House, M.D.

Ever since St. Elsewhere -yes, I am really, really old- I am addicted to hospital series, from ER to Grey's Anatomy. My favourite, since I like caricature, and the overt references to the House of God, is Scrubs. There are more series, and one of them is annoying beyond description: House, M.D.. Apparently nobody shares my dislike.

Why do I have a problem with this particular series?

1. House simultaneously works as a paediatrician, gynaecologist, nefrologist, gastro-enterologist, radiologist, surgeon, et cetera. For some reason his hospital does not need medical specialists. Internists do know alot but those I have met never attempt to be any other type of physician.
2. Oddly enough, his diagnosis will ignore more obvious possibilities, and instantly requires us to accept a more unlikely scenario.

The first point should be self-evident, the second I will explain in more detail. Let me be absolutely clear, in no way am I suggesting the presented diagnoses are incorrect. One can argue that technically every episode is medically possible. Whether the sequence of events is plausible is something else.

From experience I can tell you that the series explores medical conditions that rarely, at initial presentation, offer sufficient information to instantly suggest their highly unusual diagnoses. The list of enigmas, i.e. uncommon diagnoses, I encountered consists of:

• Systemic Lupus Erythematosus (SLE), initial presentation: severe thrombopenia
• Idiopathic Thrombocytopenic Purpura (ITP), initial presentation: severe thrombopenia
• Glanzmann's thrombasthenia    
• Autoimmune hepatitis   
• Heparin-Induced Thrombocytopenia (HIT)
• Transfusion Related Acute Lung Injury (TRALI)
• Ogilvie syndrome    
• Toxic Shock Syndrome (TSS) which, within four hours after being admitted to A & E, developed into Multiple Organ Dysfunction Syndrome (MODS)   
• Stevens–Johnson syndrome    
• Irreversible brain damage because of prolonged hypoxaemia following acute and severe carbon monoxide poisoning   
• Carotenaemia evaluation jaundice after visit to the tropics  
• Fièvre boutonneuse evaluation after visit to the tropics, GP thought of malaria (in case of fever + tropics malaria should be the first in your DD) 
• Lassa fever    
• Wolff–Parkinson–White syndrome (WPW)  
• Dissectio aortae requiring a Bentall procedure    

Only carotenaemia (jaundice without yellow eyes), and fièvre boutonneuse (eschar), were an on-the-spot-diagnosis, the others involved extendsive investigations. Eventhough I worked in highly regarded hospitals, no physician was able to pull any rabbit out of his hat. House, of course, would have known the answer within seconds. Utterly unrealistic, especially those that invlove a diagnosis per exclusionem, it is ridiculous to let House skip the exclusionem part.

Add to that the convoluted, and at times incomprehensible, decisions and you understand my being underwelmed. In all honesty, his diagnostic and therapeutic approach are so aberrant it immediately removes any credibility for me. Even the caricature Scrubs has an air of authenticity.

His Asperger-like antisocial personality I find less offensive, it resembles many physicians I have worked with. Totally incapable of thinking of others, and convinced of their infallability. Admittedly, like House, they do tend to know their stuff. Strangely enough this part of the character is true to life.

His magician-like ability to conjure up the right answer out of thin air makes me incapable of watching the series.