The End of House, MD

Tomorrow Fox television’s, “House” will air its last show and the timing could not be more appropriate.

Dr. Gregory House, MD was a fictitious diagnostic physician, played by British comedy fixture Hugh Laurie, who took our original view of the physician, Marcus Welby, MD, to a more-twentieth century high-tech level. His diagnostic skill trumped his personal flaws allowing him to keep his job despite an opiate drug addiction in a large, presumably academic medical center. No diagnostic test would remain outside the realm of diagnostic possibility as residents scanned, biopsied and drug-tested their way to the ultimate pathologic truth.

Yes, the image of Gregory House MD must end, because like Marcus Welby, MD, he no longer exists.

That’s because instead of “House,” our medicine is now morphing into the “Office.”

As disparate physician groups, each with their unique personalities, join expanding hospital consortiums, an almost comical realignment of priorities is taking place as physicians must be molded into a large employee corporate construct. As this occurs, we see the “Office” plan hours upon hours of meetings to organize its burgeoning physician workforce unaccustomed to “Office” protocols, employee handbooks, quality initiatives, and ever-expanding performance measures.

Some of the “Office” employees adapt easily, others not so much.

For patients, gone are the white boards, the brainstorming sessions, and long nights of anguishing as your personal physician attempts to debug your mysterious seizure-like activity and symptom set. In its place are teams of administrators, doctors, nurses and techs working shifts. Check-boxes are checked to fulfill the proper mandated computer-generated workflows. Tests are minimized. Work hours and productivity ratios are carefully tallied. Bedside contact is minimized to improve efficiency and safety. Yes, nuance, subtlety, and psychology blanch under the fluorescent lights of the “Office.”

But rest assured you will be treated according to an approved clinical pathway that follows multiple and ever-changing guidelines for care. The path might be the wrong one, but all the mice in the maze will be busy as the path is dutifully followed. Cubicles will be buzzing and computers keyboards clicking as the goal now is to get you out and keep you out, never mind the diagnosis, just so the Office gets paid.  And when the doctor becomes team-leader with a caseload of hundreds of patients, “House” becomes a relic of the not-so-distant past.

This is not what doctors wanted. This is not what patients wanted. And I doubt our medical students of today expected they'd be hourly shift-workers, too.

But while Steve Carel might have been funny as the frustratingly bureaucratic boss in a Dilbert-like “Office,” as we move to our new model of comically-named Accountable Care Organizations, I worry that the joke might be on us.

-Wes