The Faulty House

by Natalie Ernecoff

"Treating illness is why we became doctors. Treating patients is what makes most doctors miserable.”  – Dr. Gregory House

The above quote is from “House,” the television series that tells of the fictitious, narcissistic physician of the same name and his unconventional case-solving skills. Many medical and pre-medical students tune in each week to watch the out-of-line doctor take on a seemingly endless number of obscure cases at Princeton-Plainsboro Teaching Hospital. While entertaining, “House” is riddled with neglect for the patient as a person. Though many of his actions are uncalled for and meant for entertainment, one is still inclined to wonder if medical students and physicians are more like him than they are willing to admit.

Granted, the vast majority of physicians surely care about their patients, unlike the disdain expressed above by Dr. Gregory House. Most people in medicine enter the field because they want to make the lives of others better. Physicians in the real world do not purposefully behave unethically or jeopardize the well-being of their patients to simply prove a point, but unfortunately that is not to say some of House’s less overt, deleterious behaviors are absent from medicine today. Is there a lesson to learn from House?"     

"Everybody lies.” – House 

If everybody lies, then the media is a major culprit. Television series based on medical practice often misrepresent doctors and the hospital atmosphere. This includes physicians’ weak interactions with patients, frequent yelling, and inappropriate interactions with fellow staff members. The general population may perceive these behaviors as standard practice, when they are often intended merely for entertainment value. Television designed for entertainment purposes can easily display misguided ethical principles. Not only might this influence the way medicine is perceived by the public, but it might also influence the way it is practiced. One can only hope that medical students do not apply many of the slippery lessons provided in their favorite television programs.

“I like being alone. At least I convince myself I’m better off that way.” – House 

Although physicians want the best for their patients, some missteps are common with respect to bedside manner, and these patterns begin during medical education. Recent studies have indicated that students’ empathy levels drastically decrease during their time spent in medical school. Most of these changes occur at a critical time when students are transitioning from the academic setting to clinical practice. At the same time, many blatantly rude behaviors, like cursing, are common in the hospital setting; from observing their superiors, students may assume these behaviors are acceptable and justifiable.

Several factors could contribute to this recoil of empathy for patients and their situations. Seeing real patients who have real families, illnesses and lifestyles can have a drastic effect on the emotions of medical students, which can in turn impact their mental and physical function. These effects can be a daunting reality to students who are accustomed to focusing primarily on hypothetical cases in their texts and lectures. In fact, students may overcompensate by trying to suppress their emotions entirely.

Researchers hypothesize that inadequate empathy toward patients is a pre-emptive tool medical students use to protect against emotional attachment. Whether deliberate or subconscious, medical students may believe that building strong connections with their patients poses the risk of making them psychologically and emotionally taxed. They perhaps feel distancing themselves from patients allows them to retain their own well-being in the long run. Though this may make intuitive sense, quite the opposite is true; research indicates a positive correlation between empathy, student well-being, and professionalism.

"Better a murder than a misdiagnosis.” – House   

Though it may be true that empathy yields better outcomes for physicians and patients, sometimes students are too preoccupied with the biomedical information they need to recall in order to properly diagnose and treat people in real time. These added stressors have the potential to decrease students’ emphasis on empathy, which in turn negatively impacts the quality of the patient’s experience. Whatever the reason behind these decreasing empathy levels, simply being aware of the deficit gives students the opportunity to take actions to either conserve or expand their empathy and their ability to convey it to patients.

In an attempt to help students do so, medical schools are beginning to offer courses intended to improve communication skills between future physicians and their patients. Not only are they addressing communication issues explicitly, but many medical schools are also expanding their curricula to include a larger humanities base. One example includes teaching students to express themselves by utilizing creative methods such as painting, sculpture and poetry. While developing these skills helps the students directly, it can also benefit patients indirectly: when faced with adverse decisions or difficult medical situations, physicians with this training can help patients manage what they are feeling in an effective and comforting manner.

"I’m pretty sure I’m not going to like you. It’s nothing personal. I don’t like anybody.” – House   

When physicians address their emotions explicitly, patients are not the only ones to benefit. Empathy-based care is correlated with good patient outcomes and adherence to treatment in the outpatient setting. When the physician indicates that he or she cares for a patient’s well-being, that patient is more likely to trust that the health care guidance he or she is receiving will be effective. This increases the likelihood that the patient will embrace treatments, which contributes to improved outcomes.

Even if physicians are not intentionally following in House’s footsteps, his antics can offer a blunt reminder of practices to be avoided outside the realm of entertainment, especially those which eliminate even more humanity from the world of medicine. Medical schools are beginning to emphasize communication and allow for more exploration of the humanities because these subjects give students opportunities to express themselves, which in turn helps increase levels of empathy. Physicians currently improve patient outcomes biomedically, but by simply being more empathetic, they have the ability to improve psychological and emotional outcomes, as well. This empathy is something most patients could use a bit more of, whether their physician is House or not.