Real doctor reacts to HOUSE MD "THREE STORIES" - Why does House limp?

hello and welcome to sick notes my name's dr. Edie hope and on this channel we talk about medicine I share some of my experience of being a doctor in the UK I've done quite a few TV medical show reviews and so I put it to you guys to see which show would you like me to do a little bit more of and there was a narrow victory for house although it was so narrow I'll probably look at these some episodes of the other shows as well I was a huge fan of house when it was on air so I thought what episode could we look at on iTunes as a collection of fan favorites I thought why don't we look through them and the first one is the episode three stories which is episode 21 from the first season if you guys remember that it's it's a pretty crazy episode is unlike many of the episodes of house but also there's a huge revelation at the end so if you haven't seen it yet I'm look I don't always talk about sport you know not having any spoilers on for these shows are quite old now so hopefully if you're interested in House you've already seen the episode and as I said it's an unusual episode it's quite a comic episode so I'm not expecting it to be super accurate it's supposed to be extra dramatic isn't it so it's a good chance just to revisit the episode and I can explain a little bit more about what's going on screen and share some of my experiences of the doctor so let's dive into it I'll do the lecture for four hours our clinic - I know you'd rather spend a couple of hours listening to yourself than listening to patients class starts in 20 minutes so easy house is being bribed into teaching medical students so house ends up - living a lecture on diagnostic medicine this is pretty Bagon actually when I was at medical school most the lectures were delivered by academics within the faculty but then occasionally maybe once a week we'd have a clinician so a doctor currently work in a hospital would come and do a kind of guest lecture their quality of they were always pretty varied but actually they weren't too far off this kind of relaxed attitude free guys walk into a clinic their legs hurt what's wrong with them I'm not gonna like you away but most likely cause of leg pain is muscle strength the most likely cause of leg pain is muscles doing that it's a really intelligent outside I like that the cliche of medical students is that they come up with the most obscure answer first so he said what's the cause of leg pain some will say like bone cancer the way we learn medicine is really about all how to organize your thoughts so how to come up with what we call a differential diagnosis what might be going on so for leg pain a good way is just to think of what the leg is actually made of so there could be something wrong with the musculoskeletal system so things wrong with the muscles with the ligaments with the tendons with the joints I said this is probably the most common cause of leg pain it's also made up of blood vessels so there's arteries blood vessels that come from the heart or veins blood vessels that take blood back to the heart either one of these could be blocked or damaged so we could have what we call clawed ocation that's a blockage of the artery or we could have that in like a deep vein thrombosis so a blood clot within the venous system we also have lots of skin and soft tissues in the legs so there might be a source of infection something which we call cellulitis or ulcers so that would be a kind of good way of organizing your thoughts for a leg pain and when you organize your thoughts it's important to remember the common things that we already mentioned but also the uncommon things that you don't want to miss that can be potentially serious what were they doing in pain presented I have no idea you didn't ask you take the history of course but all that told us is what they said happened take you the history basically just asking the patient what happened is the most important thing you do when diagnosing a patient which may surprise a lot of you obviously many conditions are formally diagnosed with blood test imaging that type of thing but the history allows us to figure out what might be going on so we can order the correct test I don't think this is early appreciated by the public how important a kind of what we call a clinical diagnosis is just last week in a knee I had a gentleman come up to me who come in with chest pain and he was waiting for to be reviewed by a doctor no he had blood tests when he came in and he came up to me at the desk and said you know how long's the wait gonna be so I gave him an estimate and he said well I can't wait for that can I just see if the blood tests all right and I'll go home now if I they just looked at the blood tests and sort of the seemed Oh everything's fine you can go that still doesn't mean he's safe luck test can tell us a lot but only in the context of what's happening with that particular patient for example if it had pain just a couple of hours before the blood test was taken that's too early to pick up any changes for saying serious like a heart attack kinda like just looking at the engine oil and then deducing that everything is perfectly fine with the engine and the car so although house kind of dismisses the history here because he's kind of a genius he can deduce all these things from the history in a kind of different way but most doctors don't have that ability so as a principle of medicine taking history is super important person a farmer says he was fixing a fence first and be volleyball practice and see we got Carmen Electra golfing so this is really well done actually very accurate we have three patients with leg pain a farmer a volleyball player and a golfer and this is exactly how I deliver my lectures for system I always pick three cases and then talk through each one and throwing the questions over to the students trying to get them to picture what they'd be like in the doctor's shoes and what they do next and that's a really nice way of learning I say we start with a farmer did you hike to the fence and how far yes it's about a half a mile from my farmhouse and where is the pain localized so first up the farm own house does a pretty good job of taking a history here even though he was belittling it yeah so what should we do first family history indicative of leg pain that's a very short list any history of bone cancer alleged this before and let it go to the doctor with leg pain and you know the second question they asked you about is bone cancer this is where it comes back to being a systemic so in general terms if a patient's stable and we take a history we think about the history of the presenting complaints of what's brought them into hospital we then ask them about their past medical history so we can find out if anything is you know they've had similar things before any conditions that can present in that way and then talk about drug history and allergies within that then we talk about their family and social history and then we do what's called I so their ideas concerns and expectations that gives us a general idea of the priority of questions and make sure we don't miss anything it could be a blood issue we should run a CBC in a d-dimer the second students operate isn't much better let's do blood tests we talked about this if the patient is stable we take a full history and examination then we do investigations like blood tests and then we do management otherwise we'll do these tests and if everything's normal have to go back to our history and things like that so we go through this systematic approach and get an MRI MRI or a PET scan and then the dude that's used to be in ten Things I Hate About You says then an MRI yeah again this investigation we'd want to do that a lot late it would takes a bit of time to get that as well sorry thanks for playing patients dead who killed him we had no time to run any tests there was nothing we could do you had time to look at the leg it's a nice little touch that they've added this in to show where medical students are and then ultimately how House sees things and where the students need to get to weirdly because it's a story that house is telling this patient suddenly turns into Carmen Electra very much fame it goes without saying that this kind of perving on a patient even in a fantasy is no bit greg:so is health out puncture snakebite that would be my guess so the patient has a snake bite in the UK I think we only have like one type of venomous snake and it's really uncommon so I literally know nothing about a snake bite so I can imagine any doctors in Australia on America and other parts of the world this is a super important thing to know about though I have no idea if this is realistic but I can guarantee that the doctors would not be there with their I guess you've got a snake Wrangler sounds a bit naughty trying to catch the snake but they do a good job they identify a snake and give the patient some anti-venom 200 milligrams our guy got bit less than four hours ago there's nowhere snake regenerates that much event that quickly so House notices that the venom test from the snake has too much venom in his fangs therefore couldn't have bitten the patient I mean that is some next-level knowledge from house but don't forget he is telling this story to a bunch of medical students in the room say he has total control over how he paints this picture and I'm so when I deliver these kind of clinical lectures I sort of do a similar thing you know you just sort of slightly bolster up your the you know your clinical ability when telling the story is a nice way of looking smart and helps your ego endlessly of course he's right at the anti-venom doesn't work and the patient continues to get worse and then House asked the medical students in the lecture theatre what should they do next so should they give the patient the next most common type of anti-venom or should they not who gives the guy the other had a better and who goes looking for the snake I assume that one choice kills him the other one saves them that's usually the way it works the light turning black stage this is a really interesting question just in terms of general medical questions so we very often treat a disease that we suspect even if we haven't diagnosed it yet if the tree that we're giving is quite low risk and well tolerated and the delay in trying to get the diagnosis can make the disease significantly worse so just off the top of my head something like a pulmonary embolism so a blood clot in the lung we treat with blood thinning medications to help the clot reduce we do that straight away without waiting for a scan to confirm that there's a blood clot there how do they teach you how to tell someone that they're dying you're role-playing stuff yeah one of us gives the bad news and one of us gets the bad news what do you have to do to get an A in your dying 101 we do get taught how to break bad news I understand where house is coming from like how can you give someone at a in telling them that they're dying because it's so hard I think as doctors when you're first learning to do it you can often trip up on your words and not find the right language because you're so aware of sort of being insensitive and saying the wrong thing so the role plays you do as a med student are actually really good although you obviously don't totally connect it doesn't have the gravitas you actually helps you to find a language and helps to find a pace in which to deliver things and there's also some kind of key aspects that are shown to be a good way of delivering this type of news so introducing yourself properly having a good environment so making sure you're not going to get bleeped when you're delivering the news making sure the patient has everyone around them that they wish to have around them asking the patient how much they want to know about what's going on some people don't and then from there we we often do what's called a warning shot so it was saying you know I have some bad news for you just to set the patient up for what they're about to hear and then you just tell them straight it wasn't a snakebite was it I said I don't remember being bit the good news is you might just live bad news history Doc's gonna die so eventually in talking to the patient house figures out that it isn't a snake bite but a dog bite that has become infected so you know that part of the history where I said he talked about the family and social history and the ideas concerns and expectations the reason why the patient was holding it back is they didn't want their dog to be put down their dog to be killed because it's bitten the owner so you know maybe house should've have spent more time trying to get the history even though the patient was kind of holding it back you might have got more information there and is this realistic as well I mean as I say I don't know anything about snake bites folks I would like to think that I could tell the difference between a snake bite and a dog bite on a person's leg also any significant bite snake bite dog bite Cuban by you would treat with antibiotics because all of those mouths contain lots of nasty bacteria that if they get under the skin would cause a problem so you would expect this chap to already be on antibiotics and the team to be thinking about that regardless of what animal has actually bitten the patient a lab test of your dog saliva revealed the type of strep bacteria it's commonly known as the flesh-eating disease this nasty flesh-eating bacteria is absolutely true we call it necrotizing fasciitis the worst case I've ever seen was a gentleman that had it around his thighs and around his genitals something that we called fournier's gangrene I don't recommend you googling it it literally looked like he had his whole saddle area kind of bitten by a tiger it was just completely destroyed by this infection is very serious and has a very high mortality so you have to clean all the tissue away give the patient lots of supportive care as well in terms of fluids and antibiotics so the patient had his leg amputated and he survives so that's one case done so on to the volleyball player and the working diagnosed is tendinitis so what is tendinitis so tendons are things that connect your muscles to your bones so as opposed to ligaments which can take connect your bones to your bones itis means inflammation so therefore tendonitis means inflammation of the tendon how old is this person I mean it's not really a four year old man on a girls volleyball team right it's a lake leg is the legs away money that house pulls them up on asking the age of the patient the age is super important in a patient in fact when we're presenting a case back to a consultant or we're writing in the notes the first thing we write is the patient's age and sex and common sense will tell you that certain diseases are more prevalent in certain age groups right so that's why it's really important in you know locking your thinking into what might be happening with this patient so I'm a little bit surprised that it's kind of downplayed a little bit here discovered a tiny Nigel which in reality is signified nothing but gave us no choice but to put a person with tendonitis through an expensive and painful test so it already told the learning of this case and it's super applicable to medicine don't over investigate things if someone comes in with a clear history and examination consistent with a tendonitis then we can just treat them with anti-inflammatory medications rest and give them some safety net and advice so if it isn't improving where to get help and that's it really so only if the patient didn't improve would we do things like this like spread a wider net and do blood tests and imaging of things like this and so in this episode this patient eventually undergoes an invasive biopsy of the thyroid gland and a biopsy of the bone in the leg to look for bone cancer so it's a really nice little case highlighting this kind of important medical concept and not to over investigate things and the final case the golf fight it's the one you've all been waiting for isn't it let me tell you why so the patient is in a lot of pain here in the emergency setting controlling pain is so important I've heard a bit of a fallacy that we don't like to give too much pain medication because it might mask what's going on which is just absolute rubbish in our and where I work you're not a any clacking card after the patients what they've come in with the next boxes how much pain they're in to encourage us to address that so the patient's more comfortable it's also a really important kind of diagnostic thing to see how responsive the pain is to medication it can help you figure out exactly what's going on patient responds to energies are really well initially which makes the team think they may be doing kind of drug seeking behavior so just faking the pain to get free morphine we're gonna put this hard rubber tube up your urethra and into your bladder oh God so House devises this extremely unethical test to figure out if the patient is faking it okay this just wouldn't happen but the theory behind it in this episode is that no one would consent to having a catheter so a rubber tube put into the penis that goes into the bladder no one would consent to having that done unless their pain was genuine even worse than this they show you the catheter here and the balloon is semi inflated so that's even worse so that balloon that you see in shot there is what we passed the tube into the bladder we put some and fluid through the bladder and that fills our balloon up and that keeps the catheter in the right place and there's no way you'd even get that into the patient with the balloon semi inflate it would be so unbelievably painful even just try having said that it's gonna make your eyes war a little bit I have seen patients who have been confused actually pull their catheters out with the balloon still inflated I mean it just must have been so pick either I actually don't even know how that's medically possible presumably all the tissues to stretch a little bit so the patient accepts the catheter so presumably they're not faking the pain and the catheter drains some dark t colored urine so putting that in the context with leg pain that team think it would be muscle breakdown now we find out at this point that it's been going on now at this stage for three days and we find the big revelation [Music] his MRI showed that the like pain wasn't caused by the self-injection wasn't caused by an infection it was an aneurysm that clotted leading to an infarction he said this is the story how House got his chronic leg problem how he got his addiction to morphine type medications and also I guess part of his personality so how it led to him become big being quite cynical doctor is this diagnosis realistic I would say absolutely but a big caveat three days that's pretty extreme that seems to be a kind of common thing in house actually is that everything's sort of realistic but the timings are always a bit obscure and things are often missed for convenience sake so the problem is caused by an aneurysm so let me tell you exactly what this is and how it caused houses problems so here is an artery in the leg remind you an artery is a blood vessel that carries blood from the heart to the tissue and because of this is under high pressure an aneurysm is a weakness in the blood vessel wall overtime due to the weakness and the blood pressure the aneurysm will expand in itself this may not be an issue but complications can arise for example because the wall is now thinner as the aneurysm expands it may rupture or leak this can be potentially fatal if the aneurysm is formed in a large blood vessel like the aorta or in a blood vessel in the brain now what house had was a different type of complication from an aneurysm what we call a thrombosis sort of commonly called a blood clot your blood doesn't usually throw those in your blood vessels due to three things the specialist lining of the blood vessel wall the smooth flow of blood through the blood vessel and the specific makeup of the blood constituents these three things are called berkos triad I changed it any one of these three can cause the blood to from bos in the blood vessel and therefore deprive the tissue of oxygen that is supplied by that blood vessel the in an aneurysm we have changes to the blood vessel wall because it's become thin and damaged and we have a disruption to the flow of the blood because of this bulging of the wall these two things mean that a thrombus can be formed in houses case this blocked up the artery meaning the muscle that was supplied by this artery became started nutrients and began to die on examination the lack of blood supply would mean the limb would have certain signs of symptoms that we remember as the six PS let's see if I could remember them so the limb becomes very painful it becomes pale it becomes perishing Li cold that's a bit of a shoehorn P in there we have paresthesia so we get funny sensations we get paralysis and we lose some of the muscle lose its ability so we get weakness and finally what's the last one are we laugh we lose our pulses so it becomes any tissue death caused by a blockage of an artery from a thrombus we call infarction and any dead tissue we call necrosis therefore to restore the circulation a vascular surgeon would either put a stent a tube inside the artery to keep it open or do a bypass that is to take a blood vessel from somewhere else and stitch it so it goes round the blockage in the artery there are a few other complications that happened in-house case but essentially the muscle was so dead that it had to be removed and this led to his chronic leg pain so there you have it we talked about loads of things today what happens at med school we talked about the importance of taking histories the importance of not over investigating the sort of normal thought processes doctors go through we've learned a little bit about blood vessels infarctions and aneurysms we've talked about why House got his chronic leg pain so if you enjoyed this you might want to check out my previous house videos or some of the other medical TV shows I do finally thank you again so much for all your support on the channel for the likes for the shares and I absolutely love the comments as well love reading the comments and hearing from you guys so thank you again and I'll be back soon and I'll see you then [Music]

Channel: Dr Hope's Sick Notes

Views: 518,811

Rating: 4.9039369 out of 5

Keywords: doctor reacts to house, medical tv drama review, real doctor reacts, house md, three stories, why does house limp, hugh laurie, medical drama, medical tv shows, doctors reviews medical tv show, house md accuracy, how accurate is house, real doctor perspective, why is house always in pain, why does house use a stick, story behind houses leg, doctor reaction, doctor watches, doctor breaks down, dr reacts, dr watches, house

Id: cHrcCQduup4

Length: 25min 7sec (1507 seconds)

Published: Sat Jun 02 2018

Reddit Comments

[u/Notoriouslyd]

I really enjoyed this. I'm going to check out the other videos since I recently started binging House again.

[u/[deleted]]

You’re my favourite youtuber!

[u/ursamaul]

This was great! I learned a lot!

[u/BFG_9000]

Thanks Doc - Fascinating stuff!