House, episode 3
This week’s episode of House was the best so far, at least in terms of the medical mystery at the heart of it. The solution was plausible and not as far fetched as the first two episodes. Dr. House and the young guns didn’t bounce around from diagnosis to diagnosis as much as they did in previous episodes. However, I was confounded by their tendency to start treatments for diseases without running simple (and quick) confirmatory tests. It’s hard to believe that this very sick patient was in the hospital as long as he was without anyone drawing a simple blood count — a test that takes maybe 15 minutes to run. I can only assume this is because the young guns persist in doing every test and procedure themselves; the hospital is bound to have a lab and specialists — use them!
The title and theme of this episode was “Occam’s Razor” — a medical “law” taught during medical school. The scene where the doctors were writing all the patient’s symptoms on the board and trying to figure what conditions would cause them was eerily reminiscent of my internal medicine rotation in medical school.
Hugh Laurie continues to fascinate as Dr. House and Omar Epps is the strongest of the young gun doctors (by the way, their specialties are neurology, immunology and oncology). Sean Patrick Leonard’s Robert Sean Leonard’s character is actually developing a personality — a first for him. The other two young guns are getting stronger, but are still mere shadows next to Epps and Laurie.
You want some medical nit-picks? Well, OK. I’m happy to oblige.
1. Protein, DNA and RNA gels take several hours to run.
2. Even though an infection may not have been at the heart of the problem, the patient still had a dangerously low white blood cell count and needed to be in isolation — isolation which was broken by Dr. House storming into the room in his “Eureka!” moment.
3. Thyroid hormone replacement is an oral medication, not an IV medication. It needs to be started slowly and gradually increased, not slammed into the patient full strength.
December 1st, 2004 at 4:59 pm
Robert Sean Leonard. Sean Patrick Flanery starred in “The Young Indiana Jones Chronicles.” (Which doesn’t make your commentary any less interesting, of course. Heh)
December 1st, 2004 at 7:48 pm
Oops! Why can’t actors have simple names any more?
December 1st, 2006 at 12:30 am
Ahhh… The legality issue actually. SAG (The Screen Actors Guild) or someone like them makes actors have names that are not the same as any other actor. Example, Michael J Fox is named such because an actor named Michael Fox was in some tiny movie before MJ Fox was an actor.
December 9th, 2006 at 8:23 pm
I’m pretty sure that the reason House doesn’t use lab specialists and stuff is because he doesn’t trust them and he wants his people to do the tests and everything.
December 11th, 2006 at 12:11 am
Dr. Chase’s (the blond Aussie) specialty is intensive care. Dr. Wilson is the oncologist.
Just thought I’d point it out. Fascinating blog, and a very engaging show, even if it takes sometimes substantial liberties with the medicine.
December 27th, 2006 at 5:03 pm
In my humble medical opinion, I think that in some episodes the therapy is taken into account too often as a diagnostic tool. I was taught, first the diagnosis, then the therapy. Most of the things going wrong caused by side effects of “If-it-works-we’re-right” could’ve been preventible if just the tests that were run _after_ things got worse would’ve been done before. Or, as my senior resident used to say, “Do the math before you stick sharp pointy things in fellow humans”.
So much for nit-picking, however, great show, and great acting done by Hugh Laurie (By the way, watch Black Adder for a quite different Hugh Laurie.)
Of course, these are just my 5 cents…
January 19th, 2007 at 3:34 pm
I think the show producers screwed up with the pills. The authentic cough pills that Chase picked up in the pharmacy had no letters on them. The authentic cough pills that Brandon recieved at the end of the show did have the letter on them. I’m sure the audience all got the point, but if you go back at look through the show, you’d see that the show actually screwed-up the screw-up.
February 24th, 2007 at 4:53 pm
As a European (we use to get prepackaged drugs here, not these orange pill containers) I didn’t get the whole thing with the unlabeled pill box Brandon received.
Anyone mind to explain? :)
March 10th, 2007 at 10:19 pm
I take slight objection to saying Occam’s Razor is a “medical law”, as it’s really a logical argument and seen most often in things like philosophy of religion and forensics rather than medicine (typically diagnostics)
March 16th, 2007 at 9:23 pm
TTS has a point: I would have expected Chase to have turned the pills over so that they could check the other side; they wrongly rejected the screw-up as an explanation based on the one-in-eight-chance that all three pills were blank-side-up and it may have been intended to look that way.
March 17th, 2007 at 2:14 pm
Ok, here’s my two cents:
- one of the first things House says is “CBC is unremarkable”, and CBC=Complete Blood Count, so yes, obviously they did a blood count ;-)
- indeed, the 1 in 8 chance (12.5%) for the 3 pills in the pharmacy showing the non-letter side means it’s quite realistic to assume that this is exactly what happened here. Otherwise the mother and girlfriend would have noticed there that the pills look different, and so for the show it was the only consistent course of action in order to keep up the suspense in this way … ;-)
April 4th, 2007 at 10:45 am
chase is not an oncologist. he is an intensivist. they are very very different.
April 7th, 2007 at 3:16 am
Re: your nitpicks.
Polyacrylamide gels CAN take hours, they can also be relatively quick, it all depends on
a)whether you’re using precast gels (which I’d assume in such a context, please correct me if I am wrong)
b)what type of equipment you use. Electrophoresis equipment with maintains constant temperature, while more expensive, can allow much higher voltage (and consequentially quicker runs) without harming the resolution significantly.
c)of course: the size of the gel. They come in all sorts of sizes, after all, from small minigels to huge gels used mainly for sequencing.
And, of course, there’s agarose gels for DNA and RNA which, especially in minigel format, are very quick especially for DNA.
So, since we’re nitpicking, you’d have to specify specific types of protein/DNA/RNA gels in a specific context in order for the statement that they take several hours to be true.
Oh, and Occam’s Razor is a basic principle of epistemology, i.e. the theory of knowledge.
May 23rd, 2007 at 12:33 pm
Ok, what about this leukopenia? Correct me if I am wrong, but most of the viruses actually CAUSE a leukopenia.
So this doesn’t exclude the viral theory at all.
They didn’t mentioned differential there (or at least I didn’t hear so). It might have been usefull if there was a lymphocytes count…
Strange…
May 26th, 2007 at 7:43 am
just curious what kind of cough medication comes in pill form. i am only familiar with over the counter cough medicine, and only know of liquid medicine–the idea being, i guess that coating the throat helps with the cough, or the tickle that generates the cough. i don’t think the liquids really helf for more than a few minutes. so there must be a different type of medicine that is prescription only.
but what is it and how does it treat a cough?
July 10th, 2007 at 8:04 am
Hey…everybody hear seems to be way smarter than me so I wont argue medicine.
One thing i’ve noticed in these blogs is that you keep seeming to mention lots of other tests to run…
Or complaining that the 3 ‘young guns’ do all the tests themselves.
From an actors/producers/directors point of view, It’s a character show. You dont see 2 nameless people do an MRI becuase it would be boring to see 2 nameless people do an MRI. As for the former I’m sure you could all understand that with a show that has a 42 minute run time not everything can be shown.
If you wake up in the morning with a muddy front yard and a wet car, you might not have seen it rain, but it’s safe to assume that that’s what happened
March 6th, 2008 at 10:19 am
Hey. I’m not a doctor but still I get the feeling that they’re playing it by ear.. I mean, they try the cure first and if it sticks, yay, if not, next diagnosis! I keep reading these posts and I kinda get how annoying it must be for those who know, to see all the medical mistakes or intended inaccuracies. I get pissed when I see somebody get shot and thrown through a window (can’t happen, the shooter would be pushed back just as far), but hey, that’s movies.
But for the love of sanity, what is the deal with the pills? I’m from Europe and we buy them prepackaged… why did the ones at the end have a letter, and what did it mean!?! Were they real, and the other ones, from the pharmacy, fake?
Thanks.
April 7th, 2008 at 4:31 am
The pills!! If you get a chance to look at a MIMS (or something like it - a medical book that has all medications available listed in it), it will have pictures and descriptions of all tablets, capsules, etc so that you know, if you’re unsure, that you’re giving the correct medication. Although, have to admit, here in West Australia our medications are usually prepackaged as well.
June 9th, 2008 at 9:14 pm
I’ve also noticed in many films that commercial pharmacies in the United States are like supermarkets, where one can walk in, take something, go to the register and pay. In Europe it is the pharmacist that deals with the medicine, and the customers only receive it when the transaction is over. Much more responsible, if you ask me.
And did you notice how House sympathised with the first Clinic patient? The one who was about to get fired? “I just don’t like being told what to do”, she said (or something similar), and this might have a little to do with it.
July 1st, 2008 at 9:57 am
Duke,
Yes, you can do that here, but only with non-prescrpition medications, like aspirin, first-aid ointments, cold pills, and eye drops.
All the regulated medications go through the pharmacist, who will not give them to you until you’ve heard the speech about proper use and signed the form which says you’ve heard the speech.
The last time I got “real” medicines, it even came with a description of what it should look like. Perhaps to prevent the very scenario presented in this episode.
July 1st, 2008 at 10:13 pm
It makes sense, but it still shows a different mentality; people here seem to know better than not to follow the doctor’s instructions. And I recently read in the BBC website that the US is probably the only country where they actually advertise prescription drugs on television. No offence to any Americans, but it sounds to me like drugs are too commercialised over there.
July 3rd, 2008 at 10:22 pm
[…] House disagrees, saying that simultaneous development of hypothyroidism and a sinus infection is more likely.They treat him with intravenous levothyroxine (an artificial thyroid medication) and Unasyn, a pencillin to treat the sinus infection. Again, bollocks. Levothyroxine is given orally. Polite Dissent has also pointed this out. […]
July 19th, 2008 at 4:59 am
Duke,
“people here seem to know better than not to follow the doctor’s instructions”
Your logic is as vapid as it is narcissistic.
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