Virginia physician: "Does ill-tempered doctor really deserve adoration?"

June 26, 2005 -- Today the Free Lance-Star of Fredericksburg (Virginia) ran an interesting op-ed by primary care physician Patrick Neustatter questioning whether a "curmudgeon doctor," like the lead character on Fox's hot new television drama "House," is really what patients want. The piece uses "House" as a vehicle to explore how the media distorts the reality of health care, with potentially serious real world results, including the unjustified glorification of certain types of physicians. To this end the op-ed relies in part on the Center's own analysis of the physician-centric show.

Dr. Neustatter observes, with a mix of bemusement and chagrin, that his patients are "loving" the cerebral "anti-hero" Greg House, an infectious disease specialist who regularly insults and abuses patients as he and his team solve daunting diagnostic mysteries and save lives. Neustatter suggests that the "drug-addicted, sarcastic" House is quite an evolution from earlier TV physicians, who include the "dashing" Dr. Kildare, the "fatherly" Marcus Welby, and the "bumbling and laughable" Frazier and Dr. Huxtable (from The Cosby Show).

The piece's basic point seems to be that shows like "House" romanticize and distort health care, and among the results are that certain types of professionals are unreasonably glorified. House's team does everything, while primary care physicians, nurses and other care givers are peripheral or non-existent. Dr. Neustatter says "God knows why" his patients like House, yet his description of the character as an "anti-hero" does capture his apparent charm: House is a witty, intriguing figure whose nasty remarks are usually shown to be correct. Viewers presumably admire House's iconoclastic, life-saving brilliance, and they may also imagine themselves getting off such put-downs to their own tormentors. Some of House's comments also have a reactionary flavor that may appeal to those who are weary of the stresses of recent social changes. At the same time, viewers may link House's bitter demeanor to his disability, which causes him constant pain and limits his mobility. The writers and the masterful actor Hugh Laurie also manage to convey the crumpled idealist under the acid exterior, with little of the sentimentality of some "lovable curmudgeon" characters. And Laurie is evidently one of the sexiest men on television.

Unfortunately, whatever the show's dramatic merits, an argument can be made that it is part of a budding tradition of media portrayals that show the conduct of arrogant, abusive physicians as a price society must pay for their brilliance. Such forgiveness, sadly, is not just a media fiction. And the real world results can include burned-out nurses, rising costs, and dead patients, since real physicians who cannot communicate or work effectively with others are likely to provide dangerously poor care.

In any case, under the heading, "Nurses down on 'House,'" Dr. Neustatter's op-ed notes that the Center is "very bent out of shape" about the "disservice" the show does to nursing, discussing the Center's review of the show's premiere:

Playing off House's premise that "everybody lies," the Center says, "The show itself is a damaging lie: that a team composed entirely of physicians would rove the hospital providing all significant care to desperately ill patients as the few nurses and other professionals stand silently in the background or simply disappear."

The piece goes on to describe the specific plot of that episode, in which House uses his "brilliant sleuthing" to discover that a dying patient actually has cysticercosis (tape worm larvae) in the brain, a diagnosis that the Center "says...would have been made by some savvy nurse seeing tape worm segments in the stool as she emptied the bedpan. Not so romantic." Though the Center did revise its initial analysis to reflect the fact that only some neurocysticercosis patients pass the worm segments into their stool, it's still true that a nurse might have noted this symptom as part of his standard assessment, and that in other cases tape worm eggs might have been found in the stool collected by nurses for laboratory analysis. In those situations, nurses would have played key roles in identifying this deadly infection. But not on "House."

Dr. Neustatter's op-ed wonders whether it is unfair to expect such shows to be realistic, whether they must be allowed some "poetic license." He does not really answer this question. In our view, the efforts of such shows (especially "ER") to provide technically realistic portrayals of the medical diagnoses and treatments of some conditions, along with the drama inherent in the real work of nurses and other care givers, demonstrate that the shows could be more realistic without sacrificing drama. Indeed, these shows actually do include some dramatic depictions of nursing and other types of health care; they just show certain physicians doing it all.

Moreover, while Hollywood dramas do often glorify abrasive physicians in sexy specialties (besides "House," there are the surgeons on ABC's "Grey's Anatomy," the ED physicians on NBC's "ER," and the plastic surgeons on FX's "Nip/Tuck"), other shows place a positive emphasis on primary care physicians, including the WB's "Everwood," Lifetime's "Strong Medicine" and PAX's "Doc." Granted, the primary care physicians tend to appear on "family"-oriented basic cable dramas, rather than widely seen, high energy major network shows. But we are aware of no nursing equivalents to any of these shows in the last decade. What we feel unites all of these dramas, along with others that only occasionally touch on health care, is rampant physician-centrism--a feature that is especially unfortunate given the global crisis in nursing.

We thank Dr. Neustatter for including some of our analysis of "House" in his op-ed, and we thank the Free Lance-Star for publishing it.

See the op-ed by Patrick Neustatter "Does ill-tempered doctor really deserve adoration?: Are curmudgeon doctors what patients really want?" in the June 26, 2005 edition of the Free Lance-Star.