Recently at my office a patient, at the end of his first
visit, showed me a high grade of disappointment when he realized that he was
leaving without a definite and sound diagnosis. I had spent 40 minutes
questioning and giving him a complete physical exam, and, yet, with laboratory
and radiologic orders in his hands, he did not have a �verdict.�
That same night I turned on my TV, and there he was, Dr.
House, showing me the reason for my patient�s frustration. This excellent and
well performed TV series made me question the real essence of being a doctor.
Portraying an anti-hero, with an eccentric way of dealing with patients and
their relatives, brings him (Dr. House) more into our 21st century philosophic
reality of �noninvolvement,� �never mind� attitude. The old family doctor is
nowhere to be seen. Instead, you get to deal with someone pretty much like your
mean next door neighbor with a temper, with an addiction, with no manners. The
medical doctor, that is, the clinician we are all supposed to be, is hiding in
an extreme science freak detective-like, compulsive person who is never to be
The distant doctor, geographically speaking, the one that is
now known in many Third World countries through teleconferences is as far from
his patients, not to be seen until he bursts, every now and then, into the
patient�s room with quotes such as �congratulations, you�ve got a tumor,� and
even then, rarely laying a hand on that person in his care, reminds the
patient�s relatives that he is the attending physician.
There is no physical exam. No, this �diagnostic expert
doctor� does not waste his precious time on such an insignificant matter.
First, although not always in the same order, diagnostic tests are performed: MRI,
MRA, lumbar puncture, colonoscopy, echocardiogram, evoked potentials, heart,
liver and kidney biopsies, among others; which, and this is worthy of taking
note, are always performed by House and his team. No medical consultants in
The drama on the other hand is well developed and trying to
guess the diagnosis is a challenge. But, make no mistake, House, is not a role
model to follow, not for the idealistic physician, devoted in heart and soul to
his patients, nor for patients to expect a doctor who, in the end, despite
saving their lives in a last minute of inspiration (say, thinking Congo Red
staining for diagnosing amyloidosis after staring at the thong of a patient�s
underage daughter), is not to be found in any hospital.
Jacobo Dib, J.r MD, is
chief of the Gastroenterology Unit at Hospital de Lidice, Caracas, Venezuela.