The "House" Syndrome

Several commentators have tried to explain the recent explosion of medicine in entertainment, from the writings of Atul Gawande in the New Yorker and the New York Times, to TV shows such as "Scrubs," "House," and "Grey's Anatomy," to memoirs about internship and anatomy lab. I studied history of science in college, at a time when the field was "hot" (or "sexy" in academic parlance). I theorized that the popularity of the history of science had a lot to do with the approaching millenium (yes, I am that old), that turns of centuries historically engender a lot of summarization and analysis by the societies going through them. A truly defining aspect of the 20th century was the rise of American dominance in the sciences - from the A-bomb to the moon walk to the unraveling of the structure of DNA (okay, that one was done at Cambridge in England, but Watson and Crick spent the majority of their scientific careers in the US) to Einsteinian relativity (also European but strongly associated with the US) and Feinmann quantum mechanics - and so Americans unsurprisingly thought a lot about the history of science as Y2K approached. What was surprising was how quickly the interest in scientific history dissipated after 2000...and yet did it? Rather it seems to have been supplanted with an insatiable interest in medicine. I suspect that this is in large part due to our struggles as a nation with the issue of health care accessibility. Perhaps if we knew more about how medicine is practiced and the people who participate in it, maybe we can reach a consensus? Kind of like putting yourself in other peoples' shoes.

While I have found "Scrubs" to be the most true-to-life of all of the doctor shows (were that all of my attendings and residents as good looking and salacious as on "Grey's Anatomy"!...), the most compelling show on TV is "House." It's momentum, I think, stems from its focus on diagnostic uncertainty, implicit in which is a focus on discovery. In fact, an obsession with discovery is a defining American trait. For a lot of people, then, the appeal of medicine as a practice or an entertainment is the chance to participate in a neat and tidy discovery.

What I learned this week, however, is that diagnosis or discovery is only satisfying if there's a treatment behind it. And this is one of the subtler points of medical training, one that I think patients do not realize factors into their judgment of doctors as either "good" or "bad." A "good" doctor is one who works not only to give you an answer, but in the end helps you.

I've been following a patient for the last week who is one of those rarer cases (less than 1 in 10,000 people with their condition have their symptoms). And as rare as they are, every physician in the department knows about their disorder because it is so fascinating and organized. In the past several days I have been given an unusual amount of responsibility for making this patient's diagnosis and guiding their work-up and management. I have two ideas in mind for what could be the root of their ills, and I'm about 70-30 split in either direction, and both with poor prognoses. Tomorrow I will go in and tell my Attending what to do. I've thought a lot about this moment in my first two years of medical school, dreaming of the day when I would "diagnose" the patient, although I didn't expect it to come so early. And instead of victory and pride, I'm hollow because the two likely scenarios for my patient are bleak. (Maybe that's why I have been given this "gift" of my first diagnosis, because no one else wanted it?) I have not helped, I have only ushered infirmity or death through the door. In their chart, my patient has often commented to the various consulting physicians and rehabilitative therapists that their goal is to "find an answer." But it's not an answer I want to give. The wise physician would suggest that all answers are beneficial, even the bleak ones, because they can bring acceptance and control to a situation and allow the patient a chance to "put affairs in order." True. But with an answer you run the risk of proposing ineffective treatments that do not promote acceptance of a terminal condition, and instead foster denial via hope in false promises.

I wonder how this will be read, as melodramatic or self-important? It's just funny that one of my largest growths as a student doctor have left such growing pains.