What House Md has taught me
I haven't been blogging for sooo long in view of my chronic fatique syndrome has progressively worsening. I am NYHA class 3 and twitching a muscle causes my heart runs wildly fast.
I mostly filled up my non-working time with activities like watching FRIENDS sitcom, Anime or Runningman and recently I revisiting House MD. I think it is pathetically awesome.
Of all the episodes I have watched (I have them from Season 1-5), I seem to have like and favor Episode 21 Season 1 - Three Stories
House MD, Season 1 Episode 21 = Three Stories
Synopsis = In this episode, House had to take a class of student and he started by giving 3 case scenarios of patients with similar presentating complaint:- right leg pain.
Case 1 = a middle aged farmer had a sudden pain while fixing his fence
Case 2 = a young volleyball player had sudden pain during practice
Case 3= a gentleman (portrayed by House as Carmen Elektra) a golfer and a drug addict
Lets go by case then:
Case 1
When House started asking the student what they should do first after given a complaint of right leg pain:-
Student A asked for more medical history, in particular family history of bone ca, etc.
Student B thought it might be some blood disorder and asked for blood count and
Student C suggested for imaging MRI or PET scan
House cut off their conversation by saying that now the patient is dead. They are too late try to work up for diagnosis without noticing that the patient is dead. Students argued that they didn't have given the chance to run any test and nothing much they could do. House replied by saying that they have enough to time to look at his leg!!!. Subsequently revealed that the patient has a puncture at his ankle.
Comment:- Truthfully it does happen in daily practice. I had once missed a hernia because I didn't check a patient thoroughly and it was really a sin! I received multiple referral for acute appendicitis and in fact upon further examination found that patient has orchitis. House had made a very important point here that a good physical examination is vital rather than ordering thousand test under the sun so in hope you might hit one of them. Lesson learned?
It was assumed that the puncture in his ankle was a snake bite. He was given anti venom but had allergic reaction to it. It was then decided to give another anti-venom. House asked the class with show of hands of many of them think that the anti venom should be given despite knowing the actual species of snake OR should they search for the snake before deciding for the second anti-venom. A student made an assumption that given only these 2 options means that one option may kill him and the other will save him. House replied:-
Case 2
A young volleyball player whom initially treated as tendinitis. House pointed out what happened if a doctor cares too much when Cameron took a very detail (including 3rd generations family history) and rambling on and on about how the girl was actually depressed because her boyfriend dumped her and she thought he was a jerk and how Cameron suddenly found a nodule at her neck. House sarcastically try to point out how unrelated all those informations are but Cameron insist that she may need further work out hence did a biopsy from the thyroid nodule. House explained that because of the doctor put an extreme interest in a patient with a less significant medical sign has put a patient on a unnecessary painful test.
Comment: Don't assume that when patient comes to ED frequently but you found nothing wrong with him, is some kind of attention seeking behaviour. He may have some disease but we are too blind or too stupid to find out. He needs to be work out extensively. Don't be prejudice and bias against drug addicts or mental disorder because I remember somewhere in the oath teaches us not to do so..
I am self-labelled bitchy profoundly recently evidenced by my last few oncalls turned me into a very bad mood swing and devil spawned bitch in disguise. Even though my intention is noble but actions do not justify it. If I am given the choice to either kiss with lies or punch with the truth, i choose the painful way. A powerful punch helps me to remember till I die. Who wouldn't remember the first patient you figuratively kill and patients whom you wish to turn back time so that you can choose the other option rather than the other bad one. The downside in this profession is that all the mistakes you intentionally or unintentionally did will forever haunt you up till one point you will question yourself " what the fuck i am doing?" When people think that murder is the worse action, they are wrong. Misdiagnosis is.
So for that reason, lets make ourselves a better doctor.
Lillahitaala..
I mostly filled up my non-working time with activities like watching FRIENDS sitcom, Anime or Runningman and recently I revisiting House MD. I think it is pathetically awesome.
Of all the episodes I have watched (I have them from Season 1-5), I seem to have like and favor Episode 21 Season 1 - Three Stories
House MD, Season 1 Episode 21 = Three Stories
Synopsis = In this episode, House had to take a class of student and he started by giving 3 case scenarios of patients with similar presentating complaint:- right leg pain.
Case 1 = a middle aged farmer had a sudden pain while fixing his fence
Case 2 = a young volleyball player had sudden pain during practice
Case 3= a gentleman (portrayed by House as Carmen Elektra) a golfer and a drug addict
Lets go by case then:
Case 1
When House started asking the student what they should do first after given a complaint of right leg pain:-
Student A asked for more medical history, in particular family history of bone ca, etc.
Student B thought it might be some blood disorder and asked for blood count and
Student C suggested for imaging MRI or PET scan
House cut off their conversation by saying that now the patient is dead. They are too late try to work up for diagnosis without noticing that the patient is dead. Students argued that they didn't have given the chance to run any test and nothing much they could do. House replied by saying that they have enough to time to look at his leg!!!. Subsequently revealed that the patient has a puncture at his ankle.
Comment:- Truthfully it does happen in daily practice. I had once missed a hernia because I didn't check a patient thoroughly and it was really a sin! I received multiple referral for acute appendicitis and in fact upon further examination found that patient has orchitis. House had made a very important point here that a good physical examination is vital rather than ordering thousand test under the sun so in hope you might hit one of them. Lesson learned?
It was assumed that the puncture in his ankle was a snake bite. He was given anti venom but had allergic reaction to it. It was then decided to give another anti-venom. House asked the class with show of hands of many of them think that the anti venom should be given despite knowing the actual species of snake OR should they search for the snake before deciding for the second anti-venom. A student made an assumption that given only these 2 options means that one option may kill him and the other will save him. House replied:-
"I'm sure this goes against everything you've been taught, but right and wrong do exist. Just because you don't know what the right answer is, maybe there's even no way you could know what the right answer is, doesn't make your answer right or even okay. It's much simpler than that. It's just plain wrong"
The patient's leg worsened and House broke the news that he is dying. Patient immediate response was his concern of his dog. Then House noted that he lied. He was actually had been bitten by his dog who has rabies. He later had to have his right leg amputated.
"Everybody lies. The only variable is about what"
Case 2
A young volleyball player whom initially treated as tendinitis. House pointed out what happened if a doctor cares too much when Cameron took a very detail (including 3rd generations family history) and rambling on and on about how the girl was actually depressed because her boyfriend dumped her and she thought he was a jerk and how Cameron suddenly found a nodule at her neck. House sarcastically try to point out how unrelated all those informations are but Cameron insist that she may need further work out hence did a biopsy from the thyroid nodule. House explained that because of the doctor put an extreme interest in a patient with a less significant medical sign has put a patient on a unnecessary painful test.
"House: problem with her thyroid gland cause her depress mental state and cause inflammation of the tendon?"
"Cameron: I run the test"
Patient then developed hypercalcaemia and
had ct of the neck in which turned out normal. After multiple scans and
serial of investigation only MRI of leg was done and found that the girl
had osteosarcoma.
Comment:-
I always emphasize this to my fellow housemen that history should be only taken relevant to the presenting complaint. Too detail irrelevant history will lead to confusion and further unnecessary investigation. House MD has explained this nicely.
Case 3
A golfer with painful right leg and was tested by House noted to have an absence deep tendon reflex of his knee. Patient was screaming in pain. House asked fellow student what they should do next.
Student A and B gave out the possible causes of pain but it was difficult to gain the history when the patient was screaming and yelling. Student C suggested to give a painkiller, to make the patient out of pain before proceed with any history taking but student A disagree as he may be allergic to painkiller and he couldn't give such history with all the yelling. Eventually, patient himself grab the syringe and injected him good on his thigh. Then found that the guy is actually a drug junkie.
He came back with similar complain and now he had tea colored urine with elevated protein kinase. House asked the class the differential diagnosis but none of them can answer until Cameron, came out with muscle death. Later revealed that the patient was House himself who had aneurysm and caused muscle death. The diagnosis was delayed and House to bear with a chronic pain.
" It is in the nature of medicine that you are gonna screw up. You are gonna kill someone. If you can't handle that reality, pick another profession. Or finish medical school and teach. "
Comment: Don't assume that when patient comes to ED frequently but you found nothing wrong with him, is some kind of attention seeking behaviour. He may have some disease but we are too blind or too stupid to find out. He needs to be work out extensively. Don't be prejudice and bias against drug addicts or mental disorder because I remember somewhere in the oath teaches us not to do so..
I am self-labelled bitchy profoundly recently evidenced by my last few oncalls turned me into a very bad mood swing and devil spawned bitch in disguise. Even though my intention is noble but actions do not justify it. If I am given the choice to either kiss with lies or punch with the truth, i choose the painful way. A powerful punch helps me to remember till I die. Who wouldn't remember the first patient you figuratively kill and patients whom you wish to turn back time so that you can choose the other option rather than the other bad one. The downside in this profession is that all the mistakes you intentionally or unintentionally did will forever haunt you up till one point you will question yourself " what the fuck i am doing?" When people think that murder is the worse action, they are wrong. Misdiagnosis is.
So for that reason, lets make ourselves a better doctor.
Lillahitaala..
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