Mark Attiah | Bring the ‘House’ down

For the vast majority of us, the only contact we have with a doctor on a regular basis is during an annual checkup. Cultural stereotypes notwithstanding, how we perceive doctors comes from a very limited number of sources. I would venture to say that certain TV shows are far and away more informative to the general public about medical terminology, diagnoses and professionals themselves than any PSA or actual doctor. Unfortunately, a good deal of that information is false.

Just like Tina Fey’s caricature of Sarah Palin during the last presidential election, medical dramas on television are meant to both embody and reinforce the persona of the archetypal doctor that we all have in our heads. The tense, adrenaline-pumping, sweat-dripping code scenes, the “ah-ha” diagnosis moments in the show House or the rampant intra-hospital sexual tension that fills the plotline of a Grey’s Anatomy episode magnify one aspect of a profession: the part that makes long white coats seem like flowing supernatural robes.

A saying among physicians is that when you hear hoof beats, think horses and not zebras. This is to say that, given a particular set of symptoms, a doctor should think of the most likely explanation and not grasp for the rarest diseases only heard of in the remotest parts of the world. However, it seems that Dr. House is constantly on a zebra safari, gathering details that others have missed and synthesizing them in a way that no one else can. The result is a mind-blowing diagnosis that at the same time is hopelessly arcane and ridiculously simple. “How could we have missed that?” all the doctors around House seem to exclaim, as they secretly wish they had his Sherlock Holmes-like intellect. The TV audience is mesmerized and catches a glimpse of what a good doctor ought to be.

Many people come to the hospital believing that their doctors’ heads are mini-calculators into which you can input symptoms and past medical history, multiply by some demographic information, divide by some tests and get the correct diagnosis and the best course of treatment. Why not? Especially at research institutions like Penn, where the doctors are top notch, the way House operates isn’t so far-fetched. He starts treating before he has the diagnosis! And what dumpster did you find your medical degree in?

Truth be told, no matter how smart he is, in real life, House probably would have been fired from his job very, very quickly. With his flippant, gruff demeanor that we love to hate, he wouldn’t have been able to get along well enough with patients to get a good history. He would have made an unbearable working environment for the hospital staff and generated a huge volume of complaints. His doctor character just wouldn’t pan out in real life.

It came as no surprise to me, then, when I came across a Slate article that said that the most accurate depiction of life in a hospital is the medical comedy Scrubs. The reason is simple: the characters are human. Not machines, not sexpots, just people who happen to work in a hospital. The inner dialogue on showcase is often similar to what real medical professionals face — self doubt, frustration, fatigue and emotions both good and bad that are eschewed for dramatic effect in other shows. My guess is that if Scrubs weren’t so goofy, very few people would care to watch it. We watch television to get away from real life, right?

A show like Scrubs undresses doctors and provides a more accurate depiction of the decisions that happen between high-octane codes. The accuracy of hospital life is a refreshing change from the misinformation that not only places doctors on an inappropriate pedestal but also spreads false information about what should happen in a real medical emergency. “I saw it on TV” is a poor substitute for seeing a procedure in real life.

A doctor’s face may not always have a five o’clock shadow and a scowl or a full complement of makeup, but it might show (or hide) a variety of emotions. One might be a puzzled look that reveals how often doctors don’t know exactly what they’re doing. Given the inherent uncertainty of disease and the limit to the information we can gather, this is okay. If they knew all the time, then they would all be stars of hit TV shows, and where would people go to get their annual checkups then?

Mark Attiah is a second-year medical student from Dallas, Texas. His email address is mattiah@mail.med.upenn.edu. Truth Be Told appears every other Thursday.

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