HOUSE: Wannabe Astronaut Tries to Drive the Bus
A worried female military pilot refers herself to Dr. House for evaluation of bizarre visual hallucinations (including some special effects not seen since 2001: A Space Odyssey). Since she is an astronaut candidate fearful of disqualification she demands anonymity and House takes the bait.
In the past I used to describe the paradigm of medical care this way: the doctor is driving the bus and the patient is the passenger. In this fictional situation the patient attempted to drive the bus by outlawing sound recordkeeping and by restricting what tests could be performed. Bad things ensue whenever the patient tries to drive the bus!
2007 UPDATE: Sadly, with the chaos of today's managed care, the current paradigm is more like a runaway bus with no driver!
The usual diagnostic scavenger hunt is quickly complicated by the patient's privacy demands. We refer to this scenario as VIP Medicine, wherein select patients are so important, so special (in the wrong way), that rules are skirted to accomodate the VIP. During this episode, as in real medicine, VIP Medicine is a mirage. Like irony? Providing 'VIP care' is superficial and dangerous - it actually provides a lower standard of care than that provided to a Medicaid patient in the most overcrowded indigent care facility. Sure enough, every time House & Company disregarded safety rules and hospital policies the patient suffered.
Click here to read about my own personal experience with VIP Medicine.
Wow, did that patient have a bad day! She went into cardiac arrest, was set afire, experienced a severe psychotic break, and gasped from near-fatal asphyxia. The eventual discovery of pulmonary cysts led to the diagnosis of vonHippel-Landau disease (vHL). This is an inherited multiorgan disorder, one of the Familial Cancer Syndromes - just like Tuberous Sclerosis. A mutation on chromosome 3 is the troublemaker. For now there is no cure.
As an ophthalmologist I have had the opportunity to learn a lot about this rare condition. Dr. vonHippel was an ophthalmologist who noted vascular growths in the eyes of patients who had similar lesions in their brain (as previously described by Dr. Lindau the neuropathologist). Forgive this small gripe, but if a person has vHL then, by definition, they should have noncancerous vascular retinal tumors called hemangioblastomas. There is no way anyone could submit to aviator or astronaut eye examinations without these lesions being discovered. Assuming it was never treated, vision in the affected eye would be very poor. Who cares about the details, it makes for interesting TV drama!
Individuals with vHL harbor a constellation of cysts, growths, and malignant tumors throughout their body. An adrenal gland tumor (pheochromocytoma) develops in many vHL patients. This tumor secretes neurotransmitters which likely contributed to her original presenting symptoms. Malignant tumors of the kidney often kill vHL patients.
Even if Dr. House decided not to alert NASA regarding this candidate's serious health problems, it would not take the aerospace medical team very long to identify all of the woman's many problems. From that moment safe, conventional medical care could be delivered.
Related Topics:
Technorati Tags: House, NASA, astronaut, cancer, medical reality show
In the past I used to describe the paradigm of medical care this way: the doctor is driving the bus and the patient is the passenger. In this fictional situation the patient attempted to drive the bus by outlawing sound recordkeeping and by restricting what tests could be performed. Bad things ensue whenever the patient tries to drive the bus!
2007 UPDATE: Sadly, with the chaos of today's managed care, the current paradigm is more like a runaway bus with no driver!
The usual diagnostic scavenger hunt is quickly complicated by the patient's privacy demands. We refer to this scenario as VIP Medicine, wherein select patients are so important, so special (in the wrong way), that rules are skirted to accomodate the VIP. During this episode, as in real medicine, VIP Medicine is a mirage. Like irony? Providing 'VIP care' is superficial and dangerous - it actually provides a lower standard of care than that provided to a Medicaid patient in the most overcrowded indigent care facility. Sure enough, every time House & Company disregarded safety rules and hospital policies the patient suffered.
Click here to read about my own personal experience with VIP Medicine.
Wow, did that patient have a bad day! She went into cardiac arrest, was set afire, experienced a severe psychotic break, and gasped from near-fatal asphyxia. The eventual discovery of pulmonary cysts led to the diagnosis of vonHippel-Landau disease (vHL). This is an inherited multiorgan disorder, one of the Familial Cancer Syndromes - just like Tuberous Sclerosis. A mutation on chromosome 3 is the troublemaker. For now there is no cure.
As an ophthalmologist I have had the opportunity to learn a lot about this rare condition. Dr. vonHippel was an ophthalmologist who noted vascular growths in the eyes of patients who had similar lesions in their brain (as previously described by Dr. Lindau the neuropathologist). Forgive this small gripe, but if a person has vHL then, by definition, they should have noncancerous vascular retinal tumors called hemangioblastomas. There is no way anyone could submit to aviator or astronaut eye examinations without these lesions being discovered. Assuming it was never treated, vision in the affected eye would be very poor. Who cares about the details, it makes for interesting TV drama!
Individuals with vHL harbor a constellation of cysts, growths, and malignant tumors throughout their body. An adrenal gland tumor (pheochromocytoma) develops in many vHL patients. This tumor secretes neurotransmitters which likely contributed to her original presenting symptoms. Malignant tumors of the kidney often kill vHL patients.
Even if Dr. House decided not to alert NASA regarding this candidate's serious health problems, it would not take the aerospace medical team very long to identify all of the woman's many problems. From that moment safe, conventional medical care could be delivered.
Related Topics:
Technorati Tags: House, NASA, astronaut, cancer, medical reality show
1 Comments:
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