La medicina di House!Interessante!, da Diane Kristine
The Metaphorical Medicine of House
Written by Diane Kristine
Published January 06, 2008
He paces hospital corridors, juggles office implements, twirls his cane, fidgets with elastic bands, plays with that oversized ball, pops another Vicodin, interrogates his team, writes on his white board, sometimes even visits a patient. Dr. Gregory House brings the act of thinking to kinetic life each week, a remarkable achievement for a visual medium like television.
"I was very impressed with House from the beginning for what they were trying to do," said Dr. Lisa Sanders, a faculty member of the Yale School of Medicine and technical advisor for the series. "What they're really looking at is how doctors think, and it's not really a television-friendly topic."
Sanders, an Emmy-winning broadcast journalist before turning to medicine, has been part of the show since before it was a show. Her Diagnosis column in the New York Times inspired executive producer Paul Attanasio, who sold the show to Fox as a medical procedural before creator David Shore would turn it into equal parts character study.
When Attanasio told Sanders the show depended on this rude and obnoxious man people seemed to love, her first thought was "Good Lord, I'm not going to be employed for long."
"It would be a different show if Hugh [Laurie] were a different actor," she said. "I think he's really an incredible talent and it's because of him and because the writing is extraordinary that I was wrong."
Even a scientist isn't immune to the irrational charms of the show's leading man. "House is such a damaged character. He's such an unreliable narrator that his personal affectation of being a total schmuck is belied by the warmth and generosity in his face," she explained.
"You look at his face and he might be saying the meanest thing ever, and you know that inside there is a deeply caring person. Even if he's not caring about you as an individual, he cares about an idea that happens to be important to you too, which is figuring out what's going on. I think the genius of Hugh Laurie is that he's able to get that duality across."
Sanders, who provides the writers with the fact-based story ideas they crave and gives her expert opinion on the medicine in scripts, is pragmatic about her role with the show. "Sometimes if it's a choice between drama or comedy and complete accuracy, accuracy loses. I understand that. But I'm there to be the voice promoting accuracy, so I point it out and they either take it or not," she seemed to shrug. "It's hard to criticize their sense of drama and character."
She did give an example of a stand she took on a line in a script meant to imply sexual contact between two characters, a line that violated the precise terminology she holds dear about medicine. "I wrote them an e-mail and I said you can't have bacterial vaginosis in your mouth. First of all, it doesn't grow there. But more importantly, it wouldn't be called bacterial vaginosis if it were in your mouth."
"So they were like, 'That's very nice, but this is way funnier.' And you know, it was. What can I say? I fought the battle for linguistic purity and I lost to prurient humour and it was funny."
She says the House writers are so sophisticated now, with the show in its fourth season, they rarely unwittingly make errors. "There are some shows that probably adhere more closely to the way things are, but I think that's because their focus is on a different thing. House is really about figuring stuff out," she asserted. "It's true that House takes liberties with the truth – you know, bacterial vaginosis – but I think it's usually in an effort to do a show about thinking."
Dr. Scott Morrison, a physician in Illinois, writes reviews of House that focus more on the accuracy of the medicine than angst over the damaged doctor's dark soul or who flirted with whom – though he doesn't ignore those important areas, either. Far from an indignant list of nitpicks, his Polite Dissent reviews are written with obvious affection for the series. Perhaps surprisingly, he remains impressed with House's accuracy.
"House is probably the most accurate of the current crop of medical television shows, and definitely well above average for the genre," he said in an e-mail interview, in which he shared Sanders' opinion that entertainment does and should trump accuracy. "It’s simply not possible for them to be 100% accurate and remain a finely tuned drama. When I point out errors, especially the smaller ones, it is not so much to detract from House as it is to let my readers know what they should expect in real life."
In real life, as Morrison points out, "tests results often take days to come back and the results are rarely as clear cut as House or other television shows make them out to be."
In real life, as Sanders points out, oncologists don't perform surgery. Plus, she said, "I have never touched the controls of an MRI. In fact, if I did, I would certainly be called before the CEO of Yale-New Haven Hospital: 'I understand you were touching our $6 billion MRI?'"
"I have never broken into any of my patients' houses," she added dryly. "I have on occasion made house calls, but I ring the doorbell and if they're not home, I come back later."
Yet she brings this up not simply as a critique, but rather a way of illustrating the show's metaphorical take on medicine.
"One of the things we do, one of the great pleasures of being a doctor, is you get to ask all these incredibly nosy, intrusive questions," Sanders said. "People can feel extremely violated with intimacy. Of course, it's part of a trusting relationship, you hope, but you probe into the inner recesses of their personal life as if you were breaking into their house."
"Their propensity to break into houses is a perfect visual representation, a psychological representation, of what we're doing," she continued. "I love that."
Sanders is also impressed by the fact that a House episode unfolds the way a hospital admissions note does. "We call it an H&P, history and physical, even though it includes much more than a history and physical," she explained. "All my columns follow that very rigid format. And House also follows that rigid format."
The teaser, for example, sets up how the illness presented and information about a patient's age and social situation. Then, as in the Diagnosis column, House progresses through symptoms, investigations, and finally a resolution. The difference is that Sanders as narrator is far more personable and far less prone to insults than House.
She is obviously an enthusiastic fan of the show that employs her, but not an apologist for it. "There are things about House that rub against what I think a good doctor is. And certainly I am way nicer to my patients," she laughed. "There are some things I hate about the House character. Some of the things I love about medicine, the character of House doesn't value at all."
Two examples she gives are taking a patient history and doing a physical exam, things House rarely does, and never does well.
House doesn't respect much, but he respects rationality above all. Yet Sanders isn't impressed by his empirical method, either. "House is what the world would be like if nobody practiced evidence-based medicine," Sanders said, deploring his refusal to check for evidence unless it fits what he expects to find.
Though she admires the fact that he recognizes the limitations of testing and cares about thinking things through, she also believes that deduction is a much smaller part of the science of medicine than the show portrays. "What we know about the body is so very limited that you can absolutely do the logical thing and be completely wrong. And actually, this happens to House a lot of the time. In fact, it happens three out of four times," she joked, alluding to the episodic formula.
Polite Dissent's Morrison agrees that House, like most medical shows, doesn't give the whole picture of real-life medicine. "It’s true that there is an art to medicine and most of the television shows are good at showing that, but the art is built on a solid foundation of science, and this is the part most television shows have problems with."
Even if he could shut off his doctor brain while watching, Morrison's reviews cause him to look for errors, and some of his commenters are fans who seem to do the same thing. "There’s certainly fun – or at least an enjoyable challenge – in looking for errors, at least in a certain segment of viewers."
He doesn't believe that detracts from the show, however. "It is possible to watch the show on two different levels: the fan and the doctor. The Star Trek series has had nit-picking fans for years. There’s even been several Nitpicker’s Guide to Star Trek published – but remember that the books are not written by critics, but by fans of the show."
Some doctors might not be able to see past the fictional medicine of the show, but many of Sanders' colleagues love it and long to be like House. "Not the rudeness," she specified, "but they'd like to be someone who's completely committed to figuring out what's going on. The biggest difference between every other doctor and House? House has one patient at a time."
Continuing her take on the metaphorical medicine of the show, she added: "House represents how much time we spend trying to figure out the things that don't necessarily make sense or fall into our expectations."
Given that House and other fictional shows often give an inaccurate picture of real-life science, it's not surprising that some scientists have conflicted feelings about the message television sends about their profession.
Structural biologist Dr. Aled Edwards is a consultant on Canadian sci-fi show ReGenesis, and while he finds it difficult to watch most popular science-based shows, he also thinks expecting accuracy from them is not realistic. "It's almost like watching a cartoon, where Batman or Superman or House is the same. When I watch Superman, I don't get upset: 'Hey, men can't fly!' When I watch those shows, I turn off my scientific brain. I say I'm watching mindless entertainment here. Because if I put on my scientific brain, I'd get upset. So I just watch it and think this is not science, this is not medicine, this is television."
Morrison believes most viewers get a positive impression of science from television, but worries "there are a significant number of viewers who cannot always discern what is real and what is fiction."
"Every doctor has had patients come in complaining of a disease they saw on Grey’s Anatomy or desiring some treatment they saw on House," he added. "I wish patients wouldn’t watch medical shows for answers, but many do. This has been going on since the first medical shows appeared, and will continue as long as there are medical dramas. It’s something we have to bear in mind, both as doctors and writers. The most important aspect of this for the writers, as far as I'm concerned, is that they not give false hope to patients with a serious disease, and conversely, that they don’t exaggerate the seriousness of other diseases."
Sanders isn't as concerned. "I think people have enough real-life experience that they're consistently and accurately able to draw a line between fiction and reality. The specifics of disease, which House often gets wrong, no one cares about that."
"But I know that people know that when they're in a hospital, if they don't want something done to them, they say no," she said. "I think most people know that in a hospital, nobody is going to stab you with a scalpel or a needle just to see what happens."
"I think the ways House is outrageous are ways people are familiar with and understand."
Sanders is most bothered by the questionable ethics of House. "I think there are very few doctors who set out to kill a patient, even out of mercy, and yet that has happened more than once on House. I think there are very few doctors who would be willing to force their perspective on a patient. Not only is it against the law, as House has touched on, not only is it assault, but it really goes so deeply against so many of the things we value."
"The way House stabs people with syringes when they're not expecting it, it's only because he's such a limited human being that he has to resort to that," she continued. "The rest of us use our relationship with the patient."
However, while she believes the viewer is on House's side even in his darker ethical moments, she doesn't worry that he'll be taken as a role model. "What can you say, the guy's a jerk. Doctors shouldn't be impaired when they're taking care of patients, either."
She seems as fond of the jerk as most viewers, despite the liberties he takes with her profession, and believes that in another sense, House the limited human being reveals the humanity at the heart of medicine.
"I think the great thing about House and other medical shows on television is that they show the human side of doctors," she said. "He often uses observations about real life – sometimes it comes from his own life, sometimes it comes from a case. But it shows that thinking just about the facts is not the only way to get to an answer. It's often not the best way to get to an answer."
She recounted the story of baseball great Lou Gehrig, whose ALS remained undiagnosed until he simply walked into the office of a Mayo Clinic physician whose mother had suffered from the same disease.
"Medicine is not this isolated category that lives separately," Sanders emphasized. "It's part of the texture of life, and I think one of the great things about House is he shows that intersection between life and medicine."
LinkMedicina...ancora.... cosa ne pensano all'università di Stanford:
Poking holes in TV medical dramas—and loving it
By MITZI BAKER
Television’s most famous surgical interns, Christina Yang and Izzie Stevens, sneak down to the morgue one night to perform an un-authorized autopsy they hope proves their theory of a patient’s death. When it shows they’re right, the attending physician, their boss, lets this transgression slide.
At this point, a collective groan issues from all viewers of this episode of Grey’s Anatomy who have even the slightest amount of medical training. No one in the field, not even an intern, would get away with what these doctors do. But, hey, it’s TV!
Talk to medical professionals hooked on medical TV — they’re easy enough to find — and you’ll find they have a love-hate relationship with the shows. They pretty much love to hate everything the shows get wrong.
“I enjoy these shows because they are so unrealistic that I don’t feel like I am at work,” says Suzanne Miller, MD, a recent Stanford emergency medicine resident who is starting a practice in Washington, D.C.
Kathy Reagan, manager of the emergency medicine residency program, laughs over the characters all arriving at the same time in the morning, not terribly early at that; always managing to take breaks and eat lunch together; and on top of that, finding parking spaces in front of the hospital. “Only in a fairy tale!” she says. She is a self-confessed Grey’s Anatomy fanatic.
In an hour of TV, fictional doctors get to see more high-adrenaline cases than many real doctors see in an entire career. It helps that TV docs flit from one specialty to another, which allows them to function as a one-person team. “On House, the residents run the CT scanner and they draw blood and they give the meds and perform surgery, which is totally bogus,” notes fourth-year medical student Graham Walker. “So if people just watched House, they would think their actual doctors are slacking off because they aren’t doing all of that.”
“On one Grey’s Anatomy episode, a patient comes in with chest pain, and two seconds later, he is rushed to open-heart surgery. That is hardly realistic,” says Prasanna Ananth, in her fifth year of medical school. But it doesn’t stop her from watching.
Joshua Spanogle, MD, who graduated in June, recalls, “A writing mentor here at Stanford said to me: ‘Now Josh, I must ask this: Is there really that much sex in the hospital?’” This floored Spanogle. “I was thinking that everyone knows that Grey’s Anatomy is not an accurate portrayal of life in the hospital.” Either that or he’s been hanging out in all the wrong linen closets.
But underlying the wacky story lines, these shows do offer a few grains of truth about the world of medicine, say the professionals. Residency is really hard work, medicine is an art not a science and doctors wrangle daily with ethical issues. Still, the mistakes seldom entail illegal acts, such as severing a patient’s cardiac assist device so he can get a heart transplant. And the ethical issues rarely arise from sleeping with your attending physician.
The funny thing is, many doctors and students take the shows seriously. Their senses of humor flatline when confronted with inaccuracies they deem dangerous. Indeed, keep the details real if possible, implores Spanogle, who has published two medical thrillers. “I pump up some elements of course,” he admits. “But I try to keep the consequences and the environment as real as I can.”
Portrayals of CPR bear the brunt of criticisms. A 1996 article in the New England Journal of Medicine documented the discrepancy between the survival rates from CPR on three medical TV shows and those seen in the real world. On the shows, more than two-thirds survive, compared with just around 5 percent in reality. In addition, TV characters’ methods are far gentler, and they tend to use poor technique — with an incorrect ratio of breaths to compressions. The issue is still reverberating.
Real-life E.R. doc Miller says she once asked a patient’s brother how he learned to do CPR. “He said he saw it on ER,” she says. “He said that’s how they did it on the show — and he saved his brother’s life, so that’s pretty darn good.” ER, which began its 15-year run in 1992, is widely known as the most accurate and educational of the fictional medical shows. “If these shows are going to do CPR, for sure you want them to do it as realistically as possible so that people can learn that lifesaving technique,” she says.
Says medical student Walker: “I feel like there are simple things that wouldn’t have any detrimental effect to the entertainment quality of the show — that would barely even change dialogue — that could provide subconscious education to the lay public.” He devoted a page of his blog Over My Med Body to an episode of Grey’s Anatomy that portrayed CPR inaccurately.
A medical advisor of that show is Karen Pike, MD, a Bay Area emergency physician who did her residency at Stanford. “I’ve tried to address the CPR issue,” says Pike, whose standing joke is: “Do the patients have to cardiac arrest again?” She notes that one episode of the show was devoted to showing the intern George O’Malley being astonished to discover that most people who have cardiac arrest die. So she does try to inject a dose of reality into the show — but her advice is sometimes ignored. “A patient coming back to life pulls at people’s heartstrings,” she says. “I have to remember that it’s still Hollywood.”
LINK****
E infine, il medical board of california contro House!
A pagina quattro del pdf linkato....
LINKpc: sono cretina, ma.... a pagina 2 c'è... il dottor Fantozzi!! ahah!
Edited by LaurieLo - 8/1/2008, 18:03
