Dr. House M.D. reviews. S1E06. The Socratic Method

A schizophrenic woman develops a blood cot and is admitted to the hospital. While there, she starts bleeding from her gastrointestinal tract and then is diagnosed with liver cancer. Ultimately, it is discovered that she is not schizophrenic, but instead has a rare condition known as Wilson’s Disease.

I was disappointed by this episode. The pathos element — the poor son, struggling to help his mother — was greatly overdone. Worse, the medicine was not up to its usual high standard. I’m pleased that the team was not dashing from diagnosis to diagnosis this episode, but I found it hard to believe that five brilliant doctors (six if you count the Chief of Staff) missed the obvious fact that the patient did not have schizophrenia. Simply put, 36 year-olds do not develop new-onset schizophrenia; it is a condition that typically starts in the late-teens and early-twenties. This information was telegraphed in the first scene, so I spent the rest of the episode waiting for Dr. House to finally decide that she wasn’t schizophrenic.

Wilson’s Disease, like kuru, is one of those conditions I call a “med school disease.” While it’s true the condition is very rare, it is mentioned over and over and over again in medical school, so it’s unlikely to be missed as long as it was.

There were a couple of other medical problems this episode as well, most dealing with bleeding and clotting — flip sides of the same coin:

1. The patient was low on clotting factors because of her liver failure therefore so she bleeds too easily. If her blood is so thin, then how did she develop the blood clot?

2. A patient with a pulmonary embolus would not be sent home from the Emergency Room on blood thinners. While someone with a deep vein thrombosis can be treated successfully as an outpatient, any patient with a pulmonary embolism is going to be admitted to the hospital, at least for overnight observation (the clots have a tendency to increase in size).

3. Why do the doctors keep running every test themselves? What do a critical care specialist and an immunologist know about performing and interpreting an ultrasound of the liver? That’s what ultrasound technicians and radiologists go to school for.

4. Call me a cynic, but I don’t think someone would get better from Wilson’s Disease that quickly.

This was the second weak episode in a row. So far, the series is ahead 4-2, but seems to be losing some of its early steam.