Morning Rounds: Why I Hate "House"
TO YOUR HEALTH -
Thursday, June 18, 2015 7:40 AM
I hate "House." I don't hate Hugh Laurie; he is a very talented actor. I just hate the doctor he plays on T.V.
House is always the "best" doctor in the room, the doctor who knows best, the man with the answers.
The problem with "House" the television show is that medicine has changed. There isn't room today for people who know all the answers - if there ever was. That kind of doctor doesn't listen to patients or the other members of his or her team. That kind of doctor misses things, important things. That kind of doctor kills patients.
Modern medicine is a team sport, and as our knowledge has grown, so have the number of specialties and roles in the teams that take care of patients today.
Doctors today are leaders and coordinators. They are still face-to-face with patients, but a lot of what they do, or what they should be doing, is working with teams to make sure everybody knows their job and is comfortable doing it. As any football or basketball coach will tell you, a highly functional team of above-average players will beat a poorly coordinated team featuring an insanely talented "star" any day.
This isn't just my opinion. There has been a lot of research into how doctors and other clinicians work together, or fail to work together, because too many people were dying in hospitals of preventable causes.
One of the most cited reports was published in 1999 by the Institute of Medicine and found that between 44,000 and 98,000 people die in hospitals each year due to medical errors. Since then, various reports and studies have pointed to communication problems as one of the biggest causes of medical errors, if not the single biggest cause.
One well-publicized series of medical mistakes occurred in a hospital known for offering a high level of care.
In three separate instances within a year, surgeons at Rhode Island Hospital, a teaching hospital for Brown University, began brain surgery on the wrong side of a patient's head.
In one case, an experienced brain surgeon insisted to a nurse he knew which side of the head to operate on, except he didn't. In another case, a doctor-in-training skipped the pre-op list. In the third, the surgeon started in the wrong place because a nurse, who knew he was wrong, didn't speak up.
In all likelihood, each of these doctors was extremely skilled and well trained. What went wrong is the doctor either didn't ask his or her team members if he was in the right place or didn't listen to his or her team members, or the team members didn't feel comfortable speaking up.
The result was that the patient woke up with a hole in the wrong side of their head.There are a lot of reasons things can go wrong in hospitals. Clinicians are often working under tremendous pressure and they may have to act quickly to save a life. If a doctor assumes that he is the most qualified person to make every decision, the patient is being cheated out of the expertise of the nurses, surgical techs, anesthesiologists, and other experts.
Today, protocols require that surgeons go through checklists before operating on patients, confirming basic information with other team members such as the identity of the patient and the procedure that will be performed.
But just as important as having the protocol in place is making sure that there is an atmosphere that is respectful of everybody on the team so that everyone feels comfortable speaking up.
House is the kind of doctor that shuts down communication, and when communication breaks down in modern medicine, the system breaks down.
House may be the medical equivalent of a rocket scientist, but what a patient really needs is NASA - a highly trained group of rocket scientists, engineers and other experts working together to solve a problem.
A really good rocket scientist may be the world's greatest expert on propulsion, but at best he is only going to get you off the ground in spectacular fashion. To get safely back down again, you need a team.
In real-life hospitals, perhaps the most important member of the team is the patient.
The best physicians spend a lot of time listening to patients, and not just about where it hurts, but about the obstacles that can prevent them from getting back to where they want to be. Understanding what those obstacles are is a critical first step in helping the patient overcome them.
One thing we know about getting patients to talk to us is that it helps to be interested. House assumes patients are lying. What matters to him is not what they think, it's what he thinks.
That attitude may make for complicated characters, edgy dialogue and lots of entertaining plot twists - including near-death experiences for patients - but in the real world it is terrible medicine.
Mark Fourre, MD, is an emergency physician and Chief Medical Officer of Lincoln County Healthcare, the parent company of Miles Memorial Hospital and St. Andrews Hospital. He also serves on Lincoln County Healthcare's Board of Trustees. Prior to joining Lincoln County Healthcare, Dr. Fourre was attending faculty at Maine Medical Center, where he developed the Emergency Medicine Residency Program and served as Residency Director.