This season’s Scrubs have been highly variable and several episodes have characters behaving in ways very inconsistent with their personalities. I suspect there are some new writers in the mix, and I worry they don’t much know what they’re doing. For that reason, I’ve move things in my TiVo subscriptions list so instead it now records the other hospital show in the same timeslot, namely;
House is really engossing, and I realized tonight after watching the latest episode (which aired a couple Tuesdays ago) that what “works” about the show is the main character is an angry, bitter, stuck-up, and incredibly grating doctor, but he is the kind of doctor you’d want to have. Not just because he is always right. It’s because he behaves like a lawyer.
Go with me on this one.
For all his supposed disdain for his patients, one of the reasons it is so hard to convince House to see anyone is because once he accepts a case he moves into the role of patient advocate, and he is the best advocate you can have. He will break every rule, do everything within his power to make sure that his patient is served. He will risk his medical license and the licences of those around him, subvert authority, screw up drug trials, anything you want. He is the best lawyer you could have, and even better, he is a doctor too. House is always set in conflict with people who are “overly” concerned about profits, not being sued, or following ethical guidelines. Most of these people have very valid points, and may be right from a big-picture point of view. But House is right from the patient’s point of view, and that is what matters most to the patient.
And one day you will be that patient. So who would you rather have as a doctor?
(If I’m lucky, Kevin will step in with a Utilitarian view on this one… ;))
After a setup like that, how could I resist?
First, a disclaimer – I haven’t seen House, so all of the following is answering the premise you set up. Also, I’m not going to take on the obviously stupid rules that basically come down to “insurance companies are evil” – that may well be the case, and isn’t particularly interesting to boot. I’m not playing with the straw man. Instead, I’ll address the more interesting conflicts, where there really are competing good values.
So, for example, let’s talk about screwing up drug trials. I’m assuming the situation is something about getting a patient into a trial who really needs the drug, but isn’t right for the trial. What that means (assuming that the trial criteria wasn’t stupid to begin with) is that the trial won’t be as valid, or will take longer. Great for the one guy who got saved – not so great for the multitude of patients depending on Miracle Drug X coming to market sooner rather than later.
More broadly, the “patient’s point of view” you mention is really the single patient’s point of view – and when it’s in conflict with something, it’s usually not “the system”, but rather other patients (perhaps those who didn’t have the good fortune to get House as their doctor).
It seems to me that the question isn’t “who would you rather have as a doctor?” Rather, it’s “would you opt into a system where you could either get House as your doctor (leaving you better off), or get someone else in the same hospital (leaving you worse off because House is screwing up drug trials, getting the hospital sued and unable to buy the new MRI machine, etc)?”
Despite not having seen House, you did a pretty good job. 😛 In the case of the drug trial, I believe the standard rule is that people who have had major surgery within a certain timeframe (30 days?) cannot participate in any trials. This woman needed to have an abortion prior to beginning treatment for one type of cancer or another.
I agree in principle that one wants to keep drug trials on track, because this leads to faster time-to-market and more net lives saved. At the same time, there are so many time variables at play in a drug trial it is difficult to establish exact causal relationships — FDA stupidity probably has a lot to do with this, but it has become clear as well that drug makers exert a lot of pressure, which could indirectly lead to more caution in accepting their findings. All that said, yes, you’re right. Interfering with a drug trial and invaldating some of the results is bad for everyone (except of course the person you’re trying to save). Its not acceptable behavior for a doctor.
You’re also correct that in the case of House the focus is always on the individual patient who happens to be here at the moment. Getting someone on the transplant list who is disqualified due to a mental disorder is probably depriving someone else of a heart, and could lead to their death.
The broader question you pose is “would you opt into a system where you could either get House as your doctor (leaving you better off), or get someone else in the same hospital (leaving you worse off because House is screwing [things] up?” Now I’m going to digress into the nature of American media.
We are obsessed with the individual struggle. We are captivated by the main character. On Star Trek you see a crewman in a red shirt die in every episode, and that’s fine, because you know nothing about them. If a main character were to die, it would be completely shocking. Its not just that it is unexpected, it is that it is unheard of.
You’re heartstrings are not going to be tugged by thinking about “1500 soldiers dead.” You’re going to care about Jessica Lynch. We need to personalize things in order to understand them, and so in television the trend is to ensure that the people we care about are getting every opportunity. A few shows are notable in occasionally breaking the mold, like Angel, which killed a main character in the eigth episode, but you’re not generally gonna see leads dying.
Where does this leave is? In medical shows like House they do have to kill a patient every now and again, to “prove” that it is “real” and House cannot cure everything. But set us up to love a patient, tell us their live story, figure out their ailment, and tell us that sorry, nothing we can do, they’re screwed by the system, they are doomed to die, and you’re gonna have some pissed off viewers. I know I’m terribly over-genrealizing, but I think it is the nature of storytelling that the most gripping and powerful stories are ones in which you are deeply involved with a character, and the most satisfying endings only come about when the character (or their surrogate) is given every opportunity to fight, every avenue that has a shread of hope for success. It just makes a better story.
I think it also goes to general human selfishness, which I’m saying in a non-judgemental way, but just looking at it as a biological imperative. Biology tells us to seize every opportunity to get better odds than anyone else. If the choice is you living or someone you don’t know living, you want to live. The people who take the other choice are the ones who become saints, because they’re so rare. So yeah, if I was sick, I would say screw it all, I want House to treat me. I want to get better. I don’t care about your arguments for the societal good, this isn’t about them, this is about me, here, now.
I know it is a bad approach. I agree that House should not be allowed to do the things he does. I understand that he is probably causing more harm than good. And yet having a few renegades like him out there also gives me hope, makes me think that there are people in medicine who are doing it for a true love of healing, who really care only about making their patients better. And when I get sick, I hope to have a doctor like that.
First, of course I understand the imperatives that drive TV shows to the storylines and narrative structures they have – I’m not saying House would be a better show if he wasn’t the way he is… I was just addressing the larger argument.
On to that argument, then. I think you miss my point just a bit when you say, “So yeah, if I was sick, I would say screw it all, I want House to treat me.”
If I had a choice, I’d opt for House to treat me, too. But the real choice we’re faced with in making policy isn’t who my doctor will be – very often, we don’t have that choice. Instead, it’s a question of whether the system will allow for House to do his thing, or not.
Let me put it another way (borrowing, albeit poorly, from Rawls’ veil of ignorance argument). Imagine two parallel universes. In one, Dr. House exists; in the other, he doesn’t (or, alternatively, he exists but behaves just like all the other doctors). Without knowing who your doctor will be, which universe would you prefer to live in?
If you’re thinking rationally, the answer depends on knowing two things: the likelihood that you will get House as your doctor; and the degree to which his behavior harms all the patients who aren’t his. Essentially, it’s a question of whether or not you want to take the small chance of a big payoff (House treating you) coupled with a much greater chance of a small harm (the marginal degree to which House’s actions harm everyone else).
Unless I have a pretty fucking good chance of getting House to treat me, or his behavior doesn’t really harm anyone else (neither of which seems to be the case), I’d opt for the House-is-well-behaved universe.
(Credit where credit is due – all that above was my very poor rendition of Rawls’ “veil of ignorance” argument, coupled with some analysis of marginal harms).