Q&A on the medicine of House, with Polite Dissent doctor

For The Metaphorical Medicine of House on Blogcritics, I interviewed Polite Scott, the doctor behind the reviews at Polite Dissent. Here’s the unedited Q&A of our pre-Christmas e-mail interview:

Where do you think House falls on the accuracy scale compared to other medical shows?

House is probably the most accurate of the current crop of medical television shows, and definitely well above average for the genre.

Do you think it’s important that a fictional TV show gets the medicine correct? Why or why not?

It would be nice if television shows were entirely accurate, but that’s not a realistic expectation. Real world medicine and dramatic television medicine are significantly different – real life is rarely as dramatic as television. For example, in real life, tests results often take days to come back and the results are rarely as clear cut as House (or other television shows) make them out to be. It’s true that there is an art to medicine and most of the television shows are good at showing that, but the art is built on a solid foundation of science, and this is the part most television shows have problems with.

Some people say shows like CSI or House, even if they don’t get everything right, help to create an atmosphere of respect for science. Others think that some of the erroneous impressions they leave viewers with do more harm than good. Where do you fall in that spectrum?

For most people, these shows are more beneficial than harmful, but there are a significant number of viewers who cannot always discern what is real and what is fiction. This can be especially difficult on some of today’s medical and science dramas, which freely mix fact and fiction. Every doctor has had patients come in complaining of a disease they saw on Grey’s Anatomy or desiring some treatment they saw on House.

I know some people can’t watch a fictional show that hits too close to their expertise, because they can’t overlook any cheating on the facts. But from your reviews, you seem to appreciate House despite the flaws you find. Do you have lower expectations of what level of accuracy to expect than the can’t-watch kind of people, or how do you manage to still enjoy despite seeing (and because of the reviews, I presume even looking for) those flaws each week?

I would say that I am more realistic about what to expect from medical dramas; it’s simply not possible for them to be 100% accurate and remain a finely tuned drama. When I point out errors, especially the smaller ones, it is not so much to detract from House as it is to let my readers know what they should expect in real life (like doctors and nurses wearing eye protection in the operating room).

Medical shows seem to draw out the armchair doctors: non-physician fans who seem to revel in pointing out errors, both real and perceived. Do you think there’s a certain element of fun in playing spot the inaccuracy? Or is it a sign that the show is taking people out of the world of the show?

There’s certainly fun — or at least an enjoyable challenge — in looking for errors, at least in a certain segment of viewers. One does not get to be a good doctor (or even a mediocre one) without developing a good eye for the details. This nitpicking doesn’t detract from the show, or break the suspension of disbelief because it is possible to watch the show on two different levels: the fan, and the doctor. The Star Trek series has had nit-picking fans for years, there’s even been several “Nitpicker’s Guide to Star Trek” published – but remember that the books are not written by critics, but by fans of the show.

I’m going to throw out a couple of quotes from my interview with House writer Lawrence Kaplow, and wonder about your thoughts on the issues he raised:

Kaplow: “The writers are just having fun, telling stories. But then because it’s a medical show, people sometimes are watching it not just to see the characters and who’s kissing who, but for answers.”

How do you feel about people watching a medical show for answers? And knowing that some do, what kind of responsibility do you think that puts on the writers?

I wish patients wouldn’t watch medical shows for answers, but many do. This has been going on since the first medical shows appeared, and will continue as long as there are medical dramas. It’s something we have to bear in mind, both as doctors and writers. The most important aspect of this for the writers (as far as I’m concerned) is that they not give false hope to patients with a serious disease, and conversely, that they don’t exaggerate the seriousness of other diseases.

Kaplow: “Sometimes we get criticized from doctors who say that would never happen. And the truth is, in your practice that would never happen because this is not the norm, but we have documentation from here backed up to NBC Universal showing that this is possible, this is what can happen. But we can’t tell you the 15 steps it took to get there, because that would be really boring.”

Do you think some of the inaccuracies people point out are actually medically possible? Do you think accuracy should be sacrificed for drama, or does a medical show needs to think about more than entertainment?

Some of what I call inaccuracies may be possible, or at least theoretically possible. There are thousands of medical articles, studies, and case reports published every month and buried somewhere in there could be anything. Most of the time, if something is unlikely, but possible, I’ll mention it, or if I miss it, one of my readers will catch it.

Later this week I’ll post the transcript of my interview with Dr. Lisa Sanders.

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