ID compared to House, MD

It is Medical Monday, yet again.  Actually, I feel like it has been a long time since the last Medical Monday.  Either way, it is time to hook up with some other medical related blogs for some medical and Monday-ish goodness.

As some of you who read this blog regularly know, I am currently on an Infectious Diseases rotation and I have likened it a bit to the TV show House, MD.

I have been giving it some thought (and noticing the continued strange popularity of my post General Surgery Is NOT Grey’s Anatomy) and decided that it is time I both prove and dispel some more TV related medical show perceptions, this time referring to House, MD.

First of all, why House?

For starters, it is one of the other medical shows I watch(ed).  Also, when I think of real medical specialties that are kind of like “diagnostician” I think Internal Medicine and, more specifically, ID or Rheumatology because they get to see some of the weird and wonderful.  And I am sure in some big places, someone really is a diagnostician specializing in the really complex cases.  That being said, it isn’t a residency or a common position.  At least, I don’t know any, so this is my reasonable facsimile.

The similarities:

• There really is a gaggle of people who deal with the complicated cases.
• People do sit in a group and bounce ideas off of one another complete with internet and journal searches and a white board, or more commonly, a sheet of paper.
  

  Image from teichdoesmedicine.blogspot.com.

• Someone who is generally much smarter than everyone else does lead the pack (and sometimes bosses people around).
• Often times, much of the staff are not fans of the person in charge of the hospital.
• Patients do lie.  For reals.
  

  Okay, not everybody. Image from Iamilliontrees.net.

• The days can be crazy long and chaotic, but also interspersed with mind numbing waiting and boredom (or time for other antics).
• When you just think you have someone or something figured out, there is a twist (sometimes).
  

  Image from eatliver.com.

• Sarcoidosis, lupus and obscure infections are often somewhere on the differential.
  

  Or is it? Image from http://www.quickmeme.com.

• You do have to work in places you don’t always like to or want to in order to keep the hospital running and such.

The differences:

• Patients do tell the truth.
• One does not generally have a team of fellows who were staff in every other area of the hospital.  Those people often just stick to their own jobs.
• You can’t just go around running your own lab tests, diagnostic scans and procedures all willy nilly.  There are people specially trained to do all of those things better than the doctors on the show.
• You would lose your job for screwing around with a clinical trial, stealing drugs, blatantly endangering patients, etcetera.
• A good start to making a correct diagnosis is a good history and physicial.  They tend to skip that step.
• A next important step to a correct diagnosis is doing the correct diagnostic test.  Most of the scans they do aren’t appropriate and then the images are not actually of the scan they claimed to order.  In fact, they often put the patient in the incorrect machine.
• You can’t order everything STAT.  That would make “STAT” routine.
• There are more staff in the hospital than the “Diagnostician” and a lone oncologist who happens to treat EVERYONE (including children) with cancer.
  

  I do quite like their bromance, though. Image from tinyobsessions.wordpress.com.

• As a consultant, you consult, not make all the decisions.
• People don’t code that often.  At least they don’t code that often and survive.
• Patients die.
• Sometimes you just don’t figure out the answer and the person either dies or gets better and you don’t know why.  That isn’t a failure.  Just life.
• Breaking into someone’s home, car, workplace and so forth is a felony, not medicine.
• It takes much more time to figure out complicated and novel cases.
• You can’t just throw drugs at people (or take them away) and expect them to get better.
• If it walks like a duck and quacks like a duck, it is probably a duck, not a zebra.  House almost always gets the zebra.
• Sometimes, it really is lupus or sarcoidosis.
  

  Image from housemdconfessions.tumblr.com.

• Nobody would let you practice medicine on that many drugs.  No matter how good you are.
• You can’t just go taking over in the OR, bursting into the OR or really, doing anything in the OR if you are not currently practicing as a surgeon.
  

  No. Just, no. Image from housemd-guide.com.

• There is a financial and ethical limit to how much you can and should do.
• Doctors aren’t immune to whatever the guy in the bed has.