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“It is much more important to know what sort of a patient has a disease than what sort of a disease a patient has.” - Sir William Osler

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    Sunday, December 19, 2004
    Good Show, Mr. Laurie

    OK. A day late and a dollar short, but like every other good medical blogger, here I am weighing in on House. I spent this weekend recuperating from bronchitis and catching up on all the shows I've TiVoed but haven't watched. One show in, I decided: screw The Avengers, Hugh Laurie is the way to go.

    If you've ever watched Jeeves and Wooster or Blackadder, you know who Hugh Laurie is. What the hell, not only is the guy funny, he can actually act. And he does a flawless American accent to boot - the only convincing one I've ever heard from an English actor. He makes the show: I could not stop watching it. To illustrate how incredible that is, I should inform you that my sentiments about medical TV shows are simple: they suck. I've never watched ER, for example. My Dad the Retired MD recently reminisced about the only time he ever watched Dr. Ben Casey years ago: "This patient comes into the ER with a headache, and this intern Ben Casey thinks he should be admitted. So his resident asks why and he lists severe headache, light sensitivity - all vague symptoms. His resident overrules him and they send the patient out. A few hours later he's back vomiting, and he turns out to have an aneurysm, and the intern was the only one who got it right, and that's the last time I ever watched Ben Casey!" My sentiments exactly.

    That's not to say the show is perfect. No way would any teaching hospital have an MD with three docs assigned to him and nothing to do but spend morning, noon and night figuring out what's wrong with one patient. In one episode, the medical team performs CPR on an infant - none of them are pediatricians. Wrong, wrong, wrong. Another blatant error: in the third episode, a patient is given IV thyroxine early in the episode and then a day or so later the team decides to recheck his thyroid function tests, which have now been rendered meaningless because he just got thyroxine. I could go on, but I don't want to bore you and in any case it doesn't matter: House is damn good TV.

    As you doubtless know by now if you've paid any attention to the show, Dr. House is fascinated by pathologic processes (that is to say, diseases) but hates interacting with patients. For my money, the best scenes are those set in the walk-in clinic where House is required to work every week by the terms of his contract. His interactions with patients and their illnesses are scathing, to say the least: I would bet that somewhere in the writers' room is a disillusioned primary care physician. Dr. House says the things we all wish we could say: he calls one patient "the idiot who didn't know how to use birth control," for example. (I know this sounds harsh, but trust me, there are a lot of idiots out there who don't know how to use birth control.) Hugh Laurie is good enough in this role that you empathize with Dr. House while seeing how rude and abrasive he is. The crusty-but-loveable senior doc is a well-known cliche. Hugh Laurie infuses this stock figure with new life.

    The diseases tracked down on House are genuinely interesting: cysticercosis, colchicine poisoning, subacute sclerosing panencephalitis due to measles. I also liked the way the show illustrates the methodical process that goes into diagnosing disease. At least once per show the team runs through the options: Inflammation? Tumor? Infection? Allergy? Endocrine problem? Etc. Also, the audience sees that imaging studies do not guarantee a diagnosis. Every patient on the show gets run through a scanner at least once, and most of the time nothing is found. If House does nothing else, maybe it will demonstrate to the lay public that getting a scan does not equal a diagnosis.

    The supporting cast is good, though they tend to follow the tried-and-true Idealistic Young MD type of character. In the later shows, the scripts have tried to flesh out each of the team docs (one went to seminary but dropped out; one of them lost a baby, etc.), which is a good thing and hopefully will contribute to the growth of the show, assuming it lasts past the first season. It should - House is a lot better than your average medical timefiller.

    Speaking of medical timefillers, did I mention that Dr. House is a fan of General Hospital? Now that's a nice touch!



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