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House, M.D. Diagnosed

January 12, 2012

I am a medical student. This doesn’t mean that I love Medicine but that is also true. The same way that Physics student (may or may not) love the intricacies of Quantum Mechanics, I love how a myriad of intracellular cascades are wrapped around calcium levels, how small, near-insignificant signs can swing a diagnosis. I love the nine causes of Pancreatitis. (NB: The Oxford Handbook of Clinical Medicine will tell you there are ten causes but scorpion stings do not cause Pancreatitis. Of course, my revised mnemonic, GET SMA-HED, lacks the same ring).

I also love House, M.D. and have just finished digesting the seventh season on DVD. Hugh Laurie’s portrayal of such a fantastic misanthrope just keeps bringing me back for more, and the other characters also have their moments. But part of me is sad because it is clear, so very clear, that it is no longer about the medicine.

The first few seasons had a format. The soon-to-be patient gets sick, opening credits, then the team puzzle over the “medical mystery” of the case, sometimes branching out into more moral discussions. There are also side-plots, personal dramas between different main characters. Eight seasons in and the show is still sticking religiously to this formula but the medicine has long since departed.

It is a TV programme. It is meant to entertain. I get that, so the medicine gets shaved around the corners to make better teleplay. But the standard has gone so far south, I assume its emigrated. Inconsistant leap from diagnosis to illogical diagnosis with bizarre treatments. It may be that as I progress through medical school, the flaws become ever more apparent. If that’s true, it’s surely a good thing. But I can’t shake the feeling that they just don’t care anymore.

Apart from forming the basis for the water-cooler-discussion du jour, and of course, the case of the week, the patients, with a few exceptions, are becoming increasing irrevelant. Some episodes, I don’t even know the patient’s name because they have spent so little time developing them as a character. This isn’t bad medicine (Well, actually it is) but it’s bad storytelling. I don’t need a gripping biopic with every episode but if I, as the audience, am not interested in the patient, why should I care if they live or die? Solving the equation of symptoms X, Y and Z is utterly meaningless unless they can be grounded in an actual character.

(It’s also incredibly contrived when it takes 45 minutes to solve a “mystery” that would have been solved sooner if the team had actually been competent doctors.)

By phoning the medical aspect of the show, what’s left is a series of personal dramas between people who happen to be doctors and who happen to work in a hospital. While these are still enjoyable (perhaps more than ever now the main characters have been so developed – Exactly my previous point), they have to be punctuated by medical mumbo-jumbo and hand-waving.

I don’t believe House, M.D. is irredeemable. The drama is solidly written and interesting. If only they could claw back some sense of reality and believability at the patient’s bedside, the show could return to the jazzy wonder I fell in love with. That said, the reason I keep watching is because, when they want to, this show can still knock my bloody socks off. It’s rewarding in the same way that digging for pearls in mediocre mud would be.

From the seventh season, which, like I said, I have just finished watching, I can heartily recommend “Bombshells” and “After Hours.” Both episodes stood head-and-shoulders above the other 21 episodes…

…And not because of the medicine.

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