18 May »
I mentioned that many doctors think Scrubs is the most realistic medical show on television. According to ER Drama, the least realistic – no surprise – is House, MD:
Watching House, MD though, things have been taken to an even higher level of unrealism… So why does this matter? It matters because there are a lot of people out there who have a big problem between fiction and reality.
The author, Dr. Heal, is an ER Doc. I appreciate his frustration, which I’ve heard from other doctors, too. It’s the same frustration attorneys have for most legal dramas, or that cops have at cop shows – for that matter, somewhere right now a meerkat blogger is complaining about the half-truths and exaggerations of Meerkat Manor. So, yes, House, MD is unrealistic. But let me explain why this doesn’t matter: if you’re a patient, it’s the best show on television.
To appreciate that, you need to understand two things that are not obvious: first, it’s not a medical show. It’s a mystery show. The series is quite deliberately modeled on Sherlock Holmes; House = Holmes, Wilson = Watson. Get it? And it’s a very good mystery show – taut plotting, crisp dialogue, and sharply-drawn characters, with some of the best acting out there. It just happens to be a mystery show set in a hospital, the way Scrubs is a sitcom set in a hospital. Neither House nor Scrubs are “medical shows”, in the sense of belonging to that particular genre.
Second: to the extent that House borrows from the medical genre, it does so as wicked satire. Even when the genre was fresh – aeons ago – medical shows never showed doctors and patients with any modicum of realism. That’s not to say fiction owes any fealty to reality: a work of art is no less true for being entirely unreal. But to complain that House, MD is an “even higher level of unrealism” misses the point: that “higher level” is it genius, its edge, its truth. That higher level shows the plain stupidity of lower level shows – current, prior, and forever.
Take, for example, the representation of doctors in medical dramas. After decades of watching TV doctors’ failings unfold in prime time, audiences are fully prepared to lionize any person claiming an MD – even an arrogant junkie misanthrope like Gregory House. No real patients wants Dr. House to be their doctor – except for the fact that he solves every case, which is true of almost any TV doctor and exactly zero real doctors. This is a trope deeply ingrained in the medical show genre; it’s not original to House, nor has the medical profession done much to disabuse audiences of the notion. You can still find plenty of doctors who wear their degrees like a combination crown/halo; every patient knows at least one. (For the record, Dr. Heal does not seem to be one of these.) I’m sure those doctors loved the image of physician as all-knowing, all-healing superman – and certainly all physicians benefit from it. Of course they don’t appreciate seeing the myth perforated; but for patients, this is an absolutely necessary step. We need to learn that our doctors inevitably possess some degree of human weakness, even if we don’t see a cane.
The best, most realistic part of House – for me, as a patient – is its sense of humor. About 99 times out of 100, when someone not sick tells you humor will help you get through your illness, what they mean is that you shouldn’t think too hard about your bold new world of suck. You are instead supposed to divert yourself with trifles: thus was born the “Hang In There” kitty. What they don’t mean – what scares and confuses them - is that you should actually laugh at illness, pain, and death itself. That makes kitty cry. Yet I have found that my best, my only defense against the horror is to laugh at it. If I allowed myself to take my illness too seriously, it would overwhelm me; fear would be my only reality, death my only hope. If I want to take my life seriously, I have to be able to laugh at death.
Medical shows can’t laugh at illness and death, because that would deprive them of the tension necessary to hold their audience for 47 minutes at a time. They have to take it all so seriously, so earnestly – and so medical shows are humorless and tedious when it comes to illness and death. But nor can they be realistic in their seriousness: if these shows were honest about the reality of medicine, without any humor, they would be so deeply depressing and disturbing as to be unbearable. They exist instead in an over-exposed snapshot of reality – where doctors win more than lose, patients are always inspiring, and every disease is an emergency. As such, these shows don’t reflect my experience, don’t appeal to my sensibility, and don’t offer anything I recognize as truth about the human condition.
But House, MD starts from a different premise – already so unrealistic, so hyperbolic and excessive, that it has no obligation to take itself seriously as a medical show. The dilemma in House is not life or death – it’s knowledge. This, to me, is a far more compelling problem than death. The truth is, we’re all going to die: we just don’t know how or when, yet. In the meantime, House, MD offers a way past the horror: because the show doesn’t have to take life and death so seriously, it gets to have a lot more fun. It gets to be funny – and therefore true – in ways a million Grey’s Anatomy script-writers typing on a million typewriters could never be. Hugh Laurie is no less than a messenger from heaven, telling us it’s okay to laugh.
Ultimately, House, MD is not a show about medicine; if you want that, there are lots of mostly accurate, perfectly dull medical reality shows on Discovery. I don’t think anyone – not any patient – should watch House, MD thinking, “this is how medicine should work.” That’s not the point of the show, nor the point of fiction more generally. Yes, there are some dumb people who don’t get it – but art, even television, isn’t obliged to the dumbest people in the audience. For the rest of us, House is one the best things on the air right now; not an entry to the reality of medicine, but an escape.
(ER Drama link via Kevin, MD)
Tags: misc
9 April »
I’m not a regular Daily Kos reader, but yesterday I clicked through from NOW! Blog to The Conservative Argument Against Universal Health Care. One item on that list caught my eye:
Just desserts
Related to the previous argument, the “just desserts” argument says that people deserve what they get. [...] By this argument, the outcome of a person’s life is caused by proximal factors (internal factors like character and judgment); less important to outcomes are distal factors (external factors like the structure of society and public policy). By laying the fact that they are uninsured on their own shoulders, conservatives can argue that ” It’s their own fault”.
A minor point: the phrase is more accurately “just deserts“, where “desert” is a word meaning “what one deserves”. Anyway, I’m not convinced of the provenance of this document, though the Kossack in question says it came from The Vanguard.Org. You can find a similar argument used as a straw man in this document from AMSA (.pdf).
Even if not a bonafide conservative talking point, this basic idea is pervasive enough to be trouble. Formally, it’s called the Doctrine of Retribution: the notion that the world is a fundamentally just place, and bad people will be punished. That may well be true, but somehow it gets distorted to also mean that every person who suffers deserves it – i.e., you’re uninsured because it’s your own fault. This fallacy informs a lot of prejudice and bigotry: you may know it as the idea that black people are poor only because they lack work ethic, or women get raped only if they’re “asking for it” by how they dress. Now we see it being applied to health care…
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Tags: care, ills
26 March »
A few posts back, I pointed out that Billy Tauzin presumes to speak for patients, despite not appreciating the typical experience of patients in our health care system. I wrote that knowing Mr. Tauzin had survived a bout of cancer against long odds. My point was not that Mr. Tauzin has no experience with illness, just that his experience is not at all typical.
Ken Johnson, senior VP for communications at PhRMA, commented:
Billy, like you, was diagnosed with a serious medical condition. He almost died from a rare form of stomach cancer that even his doctor only gave him a 1 percent chance to beat. He celebrated an important milestone this week: He’s been cancer-free now for five years.
Fortunately, both of you continue to beat the odds.
This is fertile ground, I think. I’ll come back to whether or not I “beat the odds” in a later post, but there’s no doubt that Mr. Tauzin did. It’s instructive to look at how that happened – and ask whether his experience was at all typical of American health care.
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Tags: biog, ills, pols
26 March »
One of the best things about blogging is the people that interact with me here and elsewhere in the blogosphere, and what I learn from them. For example, Joe Wright commented on my post about disease organizations, and points to a response on his own blog. You should read his post – in particular, towards the end where he talks about the 504 sit-ins in 1977. This is the first I had heard of it, but it’s important history to anyone who is disabled or chronically ill. The eventual result of these demonstrations was the Americans with Disabilities Act, and the more recent the ADA Restoration Act which includes those with serious illness under the protections of the original Act. If you have a few minutes, listen to the NPR report on the 25th anniversary of the sit-ins.
In the second part of the report, Paul Longmore makes the point that prior to the sit-in, disabled people understood their disabilities primarily in medical terms; the obstacles they faced were assumed to be intrinsic to the disability. The sit-in helped people appreciate the extent to which the obstacles they faced were in fact the result of other people’s decisions and actions, and that disabled people could work together to remove those obstacles.
I got into blogging in part because of a similar realization: the biggest limitations in my life are not the clinical features of my disease, but the actions and decisions of others vis that disease. So where other patient bloggers talk about their symptoms, meds, diet, etc, I spend much more time talking about health care reform, patient empowerment, and so on. Maybe that costs me readers, but I really do believe that chronically ill people face subtle but pervasive discrimination in American society – and that it won’t change until more people know about it. The ADA Restoration Act was a big step in the right direction, but we’re still some ways from a society in which sick people can participate fully and freely. It’s inspiring to see the previous generation taking on a very similar fight – and winning.
Tags: care, ills
20 March »
I mentioned a while back that I have some problems with the research/fund-raising agenda most disease organizations pursue. I want now to be more specific: most of these organizations are not helpful, and possibly detrimental, to the lives of sick people. You know the organizations: the sort that sponsors showy fundraiser walks, always clad in upbeat copy about how you’ll be ‘making a difference’ or ‘bringing hope’ or ‘changing lives’. It all sounds great, I know, but my advice is “don’t walk” – at least not until you’ve heard me out.
In that earlier post, I quoted Harold Varmus from his interview on the Daily Show: “you don’t want the disease advocates warring with each other”. Dr. Varmus was speaking as former director of the National Institutes of Health, where balancing competing research interests was a major – and difficult – part of the job. He apparently did a good job of balancing, but I think the problem is bigger than the NIH. There are a lot of disease advocacy organizations in this country, and they not only compete with one another for funding, but with other people and priorities. Most of these organizations channel their resources towards a very specific goal, research for a cure – which is a worthwhile goal, but not the only or most obviously-worthwhile goal. The kind of tension Dr. Varmus mentions – between basic science and disease-specific science – exists across a number of other dimensions, too.
Most of these organizations operate on a model that, as far as I can tell, was pioneered by breast cancer activists. There was a time when breast cancer was an underfunded, unknown area of medicine; also, dinosaurs roamed the earth. Today, everyone knows breast cancer exists, the federal government funnels billions of dollars into breast cancer research, and the pharmaceutical industry throws tens of billions more at the problem. By any account, this model worked very well for breast cancer as a “cause”, so no surprise that it’s widely imitated.
My own experience with this model is largely through the CCFA, of which I am no longer a member; I gather that nearly all disease orgs. follow the same model. The reason I am no longer a member of CCFA, and the problem I have with these organizations in general, is that they reduce the entire experience of their particular disease to a single problem – lack of cure. This attitude ignores a lot of any given person’s struggle with illness; even for a disease as specific as breast cancer, that experience is going to vary from patient to patient. I know two women dying of breast cancer. One – comfortably retired – puts a lot of stock in the various “for-cure” organizations. The other – a single mother struggling to pay her bills and put her kid through college – doesn’t; for her, they’re no help at all.
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Tags: care
