Doctors diagnose accuracy of House

In a single recent episode of House, M.D., a team of doctors breaks into a patient's home, runs a few dozen thousand-dollar tests, accuses a patient of sexual misconduct and administers a risky drug to a patient without consent.

It's not exactly everyday medicine. While House markets itself as one of the more medically accurate dramas on TV today, it still features plastic surgeons performing endoscopies and forging prescriptions.

Numerous journals and blogs have discussed the medical accuracy (or lack thereof) of shows like House, Grey's Anatomy, Fringe and Scrubs.

One of the most dependable and dedicated analysts of medical TV shows is a family practitioner who goes by Scott; he has reviewed every episode of House for the past five seasons on his blog, Polite Dissent. Take Scott's review of "Unfaithful" (Season 5, Episode 15) as an example: The episode begins with the patient, an alcoholic priest, hallucinating Jesus, "stigmata present, floating a foot above the ground." Two dozen differential diagnoses for the patient soon follow, and Scott details each one, linking the reader to pages that explain the suggested diseases.

When watching House, the personal drama and medical emergencies fly by so fast it's often hard to track the team's thought process. When Scott lays everything out, the absurdity of the medical jumps - from epilepsy to carbon monoxide poisoning to leprosy to Guillain-Barre to AIDS? - becomes clear.

Every House episode contains a spectrum of medical inaccuracy, and Scott ranks these errors ("major complaints in red, minor in blue, and nit-picking in green") at the end of the episode summary.

His complaints center around conclusions the team draws from various medical tests ("Taub can rule out pneumonia, pleurisy and an embolus just by fluoroscope?"), the team's causal leaps ("If the patient had low white count, I wouldn't think of the spleen first thing, or even second or third.") and even the logic of the non-medical plot.

Scott then "grades" the medical mystery, the medical solution, the medicine and the soap opera. His blog receives an average of 100 comments per review.

And yet somehow, through all this analyzing, Scott seems to truly enjoy House - he's followed it religiously for over five years. The obvious explanation probably applies: even if someone is well-educated about medicine, they don't watch TV to fact check, they watch it to be entertained.

But there's also something about House's rude, blunt personality that appeals to viewers, especially doctors who would never be able to blow off clinic duty in real life. The hero-as-a-villain is rarely done well, and while we probably wouldn't want to have House's heart, we wouldn't mind getting access to his brain.

The human physician who deals with drug addiction and flirtatious colleagues is a fairly new addition to television. Ingrid Katz and Alexi Wright, medical residents at Brigham and Women's Hospital in Boston, recently wrote an article for Slate that describes this shift in the portrayal of TV doctors. Throughout the 1950's and 1960's, the American Medical Association, "demanded from television producers the right to revise scripts in the name of medical accuracy."

Many times, the AMA complained about the doctor's conduct instead of his diagnosis; doctors don't talk about their personal lives or medical malpractice and they don't "discuss dying patients casually over coffee."

And physicians certainly would never have cause to force entry into their patient's homes or medicate them without their permission. House manages to break all these rules and still figure out that the patient is suffering from Wiskott-Aldrich Syndrome. "While it's certainly true that the quality of the show has suffered some over the past few seasons," Scott wrote on his 100th House review, "it still remains the best medical show, if not the best show outright, on television."