Ever wonder if those bizarre cases Dr. Gregory House cracks every week on TV really happen? Like many med dramas, the Fox series has MD consultants, and like another successful franchise, Law & Order, the plots from House are ripped from the headlines — in this case, out of medical journals.
David Foster, an internist who's a writer and producer on House, tells today's Wall Street Journal that he gets some of his best plotlines from the clinical problem-solving column in The New England Journal of Medicine (NEJM) — "one of the great gold mines of diseases," he tells the newspaper. Other ideas come from The Merck Manual, Harrison's Manual of Medicine (a textbook), friends, and (surprise) the Internet. "It's good for us but bad for humanity that there are so many ways that the body breaks down," Foster tells the Journal.
Back in the 1996, during the generation of TV medical dramas including ER, Chicago Hope and Rescue 911, doctors writing in the NEJM griped that those programs "fostered trust in miracles" by too often saving patients using CPR. Analyzed as a group, the 97 episodes from seasons 1994 and 1995 portrayed three-quarters of patients being successfully resuscitated, and two-thirds living over the long term. In the real world, zero to 30 percent of people survive cardiac arrest, depending on its cause and where they are when their heart stops, according to the study. "The misrepresentation of CPR on television shows undermines trust in data and fosters trust in miracles," declared the study authors from the University of Chicago, Duke University, and Durham Veterans Affairs Medical Center in North Carolina.
Is House, which premiered in 2004 and aired its 100th episode on Monday, any more realistic? Yes and no, says Andrew Holtz, author of the 2006 book The Medical Science of House, M.D.
"We're definitely not in the Ben Casey days when the medicine on the show was as fictitious as the people," Holtz says, referring to the 1960s drama about a hardnosed doctor. "The inaccuracies [now] are more global than specific."
In the 30 or so House season one and two episodes that Holtz analyzed, the characters pronounced the medical terms correctly, picked up surgical instruments at the right time and described symptoms of real conditions. In the interest of plot, however, House did occasionally miss obvious symptoms that any medical resident would have spotted, Holtz says.
Where the show goes "off into fantasy land," he says, is its portrayal of patients as generally young and pretty, not old and riddled with chronic diseases, and of the healthcare establishment, with doctors filling typical nurses' duties such as giving injections and drawing blood. Not to mention House's ethically questionable behavior: He's addicted to painkillers and is willing to perform procedures that are in his but not the patient's interest, such as a nerve biopsy on a teen girl who's otherwise healthy but never feels pain.
But, like in the real world (physicians can now get help from medical societies for drug addiction), there are repercussions for the hero doctor. "They’ve confronted his bad behavior and made him pay for it," Holtz says of the grumpy Dr. House. "They're not oblivious to the flaws in his character."
Image of Dr. Gregory House (Hugh Laurie) courtesy of Fox