Each week I watch Gregory House, M.D., dissect the conundrum (aka patient) that crosses his examining room. On one level, this television show is a variation of the whodunit: the whatdunnit. What microbe, disease, malady is afoot? In a heavy-handed way (television is not famed for subtlety) Gregory House is a medical answer to Sherlock Holmes, complete with addiction (his is to pain-killers, more medically relevant than Holmes opium) and sidekick (Dr. Wilson, pinch-hitting for Dr. Watson). Like Holmes, House is misanthropic, interested more in the puzzle than in the patient. This is no genial Marcus Welby or Dr. Kildare. And, like Holmes, he has no lasting romantic entanglements (though some shows have hinted at women who haunt him, a la Holmes Irene Adler.)
Yet the show is more than a mystery cloaked in medical jargon. I suspect the show awakes in viewers a yearning for Fantasy Medicine.
For Houses patients, the clue to their illness doesnt lie in their lifestyles. In fact, his team (not quite the Baker Street irregulars, more a collection of plodding Scotland Yard colleagues) initially points to the obvious: lifestyle. And House quickly nixes that. The fat patient isnt fat from overeating; the cirrhotic patient doesnt drink. Patients suffer from exotic maladies that they cannot control. For those of us mired in reality, the fantasy patient is alluring: it is tempting to hope that whatever we do to ourselvesfrom smoking to over-eating to not wearing seat belts to drinking too muchwont wreak damage. On television the sick patients are largely blameless; in real life, not necessarily so.
Fantasy Medicine, moreover, has escaped the clutches of Reality-Insurance. Insurers dont hover over Dr. House. He orders test upon test, without getting anybodys fiscal approval. If he needs medical approval from a superior, it is a formality that doesnt matter. Whatever Dr. House orders, the patient gets. And on television, nobody gives the patient a zillion dollar invoice afterward.
Indeed, in Fantasy Medicine, insurance status seems irrelevant. Among the details gathered, nobody lists Aetna, Blue Cross, Medicaid, orthe dreaded word in Reality-Medicineuninsured.
Regardless of insurance status, Dr. House and team give the patient undivided attention, at least throughout the 60-minute taping. They visit the patients house. They talk to family and friends. They read the charts, assessing the notes from past hospital admissions, past medical tests. Anybody who has been whisked from waiting room to examining room to doctors office, all within 20 hurried minutes (after 30 unhurried minutes reading aged magazines in a waiting room) marvels at this fantasy: all the personnel revolve around the patient and his/her problem.
Dr. House is startlingly unmaterialistic. He doesnt crave much beyond his motorcycle, his piano, and of course his drugs. So there is no hint of conflict of interest when he orders myriad tests. We know that he doesnt own a stake in a diagnostic imaging company. We know that he isnt on the dole of a drug company. (In one show he flamboyantly said no to participating in a clinical trial sponsored by a drug company). He doesnt lecture to promote treatment x versus treatment y. He is not a spokesperson for a medical device. I suspect he is smart enough not to have invested in anything for these past seasons of shows. In Real-world Medicine, sometimes we patients wonder what has inspired a physicians enthusiasm for a drug, a consult, a test.
He doesnt make stupid, senseless mistakes the kind everybody makes, unwittingly. All the infection control and risk management personnel who labor in Reality-Hospitals to minimize errors are invisible, maybe unnecessary in Houses world. In Fantasy Medicine, patients need not fear sepsis, incorrect drug dosages, or wrong-site surgeries.
Finally, in Fantasy Medicine, most patients manage, almost miraculously, to recover fully, thanks to the brilliance of a dogged investigative physician who spares no expense, worries about no timetable, is oblivious to the real-world bogeys of insurance, budgets, and deadlines.
At the end of the hour, I, along with other House-groupies, return to Reality-Medicine.
Joan Retsinas is a sociologist who writes about health care in Providence, R.I. Email firstname.lastname@example.org.
From The Progressive Populist, July 1-15, 2009
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