Monday, October 16, 2006

Book Review: The Medical Science of House, M.D. by Andrew Holtz

If I had a tendency towards megalomania, I might think The Medical Science of House, M.D. was written specifically for me. It fills such a peculiar niche, I can't quite imagine the broader audience for it.

House happens to be my favourite show at the moment. It's not, however, even the highest rated medical show on the air; that would be Grey's Anatomy. And the book doesn't explore the world of Hugh Laurie's alter ego in any depth. It's mostly a Dummies Guide to the Health Care Industry, with the show as its jumping off point, so anyone reading specifically for real insight into House might be disappointed.

That said, I really enjoyed it. But I'm a nerd.

Author Andrew Holtz, a health journalist with a master's of public health degree, writes with obvious affection for the show and careful recognition that fiction has no duty to strict reality. For the most part, he refers to the show's cases that, while improbable, are possible.

At times, he gently points out where the cases depart from reality, but always in order to make some broader point. For example, the treatment of House's Vicodin addiction in the "Detox" episode is one clear example of the show deviating from medical reality. The episode's proof of addiction - withdrawal symptoms - are no proof at all, say the real-life doctors. But Holtz doesn't dwell on the bent truth except to mention the reality the fiction illuminates; he uses the case to bring up the very real problem of impaired physicians.

The author brings expert testimony, through research and interviews, to a discussion that's often quite unrelated to any specifics of House. Holtz's purpose is not to nitpick the show, or to glorify it as an example of medical realism, but to wrap a discussion of the health care industry and medical ethics in a palatable coating. The lengthy, explanatory sidebars - which are unfortunately confusingly presented in the middle of the main narrative - usually don't even pretend to be connected to the show.

Still, it's an interesting discussion for those who aren't intimately familiar with the system or all the issues. It's perhaps especially so for us non-Americans who might relish an engaging lesson in the US health care system we think we know so much about, usually from fictional sources.

A scan of the table of contents gives an accurate idea of the focus of the book - and what a wide-angle lens Holtz is using. He covers the patient's first presentation, the physical exam, tests, computer analysis, the whiteboard of the differential diagnosis, choosing treatments, bedside manner, and the health care team.

That last one, which discusses nurses among other careers nearly invisible on the television show, is one sign that we're not really talking about House.

Holtz quotes a nurse at an actual hospital in Princeton about how she would deal with House's attitude: "I would have that physician in my office, and there would be a discussion about what appropriate communication is, and how I would not accept that kind of behaviour."

A wordy disclaimer on the cover informs the reader that no one involved with the show authorized or endorsed the book - they might as well have said "they wouldn't touch it with a ten foot pole." So I suppose it's futile to hope that creator David Shore might be inspired by that particular quote, because I would pay good money to see how well that discussion would go over with our fictional hero.

The perspective on the character of House is far different in Holtz's book than on the small screen. The renegade hero of fiction is the dinosaur of reality, according to one physician: "In some ways, it is a vision from years past of the doctor as an iconoclastic brilliant, virtuoso free spirit, who does it his own way and the hospital is there to do his bidding."

Fortunately, Holtz's informative book never loses sight of the fact taht an iconoclastic, brilliant, virtuoso free spirit is likely to be far more interesting than the tamed doctors who supposedly exist today. Plus, the glimpse of how well House stays rooted in reality, while taking liberties for dramatic flair, actually highlights the beautiful balancing act performed by the show each week.

The Medical Science of House, M.D. by Andrew Holtz is available from Penguin books.