TV Doctors never write Medical Notes

There are only two doctor shows I can stand to watch on TV - House and Scrubs. Both of these shows were better in their earlier seasons, but after getting involved in the character stories I just watch out of inertia. Scrubs is probably more realistic, but House tends to have more interesting cases with entertaining Sherlock Holmes-type medical mysteries. The most annoying unrealistic thing about House is that the multiple overqualified MDs are in a never ending internship disguised as a fellowship for a specialty which does not exist. These docs can run any test in the hospital - MRI scans, cardiac catheterization, exploratory laparotomy, neurosurgery, genetic assays, autopsies, bacterial culture, breaking and entering. Every mundane test is run with the personal attention of doctors in perfectly tailored white coats without the help of any nurses or techs. The only mundane task these doctors are almost never seen, even miming, is the act of writing a medical note. Since my last month of medical school is flex time, I spend my time painting, playing guitar, and watching TV online. As I watched an episode of House in a feeble effort to exercise my already atrophying medical knowledge, I started to wonder what the medical chart would even look for an episode of house. In an exercise of pure boredom, here is what the chart would look like for the House episode "Brave Heart."

History & Physical

History: 39 year old male presenting with trauma, fell 30 feet from building

Family: Father, paternal grandfather, paternal great grandfather - death in 4os from heart disease

Social: Detective, Reckless because he thinks he's gonna die at age 40 like his relatives, unmarried, no children

Physical: 2 broken bones, severe concussion, collapsed lung

Assessment: Trauma stabilized, but unknown cardiac condition warrants an inpatient work up. Differential Diagnosis includes familial hypercholesterolemia, marfan syndrome, brugada syndrome, idiopathic

Plan: Admit to diagnostic medicine service, EKG, cardiac catheterization, genetic testing, routine labs

Progress Note

Tests: Negative

Assessment: Um... still probably genetic

Plan: Will get consent to exhume bodies of relatives (would insurance EVER cover this, put it on credit card, he's gonna die at 40 anyway!)

Progress Note

Interim History: Patient's ex-girlfriend presented to hospital revealing patient has a son.

Pathology on relatives bodies: Negative

Assessment: Um... still probably genetic

Plan: Get fresh pure squeaky clean bone marrow biopsy for genetic analysis (a little painful, but what's the pain of a child compared to cinching a farfetched diagnosis!)

Progress Note

Son's Bone Marrow Biopsy: normal

Assessment: Probably faking it = idiopathic, Will give patient imaginary diagnosis of Ortoli Syndrome, a rare cardiac disease treated with pills

Plan: Give patient sugar pills, discharge home

Autopsy Note

History: Patient collapsed 4 hours after discharge. Found in laundry room of apartment building by landlord. Pronounced dead on arrival by EMTs

Procedure: Post-mortem incision at midline of sternum revealed active bleeding. Patient comes back to life coughing and screaming in distress

Assessment: Not dead yet. Extreme Bradycardia. Differential Diagnosis includes sick sinus syndrome, metabolic disease, isolated anti-ro antibody

Plan: Transfer to ICU, start steroid treatment

Progress Note

Interim History: Jaw and tooth pain, patient pulled out own tooth with forceps from cart in room. Dentist analysis of tooth revealed normal tooth

Assessment: Source of pain could be bone cancer with paraneoplastic syndrome. Li fraumeni syndrome

Plan: Gamma survey to look for tumors

Progress Note

Gamma survey: normal

Assessment: Source of pain could be related to nervous system - hereditary sensory autonomic neuropathy type 1

Plan: Carbamazepine

Progress Note

Interim history: patient with continued pain and urinary incontinence

Assessment: Wilson's disease (is there a single episode where this isn't in the differential? seriously writers, it's just like Lost's obsession with dural sac rupture)

Plan: Penicillamine (why diagnose? just start treatment!)

Progress Note

Interim History: Dr. House heard the word "button" triggering the concept of heart attack button leading to the obvious next diagnosis of intracranial berry aneurysm pressing on brainstem

Assessment: Intracranial Berry Aneurysm

Plan: Neurosurgery for both father and son, then heartfelt reunion!

Good lord this show is stupid laid out like this! But inertia is terribly powerful so I will likely keep watching.

--By Farrah, who spent the last 5 days babysitting her 2 year old nephew and who never knew she could pull off the unkempt mom look so well, several people told her to have a happy mother's day