Magical Medicine on TV

Dr. House and his team solve medical mysteries with the flair and resourcefulness of private investigators. On a recent show, doctors made multiple visits to the home (even the school bus) of a teenager with convulsions before determining that he had a rare pesticide poisoning.

My wife, a general internist, finds the show absurdly “unrealistic.” “Doctors don’t do that,” she cries whenever a House physician blithely ignores the boundaries of medical subspecialties. (The same doctors, for example, might perform cardiac catheterization, gastrointestinal endoscopy, bone-marrow biopsy and liver ultrasound.) I agree the show is unrealistic, but for a different reason. It portrays a world where doctors have time to solve problems.

I have worked in teaching hospitals in New York for seven years, first as a resident and now as an attending physician, mentoring residents and fellows. Over this period, I have discerned a gradual decline in the intellectual climate of these institutions. It has been dispiriting to watch. Of all the places one might expect doctors to be curious about medicine, teaching hospitals should be first.

Young doctors I work with today seem disengaged and mentally fatigued. With patient rosters of 15 or more, they are preoccupied with getting their work done. Interesting cases tend to generate anxiety, not excitement. Mysteries are, by and large, abhorred.

What a sad and profound commentary! I love medicine for many reasons, but especially for the mysteries. I love working through a challenging presentation, searching for the truth. I collect clues from various sources: history, physical, laboratory, imaging, and literature research.

Fortunately, my personal work situation allows me (and my housestaff) to spend time thinking about our patients. I insist that we sit down and discuss our plans and thoughts prior to visiting the patients. This time, during which anything goes, allows us to explore our ideas. We develop a “game plan” for figuring out what is going on.

Physicians need time to think. They need to devote intellectual time to patient problems. This commentary saddens me. We must have enough time to think through patients.

Certainly House is unrealistic – it is TV afterall. Nonetheless, I still see enthusiasm amongst my students and housestaff for medical mysteries. I still have that enthusiasm. We cannot let that disappear.