Pushing medical practice to the extreme may be the cost of keeping viewers hooked on Fox鈥檚 hit show, which dramatizes the diagnosis of rare maladies. But for patients treated in Mercer County, N.J., where House鈥檚 mythical hospital is located, that sequence of tests would likely tally charges of more than $9,200, according to NewChoiceHealth.com, a Web site that compares hospital charges, and MTBC, a physician billing company.
For most cases, doctors say, that style of 鈥渟hotgun testing鈥 鈥 a barrage of seemingly random tests 鈥 would do little to help patients or lead to a diagnosis. And policymakers, as part of the health care debate, are talking up the importance of using medical know-how more judiciously and effectively to rein in costs.
Excerpt From The Episode
Dr. House: 鈥淒o an amylase, d-dimer, c-reactive protein, get a urine, and do a bronchial sputum while you鈥檙e at it. You, check his lab for radiation and toxins. And do a bone-marrow biopsy.鈥
Younger doctor: 鈥淎ll of that in twenty-four hours?鈥
House: 鈥淣ah, whatever you don鈥檛 get done, you can finish at the autopsy.鈥
But media analysts say medical dramas like 鈥淗ouse,鈥 as well as glowing news accounts of high-tech medicine, encourage patients to expect that the latest devices, drugs and other treatments will yield miraculous results. The downside of tests and treatments, such as their high costs and possible side effects, get less air time.
鈥淭here鈥檚 a real disjuncture between the model [for health care that] policymakers are trying to push compared to T.V.,鈥 says Joe Turow, a professor at the University of Pennsylvania. Turow鈥檚 forthcoming book, an update to his 1989 volume 鈥淧laying Doctor,鈥 will examine medical dramas from 鈥淢arcus Welby, M.D.,鈥 which debuted in 1969, to 鈥淗ouse鈥 and 鈥淕rey鈥檚 Anatomy.鈥 Television has consistently portrayed medicine as an unlimited resource, he says.
That message cuts against the one that President Barack Obama is trying to deliver: That the U.S. needs to save money by cutting unnecessary tests. Patients are 鈥済oing to have to give up paying for things that don鈥檛 make them healthier,鈥 he said during a July press conference. 鈥淚 think that鈥檚 the kind of change you want.鈥
Yet some analysts suggest that what patients really want is medicine as practiced on TV. Advice such as 鈥渨atchful waiting鈥 does not make for good storylines, so some patients might resist a suggestion from a doctor to forego intensive tests and treatment for their illnesses.
David Foster, a Harvard-trained physician who is a 鈥淗ouse鈥 writer, points out that House鈥檚 patients, along with those in most other television shows, are frequently near death by the time they come under the care of their fictional doctors. 鈥淭he conceit of our show is patients are dying,鈥 he says. 鈥淭hat is an area where everybody agrees money should be spent.鈥
Researchers haven鈥檛 examined the influence of medical dramas on the use of health services, but studies indicate that television shows can affect viewers鈥 understanding and perceptions of situations. Vicky Rideout, a Kaiser Family Foundation researcher, found that an episode of 鈥淕rey鈥檚 Anatomy鈥 quadrupled the percentage of regular viewers with accurate knowledge about HIV transmission during childbirth. The foundation provided the show鈥檚 writers with medical information about HIV transmission.
鈥淚t does have an effect,鈥 Rideout says. 鈥淧eople do retain health information on T.V.鈥 A decade-old foundation survey found that one-third of regular 鈥淓.R.鈥 viewers said 鈥渋nformation (from the show) helped them make choices about their own or their family鈥檚 health care.鈥 (KHN is part of the foundation.)
But what if those choices are the wrong ones? Some information may encourage patients to seek care they don鈥檛 need. In 鈥淗ouse,鈥 the curmudgeonly doctor鈥檚 鈥渋nterventionist bent鈥 reinforces the attitude that 鈥渁ction is better than inaction,鈥 says Andrew Holtz, the author of the 鈥淢edical Science of House, M.D.鈥
鈥淭he amount of information out there, the amount of media out there, the amount of attention to what can be done in health care, has persuaded everyone, including doctors, that more is better,鈥 says Steven Davidson, an emergency room doctor at the 705-bed Maimonides Medical Center in Brooklyn.
The poster child for this phenomenon is 鈥渢he kid who鈥檚 had a lick to his head,鈥 and whose parents insist on a CT scan, he says. Most of the kids don鈥檛 need it. 鈥淭hey will do just fine with a brief period of observation,鈥 he says. According to an article in the July edition of 鈥淧ediatrics,鈥 evidence from earlier studies shows only a small percentage of scans on children with head injuries reveal information that doctors choose to act on. Meanwhile, the scans do have a downside: They can cost thousands of dollars and expose patients to excess radiation.
When Maimonides doctors decline to order services they thought were unnecessary, the hospital has sometimes received letters from patients complaining that they were denied care, Davidson says. The patients often report that other doctors were happy to provide the tests or treatments. 鈥淧atients and doctors have formed a kind of implicit conspiracy or cabal to test more and consequently to treat more,鈥 Davidson says, noting that doctors can bill for a CT scan, but not for educating the patient about its risks.
Foster, the 鈥淗ouse鈥 writer, wonders, 鈥淚s it bad that patients come in and say, 鈥業 need a CT scan?鈥 It just takes more time to explain why you don鈥檛 need鈥 it. Patients have been empowered by their greater access to information through media sources, while at the same time, doctors are finding themselves with less time to treat and educate patients, he argues.
鈥淚 hope that patients come away from watching our show thinking that they should be involved in the diagnostic process,鈥 Foster says. Still, he adds, it is up to the doctors to supervise the medical care. 鈥淎 patient may come in with a certain expectation. But the patient didn鈥檛 order the test.鈥
At his family practice in suburban Illinois, Dr. Scott Morrison, who also blogs about medicine on television and in comic books at politedissent.com , encounters such problems. One of his patients recently received a CT scan at a local emergency room that 鈥渞evealed a small abnormality.鈥 It was nothing to worry about, Morrison says, 鈥渂ut she became fixated on it. It took three visits before she finally agreed she didn鈥檛 need another鈥 scan.
Foster responds that one way to deal with media hype is to change the financial incentives for doctors, who currently are rewarded for doing things. 鈥淟et鈥檚 pay money for talking鈥 instead, he suggests.