"House"

Dr. Gregory House is a fictional character in a television program named "House". Dr. House is a cranky, caustic, rude, conniving, constantly in pain, drug abusing, brilliant physician. His specialty is diagnosing difficult cases that present themselves in a New Jersey teaching hospital. He does this by using his genius mind to play off other brilliant Doctors on his team, as they attempt to cure mystifying diseases and conditions that seem unsolvable. The typical storyline involves a patient who suffers a collapse of some kind and ends up in House's unit. House rarely sees the client in person, but uses his extraordinary mind and the hands-on talents of his team to eliminate possible conditions and maladies one patient at a time. Usually, they come upon a diagnosis and immediately begin a course of treatment that seems right until new and puzzling symptoms pop up to throw the whole diagnosis off. At that point the team reassembles and they order a series of intricate and exotic tests, ranging from tissue and fluid sampling to major surgical biopsies or procedures. In the end House usually has some brilliant, intuitive idea that leads him to the correct diagnosis and a cure that seemed impossible. Once again House finds a miracle cure to solve the problem while being a pesky, near sociopath, prankster with a roguish charm.

To call this "fictional" is an understatement. Last week my wife and I accompanied my mother-in-law, Ellie, to a medical appointment at a teaching facility in Oregon. She was there for the fourth time in several months with a medical scenario not unlike something that might appear on an episode of "House". I won't go into her personal medical issues, but I can say that she has been experiencing a series of troubling and debilitating symptoms for some time that, up until now, have gone undiagnosed. Her condition and the symptoms have proven to be a mystery thus far, and she continues to develop new symptoms regularly. Sound familiar? It could be an episode of House.

This is the point at which the fictional hospital where House does his magic takes a serious departure from the reality of our health care system. My mother-in-law didn't start at a teaching and research facility. She started with her home-town Family Practitioner. He spent several months diligently attempting to decipher the symptoms and treat her- but to no avail. One of his tests suggested a serious brain malady-but it could not be diagnosed definitively, locally. Being a good doctor he knew he needed to send her to a more specialized diagnostic facility. He gave her a couple of out-of-town options and she chose a facility in Oregon that's part of the University of Oregon medical complex. For her, and my father-in-law, this requires long car trips and stays in motels to complete the process. These trips are costly and are a hardship themselves, because they are elderly and they each have mobility problems.

Once my mother-in-law finally heard back from the facility after the initial referral, she had to wait several very anxious weeks for her first appointment. The wait was difficult because her local doctor's suspicion was for a very grave, life threatening condition that normally would be treated immediately. Upon her eventual arrival she was attended to by a Resident who was only willing to discuss the symptoms and have her back in a few weeks for the actual testing. Her oldest daughter (my sister-in-law) was along for that trip and pressed them to do the testing during this visit to eliminate the need for additional travel. Blood tests, MRI, vision tests, and the like resulted in more waiting, unanswered phone messages and E-mails.

It has now been two months since Ellie has been traveling to her appointments in Oregon. Fortunately, they have determined she doesn't have the condition that was originally considered. Unfortunately, the doctors have not been able to diagnose her yet and her condition continues to worsen significantly. Even though Ellie and the family are still waiting for the diagnosis, and it seems like this whole process is taking too long a time to get resolved, this article isn't about being upset with her care. It's about the difference between expectations and reality in the complex world of health care. It's about the frustrations patients feel with the slow grind of science and health care access.

At fictitious Princeton-Plainsboro hospital where House practices he and his team see patients immediately. House can order a test and it happens instantly. House doesn't need to have his patients take an appointment weeks from now because "that's the next available time". House never has to get an insurance company to approve a test or a treatment, and he is NEVER told to look for a less expensive drug. In House's world a patient needing a brain scan will be in the tube before House can pop another pill. In the real world it takes time to get appointments. It takes weeks or months to get results, and it takes patience to deal with communication issues in an overburdened system of care. All the while patients suffer the endless days of worrying about their future and suffering from untreated symptoms. Perhaps the fictionalized, TV version of  medical care has us a bit spoiled. But running into it in real life is another matter, entirely. I don't fault the folks at the facility in Oregon trying to help my mother-in-law. They are all fine practitioners, I'm sure. I know we have the most advanced medical care available anywhere in the world.

Even though we have the best medical technology and the most highly trained medical professionals available on the planet, our system doesn't produce the best medical outcomes. Our health care system is the most expensive in the world (by percentage cost vs. total GDP, and actual dollars spent) and our results rank pretty far down the list compared to other countries. The answer has to be access, and a lack of emphasis on prevention along with holistic health. Any system driven by private enterprise will always seek to protect the capital that it generates. As we are entering a new era, and the basic debate over the kind of country we will be goes on, we must answer the difficult questions about universal access to health care.

Most of us have (or will) come face-to-face with these issues, as our family is now. Most of us feel lucky just to get through our critical medical issues, then we move on without too much thought about fundamental change that must happen. Until we can all have the kind of care House can deliver at Princeton-Plainsboro there will continue to be problems in a system of care that is corrupted by the system of commerce that infects our health care industry. Should our health care system really be subject to the ups and downs of a private eneterprise model built to generate capital? I have to imagine what kind of timeliness would be applied to a very wealthy person who might find themselves in Ellie's situation. Would they wait weeks for test results? Would they spend six months suffering, searching for answers? I doubt the Trumps or Buffets of the world would be told to wait three or four weeks for an appointment with a Resident. And yet this is the system we have because we still cannot bring ourselves to adopt a universal health care system. The myths we hold about private enterprise are sacred- even when the health and wealth of the nation are at stake.

We know better when it comes to a decision of conscience. For instance, we don't tell our veterans to seek medical care through the marketplace (even at government expense). When we decide that medical care is an absolute priority (like the VA-or active-duty military health care) government provides it- and does so at greatly reduced cost. Government has no overpaid CEOs who get big bonuses for NOT providing care while collecting your premiums- Government has no share-holders to pay-off. Some things we do because it is the right thing to do and it promotes the common good of the country and its people. I look forward to the day when we can come to our senses on this issue and all the Ellie's of the world will have the same access to care and timley service that the Donald's and the Warren's have. That seems a great deal more humane to me.  I think even Dr. House would agree.

Thanks for looking in.