Physicians

Gregory House, MD, RIP

Dr. Gregory House hung up his stethoscope and cane for the last time last night and shuffled off into eternal life in the Land of Reruns. House — the brilliant, misanthropic, drug addicted, my-way-or-the-highway physician — has been an entertaining presence on FOX television for the past eight years. I enjoyed the series and even learned a little medicine. I also took some pride in the show, since House was television’s first hospitalist, a term I helped coin and now the fastest-growing specialty in modern medicine.

But as entertaining as he was, House was a throwback to an era in which the antisocial tendencies of some physicians were seen as irrelevant to their doctoring. As medical leaders strive to redefine “the great doctor” of today, House’s departure is both timely and welcome.

When I went to medical school in the 1980s, many of us valued nothing more than our autonomy. We saw medicine as an individual, not a team, sport, and interpreted professionalism as unwavering advocacy for our patients. While this was often healthy and noble, in some cases it crossed the line into obnoxiousness, even rage. (Today, we call doctors who cross this line “disruptive physicians.” Dr. House would certainly qualify.)

Hospitals were co-dependent. All too aware of their heavy reliance on the physicians’ control over their revenue stream, hospital administrators learned to coddle doctors, with everything from prime parking spots to a personalized menu of surgical equipment. This kept the doctors happy, but also led to wildly expensive and sometimes risky variations in practice, even within the same institution.

This reliance also made everyone tiptoe around the dysfunctional behaviors that Dr. House so memorably illustrated each week. In one survey of more than 700 nurses, 96% reported seeing doctors engaging in disruptive behavior, and almost half pointed to fear of retribution as the reason such acts went unreported. Another survey found that one in four doctors and nurses believe that disruptive behaviors are associated with preventable deaths. I agree, having seen cases of medical errors in which a scrub nurse or physician trainee suspected that a senior doctor was about to commit a terrible error, but kept quiet rather than risk the physician’s ire.

Former secretary of State Henry Kissinger once observed that “weakness is provocative.” When it comes to taking decisive steps to address the problem of disruptive doctors, we have been both weak and provocative. The reasons are several and knotty. We doctors are not schooled in managing confrontation, and we’re particularly timid when asked to judge the behaviors of our colleagues under our system of “peer review.” Moreover, we worry about being sued if we act decisively against another physician.

But another reason goes to the heart of House’s widespread appeal: patients seem to believe that the Gregory Houses of the world must have terrific clinical skills, whether in performing brain surgery or diagnosing a rare case of strongyloidiasis. While Dr. House did have Sherlock Holmesian diagnostic acumen, the insider’s secret is this: great doctors are skilled at both medicine and teamwork. Patients shouldn’t have to choose one or the other.

Spurred by the patient safety movement, the medical community is finally taking steps to address the problem of antisocial doctors. Gerald Hickson, MD, of Vanderbilt has created a program that begins with a “cup-of-coffee conversation” but escalates to the loss of hospital privileges for physicians who fail to respond to education and counseling. In my own hospital, we have dismissed several physicians over the past few years for behavior that I’m certain would have been tolerated a generation ago. These are wrenching decisions, but ultimately correct ones.

While we’re getting better, we are still not where we need to be. Hospital peer review committees are only partially shielded from lawsuits, which creates a chilling effect. Options for counseling aimed at improving the behavior of disruptive doctors are limited. And doctors released from one hospital for behavioral problems are generally able to continue practicing in other settings, even if their behavior hasn’t changed.

Over the past decade, we have come to realize that, for all its miracles, the American health care system produces uneven, error-prone, and backbreakingly expensive care. These problems are complex and require an array of solutions, ranging from computerization to standardization, from simulation training to patient engagement. But we also need physicians who are smart, well-trained, innovative, intensely focused on delivering the best care to their patients, and who can play well with others. While House had many of these skills, the teamwork part was his fatal flaw. If he worked for me, I would have fired him, somewhere around Season Three.

So rest in peace, Dr. House. Thanks for being in our lives for these past eight years.

And thanks for leaving.

This post first appeared in USA Today.

Robert Wachter, MD, professor of medicine at UCSF, is widely regarded as a leading figure in the patient safety and quality movements. He edits the federal government’s two leading safety websites, and the second edition of his book, “Understanding Patient Safety,” was recently published by McGraw-Hill. In addition, he coined the term “hospitalist” in an influential 1996 essay in The New England Journal of Medicine and is chair-elect of the American Board of Internal Medicine.  His posts appear semi-regularly on THCB and on his own blog, Wachter’s World.

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ClintNurse NancyCharlene MjohnBrant Mittler, MD JD Recent comment authors
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Clint
Guest

The writers of the show created this character for one purpose: eyeballs and attention. Of course he’s not similar to real life doctors, because there wouldn’t be millions of people watching. People love to watch simulations, not the real thing. I can watch Game of Thrones and see people getting mutilated left and right, but I wouldn’t want to watch it in real life.

Nurse Nancy
Guest

I am going to miss the bastard! But lets face it, if he was the portrayal of a doctor the way they should be (nicer, friendlier, etc) then nobody would have watched the show.

I got to meet Henry Liker one time, one of the earlier advisors to the show. I guess they took good care to make sure at least some of the stories and plots were plausible.

Charlene M
Guest
Charlene M

“the American health care system produces uneven, error-prone, and backbreakingly expensive care. These problems are complex and require an array of solutions, ranging from computerization to standardization, from simulation training to patient engagement…”

Meaningfully flawed concept. Computerization in its current form is 180 degrees from what is needed.

john
Editor

What the hell, Bob? A generation of young med students and would be doctors watching House has grown up getting the message that doctors should think outside of the box, that intelligence can be cool, that smart people should think of medicine as as challenging and as interesting a field as society’s new chosen professions (tech entrepreneur, lawyer, Wall Street greedhead). I don’t get it.

Brant Mittler, MD JD
Guest
Brant Mittler, MD JD

Dr. Wachter probably made an “A” in organic chemistry. That’s the test medical school faculities use to screen for those who will be docile, compliant medical students and later doctors — doctors who will be the worker doctors that “boss” doctors like Wachter will tell what to do. The organic chemistry test was first explained by Dr. Eugene Stead ( late Duke medicine chief) who trained more chairpersons of internal medicine than anyone else on the planet. Stead liked for his trainees to be disruptive, in the most creative sense of the word. Today, being disruptive — challenging hostpial administrations… Read more »

DeterminedMD
Guest
DeterminedMD

Amen to this above comment, from someone who has rattled the bars of physician enslavement these past 15 or more years. Just look to the AMA who blindly and selfishly signed on to support PPACA. Oh, hello, I don’t see 50% or more of actively practicing doctors having positive praise for this legislative insult on clinicians. Unfortunately, House is not the poster child of what should be right. But, responsible and supported criticism of systems should not be water boarded either by, yep, here it comes again, the profit mongering few who have figured out how to steal as many… Read more »

anonymous
Guest

Seriously guys. It’s a television show. Yes, lifecan be influenced by art and art is certainly influenced by life. But, did anyone actually believe that George Clooney’s character was doing emergency brain and heart surgery in the pediatric ER?? House was based on the NYT column from Lisa (I forget her last name) at Yale and meant to be more of a medical detective show. They made him like Sherlock Holmes – cantankerous, drug addicted, brilliant – because it was good for ratings. And because it’s boring to look at doctors as one large, homogenized, standardized, automated, checklisted goo. Even… Read more »

Lynn in SC
Guest
Lynn in SC

When watching House, I would add up the hospital charges/costs of his ordered care for patients. There were always three full time physicians dedicated to a single patients with never a nurse in sight, fellows were delivering all the care a patient needed and performed all the procedures even visiting a patient’s home in search of clues. Very public health. The premier academic medical center in NJ couldn’t afford to employ a MRI tech? We all want House level of care but we never wanted the bills. How the Medical Board of NJ allowed Dr. House to hold a medical… Read more »

Peter1
Guest
Peter1

Me too Lynn. I’d say, “Who’s paying for this?”

Let’s be clear, a humility doc that used a mild mannered team approach (and weighed costs) would not have attracted the viewers to sustain an 8 year series. I watched for a time viewing it as a medical “who done it” with House being the Sherlock Holmes of medicine. Brilliance always gets it’s own way, and in the series House’s approach was always being questioned by his colleagues as part of the intense interaction.

Dr. Rick Lippin
Guest

I like to say that “the best medicine for organized US Medicine is a large dose of humility”. That would be a welcome relief from the self proclaimed “MDeities” still among us.

DeterminedMD
Guest
DeterminedMD

So where has medicine traveled? From the paternalistic, frat boy protectionlism extremes of the 60s through 80s to the business controlled micromanaged non clinician directed evidence based cluelessness of this millennium. Isn’t it pathetic how we as a species just bounce from extremes and just ignore the moderation of responsible reality based care? The more things change, the more they stay the same. Except the a-holes running the show now are shielded from accountability. Or so they think. The mob scenes of politics will metastasize into other arenas of life concerns. Art imitates life. There will be Johnny Q moments… Read more »

George Dawson, MD, DFAPA
Guest

Agree with the above. I also went to medical school in the 1980s and have never seen physician behavior even peripherally similar to this character. House would have no allies in any place that I have ever worked. He is part of the fantasies about physicians that are typically played out on television. I would hardly see this TV program as rationale for a program for disruptive physicians. Many of those processes are pure politics and the result of “personality conflicts, turf battles and competitive issues.” (see par 10). In some cases state medical boards are also involved. http://www.startribune.com/opinion/commentaries/141250683.html

JP
Guest
JP

I only saw this show a couple of times, which was 2 times too many for me. Everything you describe about this character — misanthropic, drug addicted, my-way-or-the-highway (and let’s not forget misogynistic) — didn’t seem to be entertainment to me. The only reason he was tolerated on the show was his so-called brilliance. If the character was an idiot, his asinine behavior would not have been tolerated (and thus, no show) or, if it were, may have been reality TV.