Friday, August 12, 2005

Rant: Why 'House' is a bad show, and doctors have bad attitudes (even if they save your life)

I have a chronic illness. What's more, it's not a trendy chronic illness like cystic fibrosis or MS, it's not pretty... in fact, it is largely an unspeakable disease. People don't like talking about the symptoms, or the diagnostic procedures (one of my friends, a so-called medical professional, has said "eeeeeeuuuuuwwwww" about one of the procedures I have had to have, despite the fact he invades women's private parts everyday, because "you get a better picture that way". Um... Yeah). And this disease occurs in an area of the body that is hard to see or indeed visualize in any way. Because the disease is not trendy(and that is another rant all in and of itself), there is not a whole lot of research funding in it, so the unpleasant diagnostic procedures are still used.

What, you may ask, does this have to do with 'House'? Well, the lead character, the eponymous House, epitomizes all that is wrong with the medical profession. He is willing to treat without adequately diagnosing, and he is willing to subject patients to unpleasant tests on a hunch or a whim. However, the thing that is the most wrong about House is that he gives nary a damn for the patient; all he is concerned with is the diseases the patients carry. It is under the illusion that you can treat the disease without taking the patient's humanity into the equation that can allow him to make the callous and often ego-driven decisions portrayed on the show. The real danger of this is not that the show will inspire medical professionals to behave like House (many of them already do), but that the show will lead patients to believe that this is an acceptable way for doctors to treat them.

It is this disconnection of the patient from decision-making capabilities, feelings, or dignity that allows medical professionals to do things like order an enterolcysis (an xray where a tube is passed via the patient's nose into their duodenum while thy are still awake, and their already-damaged bowel is filled to maximum with contrast -- all this without sedation or pain relief) or do a transvaginal scan (saying objection to this is "sentimental") in the name of getting "better pictures". Is it worth entirely sacrificing a patient's comfort, dignity, modesty and privacy so a miniscule amount of further understanding may be gained about their condition? Is it ethical to refuse to do things any other way? Is pain (and it's deliberate infliction by medical professionals) a legitimate diagnostic tool?

As a professional patient I say no to all the questions I have just asked. For non-surgical procedures, I believe no doctor or medical professional should be allowed to perform a diagnostic procedure without first undergoing it. If they do not have the requisite anatomy, they should not perform it at all (what is with all these weirdo male gynecologists? I mean, how does that ever seem like a good idea?). I believe that for many patients, particularly the ones who are long term patients and need to make decisions about their health every day, informed consent includes offering a selection of different tests and explaining the risks and benefits of each (we, in particular, struggle to maintain dignity and identity as patients). I believe that uncomfortable tests are not legitimated by their lesser cost (than tests equally as accurate, but more expensive).

I understand where the doctors and medical professionals are coming from. To think of every patient as an individual suffering from something unpleasant would be mind-bogglingly difficult, and would result in burnt out professionals very, very quickly. However, treating each patient as a being with dignity, pain and feelings should be considered part of the job. It can be hard when dealing with uneducated patients to explain their options, and it may even be more humane not to explain all the options in every case as decision making can be agonizing for those who are not well informed prior to the appointment (and to educate everyone prior to an appointment would be prohibitively costly). However, medical professionals should be charged with the responsibility of making humane decisions, and in a case where a patient clearly knows what they are dealing with, including them in the decision making process.

Most of all, I believe everyone, doctors, nurses, diagnostic professionals, other healthcare professionals, and patients alike have a responsibility to ensure that 'House' is not what we expect of a medical professional, nor even acceptable.

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