where you become frightened because you say, ‘In ER they didn’t manage to save that person’s life, so that will also happen to me.’ Instead, it’s totally unconscious. But there are studies which clearly document this process, which we call ‘cultivation.’...

How Cheery Marcus Welby MD Became Surly Greg House

Whatever you thought of last night's season 8 premiere of "House", you have to admit that it's hard to imagine the medical TV icon of an earlier generation, Marcus Welby, M.D., ever finding himself behind bars. The evolution from TV physicians who were almost always really nice guys to the rough and biting Dr. House is just part of a TV industry response to changing technology, according to communications researcher Amir Hetsroni, PhD.

Don't Expect a Happy Ending on House (or other TV shows)

Season 8 of House premieres tonight in the United States.

While the show is often loads of fun, the fates of patients on this and other TV medical dramas is often not the kind of "happily ever after" we tend to believe define Hollywood Endings. In sharp contrast to the common belief that things work out better in fiction than in reality, a recent survey of hospital patients on TV shows found quite the opposite.

What You Think You Know May Be a Fantasy

How often do you hang out in a hospital or doctor’s office? Not often, unless that’s where you work, right? What if I pointed out that you probably see the inside of a clinic or hospital ward or even an operating room almost every day? 

House Orders: Patients Must Live

Living longer is good... for most people... most of the time. But maximum survival is not always what people want. There are many cases of patients choosing to forgo treatment... or even commit suicide... rather than endure the unendurable.

House is Gray-Blind

House almost always sees decisions as black-or-white, live-or-die. He overlooks the (less dramatic) middle road or third option. I interviewed bioethicist Dr. Mark Wicclair for “House, M.D. vs. Reality” and he offered an example of how the contrasts and choices House sees frequently miss the shades of gray that real doctors and patients have to deal with:

Dreams of Being Dr. House

As I noted recently, many people who work in health care are irked by the portrayals of their profession on TV in shows such as House and Grey's Anatomy. But the shows can be a guilty pleasure for them, though perhaps in a different way than for people whose only view of an operating room is the light on the ceiling as the anesthesia meds kick in.

House gets away with all sorts of things real doctors can’t, and he exudes a confidence and certainty few real doctors would dare to.

“In terms of medical professionals and students, I think it’s really kind of a fantasy world for them, where they see somebody talking back to patients and family members, treating them quite brusquely, and they get away with it. I think that’s one of the reasons [medical] students enjoy it so much, besides the fact that it’s just good entertainment, I think every medical student has had a situation where they would have just loved to tell a family where to go, like House does, so it’s a bit of a fantasy for them.” - Mark Wicclair, PhD, professor of philosophy and an adjunct professor of community medicine at West Virginia University in Morgantown.

Read the full discussion in “House, M.D. vs. Reality”

Dr. House: Bioethics Instructor

In my last couple of posts, I've quoted Dr. Howard Trachtman about how TV shows like House distort how patients in the real world look at doctors and health care in general. I came across Dr. Trachtman because of a commentary he wrote for a special issue of the American Journal of Bioethics that focused on the TV viewing habits of medical and nursing students.

Trachtman asked readers to understand that he wasn’t arguing against shows like “House,” but just asking that the entertaining fictions be kept in the proper perspective.

Bending Reality for TV Bends Reality... Really

Yesterday I wrote about the warped perceptions that come from TV medical shows dramatically (as in, for dramatic effect) collapsing the time course of disease, diagnosis and treatment.

Obsession with the bizarre has a similar effect. Certainly, people would not watch House and other medical shows in such numbers if all the cases were boringly routine. The point of entertainment shows is to be more colorful and exciting than real life, but some health experts worry about viewers being distracted from the real issues society faces as we try to improve health care. They say people should understand that the greatest improvements in health come from small changes in dealing with common things that affect a lot of people, not the bizarre, though exciting, cases that House takes week after week; cases that are far more rare than lightning striking a person.

“The TV shows are about the lightning strikes. They are interesting. And they are fun. And they are engaging. And they are exciting. And they make us all feel better.” - Dr. Howard Trachtman.

But the steady diet of “lightning strike” cases, may lead viewers to overestimate just how much they need to worry about being struck by lightning, in the medical sense. And so the desire to have a health care system of heroic doctors available to rescue them from freak occurrences may trump their interest in supporting basic, routine care.

Read the full discussion in “House, M.D. vs. Reality”

Time Travel is a Weekly Occurrence on House

It's not just House. All medical TV shows, indeed all TV shows, engage in time travel.

I'm not talking about sci-fi plots involving meeting your grandparents when they were young, but the way a lab test involving cell cultures that takes weeks in the real world can produce results during the lunch break on TV. And of course, in order to keep emotions running high, patients wildly swing between full health and near death in minutes or hours of TV time.

Sometimes things do happen fast in real hospitals. The high-speed dance of a trauma team swooping in on a car crash survivor is wonderful to behold. But things almost always transpire at a much slower pace and with much less certainty. Doctors almost never know the full effects of their decisions right away, and when the results are known, they are almost always in-between; that is, neither a clear victory nor an absolute defeat, unlike on TV.

One doctor I interviewed for “House, M.D. vs. Reality” put it this way:

“It’s always predicated on a clear-cut black-or-white outcome. Most of the time, for myself in pediatric nephrology [kidney disease in children], it’s rare for children to die in my subspecialty. I win, I lose. It’s all in very subtle gradations,” Dr. Howard Trachtman told me. Yet every now and then, things do happen quickly. Dr. Trachtman recounts one such case in which a patient declines rapidly and deeply. "The slope of her illness is so steep. It almost does remind me a little bit of a TV show. But that is so exceptional. They make it the rule. I find it to be the exception. Most of my encounters with patients are very, very evolutionary in nature. And most of what I do is a mixed blessing.”

The speed and certainty of TV medicine raises the expectations of patients to unrealistic heights. As a surgeon told me recently, "Patients think we should have all the answers within 45 minutes. I actually have told many [patients] that this isn't TV."

Read the full discussion in “House, M.D. vs. Reality”

House Teaches Ethics to Med Students. House?!

Mark Wicclair, Ph.D. teach bioethics to medical students. He has this to say about House:

"I really love the show."

Really. Wicclair, a professor of philosophy and an adjunct professor of community medicine at West Virginia University in Morgantown who also works at the University of Pittsburgh’s Center of Bioethics and Health Law, says he sees value in examining the world of health care according to House.

"Is it worrisome that medical students appear to enjoy watching a series that features such an unethical physician?...

No One is That Good

Dr. Greg House gets away with a lot mostly because he is so dang good. So what if there are ethical or even legal lapses in how he diagnoses and treats patients. After all it's the cure that's the goal, right?

“It all works out marvelously well. Generally, House finds out what the condition is, diagnoses it, comes up with the treatment, and at the end of the show patients are very grateful. You know, that’s not the way the world really works. If physicians were to act that way in the real world, chances are that they wouldn’t find the proper diagnosis, or even if they did, the treatment would have some horrible side effect and the patient would get sick and wouldn’t be terribly grateful.” - Mark Wicclair, Ph.D., professor of philosophy, adjunct professor of community medicine, West Virginia University in Morgantown.

Unfortunately, when the methods of TV docs are examined, they are seen to bear the same relation to real clinical care as the supernatural beauty of the stars, aided by make-up, kind photography, lighting and editing, has to the looks of the average doctor or nurse after working overnight call in a Level III Trauma Center.

Read the full discussion in “House, M.D. vs. Reality”

Now How Will We Know What Dr. House Has Done?

From previews of the upcoming season of House, we know that he's in trouble again. 

Curious Expeditions

While doctors in the real world don't match up to Dr. House in many ways both good and bad, sometimes they mess up. But it's often very hard for patients to find out if their doctor has a skeleton in the closet... and not the one used to learn about the bones in our bodies.

If you live in New Jersey, where "House" is set, a good place to start is the Web
site of the New Jersey State Board of Medical Examiners. Other states release information on health care provider discipline to varying degrees. One catch is that a doctor, nurse or other provider who gets into trouble in one state can pull up stakes and move on down the road.

The federal government does maintain a National Practitioner Data Base. It is primarily intended for use by hospitals or others who need to check the background of a provider applying for a job. Some data, without doctor names, has been made available to the public.

Public Use File Closed

Oops, let me update that last line. Just recently the federal government blocked access to the public database. It seems that some people didn't like the fact that journalists were using the information to reveal breakdowns in the oversight of health care providers. On Sept. 15, 2011, three major journalism groups sent a letter of protest to the Obama Administration. The announcement by the Association of Health Care Journalists of its protest includes a link to a site where you can download a copy of the data that was removed from the HHS web site. The archive is hosted by the Investigative Reporters & Editors group.

Read more about disciplining doctors in “House, M.D. vs. Reality”

A couple of references:

Weber, T., and C. Ornstein. “Dangerous Caregivers Missing from Federal Database.” ProPublica.org, February 15, 2010. Available online at www.propublica.org/feature/federal-health-professional-disciplinary-database-remarkably-incomplete.

Wolfe, S., and A. Levine. “Hospitals Drop the Ball on Physician Oversight: Report on Under-Reporting to the National Practitioner Data Bank.” Public Citizen, May27, 2009. Available online at www.citizen.org/Page.aspx?pid=585.

More references related to topics in "House, M.D. vs. Reality" available here.