The real life Dr HouseBMJ 2010; 341 doi: https://doi.org/10.1136/bmj.c5522 (Published 14 October 2010) Cite this as: BMJ 2010;341:c5522
Anna Mead-Robson speaks to Lisa Sanders, a technical adviser for the television show House
Name: Lisa Sanders
Position: Adviser to House
Biography: Worked as a television journalist before studying medicine at Yale University, where she still works as a doctor of internal medicine. Since 2002 has written a column for the New York Times magazine called “Diagnosis,” which was the inspiration for the television series House. One of three technical advisers to the show.
Where did you go to medical school?
Before studying medicine I had worked as a television journalist for 14 years, so I was much older than most medical students. To go to medical school at 36 is very unusual in the United States, or at least it was at the time. However, Yale Medical School has a tradition of allowing students from non-traditional backgrounds to make up 10% of the class, so I went to Yale as one of their many non-traditional students. In my class at medical school there was a professional baseball player, a well known architect, and a pretty well known physicist. After completing medical school I stayed at Yale for my residency programme, and I’m now on the faculty.
What do you specialise in?
My specialty is internal medicine, but I’m also interested in obesity. However, for the past seven or eight years I have focused on diagnostic clinical reasoning—partly because I write a monthly column for the New York Times magazine, called “Diagnosis,” about interesting clinical cases. I also wrote a book last year called Every Patient Tells a Story, which is really about what diagnosis entails.
How did you get your column?
When I first started writing my column no one really talked about diagnosis. As a television journalist I had covered medicine for years, and I had told many stories about medicine and doctors. They all dealt with either diseases or treatment, but not this mystery story that’s at the heart of the doctor-patient encounter. When I got to medical school I realised that, from my perspective, this was where the excitement was. One day I was telling a story to an old friend from my days in television who worked at the New York Times. He telephoned me and said, “Do you think these stories would make interesting pieces?” Initially I thought the idea was ridiculous and that the column would not be popular. It turns out he was right and I was wrong.
Is it easy to combine clinical practice with journalism?
Easy? Well you can’t use that word. Being a physician is never easy. However, I think that writing balances out medicine, because medicine is extremely close up. You are right there with the patient. It’s very personal and focused, and that’s essential for the patient. But writing about medicine gives you a chance to step back for a moment and think about what all of it means, so I think the two disciplines go together. From my perspective they require each other. I think that’s why there are so many writers who are also doctors.
How did you get involved with House?
The show was based on my column. When the producers decided to make the show, they telephoned me to see if I would be interested in getting involved. So I asked them to tell me more about the show, and they explained that it was about an arrogant, irritable, drug addicted doctor who hates patients but loves diagnosis. At first I was a bit shocked. Who would watch that on television? But I thought that I’d better say yes because I may never have another chance to get involved. So now I’m one of three technical advisers to the show.
Was any part of Dr House’s character based on you?
I love diagnosis, but that’s about all we have in common. In my book I spent a lot of time writing about how important the doctor-patient relationship is to making a diagnosis. House always says, and it’s true, that “everybody lies.” But what he doesn’t say, and what I think every viewer must add in their own mind, is that of course everybody lies to him because he’s such a jerk.
Do you have a favourite character?
Isn’t everybody’s favourite character Dr House? Because Hugh Laurie is such a gifted actor you can look into his eyes and see that even though he’s a jerk on the outside, and maybe on the inside too, he still has a very deep interest in the patient. He may not be interested in the patient’s whole life, but he is committed to figuring out their illness to help them go on with their life. That duality makes him a fascinating character and certainly my favourite.
Do you work with the scriptwriters or the actors?
I work almost exclusively with the writers and the executive producer. Sometimes I go to Hollywood to see the actors because it’s fun. Seeing people who are good at a craft perform that craft is always an honour and is awe inspiring. But I only really go down there because it’s cool; they don’t need me there. I do almost all of my work through the internet.
Do the scriptwriters ever ignore your advice?
Oh absolutely, my advice can be ignored. The producers were clear from the beginning that this is a medical drama, but it is also entertainment. Once one of the writers wanted to write a storyline that implied oral-genital contact between two consenting adults. So they gave the man a rash in his mouth, and the diagnosis was bacterial vaginosis. When I read this I totally flipped. One of the things I love about medicine is the language: just the name of a disease can tell you so much about it. So I wrote a long email to the writer explaining that this type of bacteria would never grow in the mouth, and if it could then it wouldn’t be called bacterial vaginosis. In the end my advice was ignored because the story was funny—and actually it worked perfectly. So even if I was technically right my approach was actually kind of wrong.
If you ask any professional about how television reflects what they do, they’ll tell you it’s not really accurate. Let’s face it, most days for most doctors are, thankfully, boring. There’s nobody running around, and mostly you don’t need to save people’s lives every minute of every day. So I think the truest thing you can say about House is that it really captures medicine at its most exciting.
So House isn’t very realistic then?
Almost all of the stories are based on peer reviewed case reports or stories from my column, so most of the stories will have happened to somebody in real life. In that respect there’s a superficial level of accuracy. But even if some parts of the stories are unrealistic, I think that the show reveals aspects of being a doctor that are metaphorically true. For instance, many of the doctors on the show break into patients’ houses to collect evidence. Just in case you were concerned about this, let me assure you that no doctor in the US has ever broken into any of their patients’ houses, at least not in their capacity as a doctor. It is a thoroughly unprofessional behaviour. However, I think that it accurately reflects the sense of violation that many of the questions we ask our patients might cause. How many sex partners have you had? Do you have sex with men, women, or both? How much do you drink each day? You know, these are impertinent questions that might feel like accusations. It can feel as though we’re doing something bad when really we’re just trying to collect information. So metaphorically House reflects things that are true about medicine.
Can House continue indefinitely?
I don’t see the writers scrambling around for stories. I don’t think they ever will run out of interesting cases to write about because in medicine we never run out of interesting cases. There are at least a couple of hundred years worth of case reports in the medical literature still waiting to be read and written about.
Can House help medical students learn?
All the cases are real, so if you can work out the diagnosis before House can, “mazel tov”—that is, “good luck has occurred,” in Hebrew.
Do you have advice for the doctors of tomorrow?
The most important thing you can do is to try to find the part of medicine that you love and do that. In the US it’s hard for medical students to do that because some specialties that students love don’t actually pay very well, such as internal medicine or paediatrics. So we have a high rate of burnout and depression among doctors because people are doing things that they don’t love to get a higher salary. Follow your passions wherever they take you in your professional life. And have faith that if you love something you can make it work.
Competing interests: None declared.
From Student BMJ