Internet "Nitpicker" Challenges Popular Medical Misconceptions

Nicholas Genes, MD, PhD

Disclosures

March 18, 2008

You know the type: someone who can't just watch a movie but has to point out all the inaccuracies in the story. Maybe you ask them why they can't just sit back and enjoy it -- but to the nitpicker, pulling apart the plot is enjoyable.

Nitpicking is a well-known phenomenon in science fiction and historical fiction, and medicine is no different; in fact, one physician blogger has turned his medical nitpicking into a thriving community of critical thinkers.

When "Scott" first decided to start a Web site, he imagined that it would focus on politics, and thus he named it Polite Dissent. But he soon discovered that his love of medicine was a perfect match for his love of media, so he began to focus on this intersection. Specifically, he began to nitpick the medicine we see on TV and in the comics.

Since we last caught up with him, Scott has continued his reviews of the Fox medical mystery drama House, MD. He summarizes each episode, explains some of the medical procedures, provides links to medical terms, and gives his critique. Here's an excerpt from this season (episode 12), in which a patient's syncope and hematuria prompted a complicated evaluation. Spoiler alert: Do not read this section if you don't want to know the solution.

-- Roz didn't just have a slight bit of blood in her urine, that was gross hematuria. In my mind, that should have necessitated a full bladder and kidney work-up from the very beginning that should have caught the nephroptosis ... They sure like to jump to the big guns early, don't they? Aromatase Inhibitors. Fludrocortisone. Ephedrine. I'm not saying these drugs don't have their places, just not first thing.
-- From what I read, there is some debate in the medical community over how significant a "floating kidney" actually is. All of Roz's autonomic symptoms (hypotension, low sodium, low temperature, etc) are quite a stretch, especially when you remember that she was lying down when many of them happened.
The medical mystery was moderately interesting, frankly not something that ... I would expect to pique House's curiosity -- I give it a weak B. The medicine was better than it has been recently, though still not without mistakes or unexplained symptoms -- another B. I thought the solution was clever and elegant, though the severity of her autonomic symptoms were straining credibility. Still, I give the solution an A-. The soap opera was good and almost -- almost -- had me liking Amber. It was nice to see Cuddy back to her normal acerbic self, especially when she was talking to Wilson. I also give this aspect an A-.

Polite Dissent hosts Grand Rounds
March 18, 2007

Scott has also highlighted the "best and worst" in the year's comic book medicine and has expanded his series on blood transfusions in comics -- a thorough list of funny, misinformed medical tales going back to World War II.

I caught up with Scott and asked him a few more questions about his online activities:

Dr. Genes: Have you been contacted by any other comic book writers, or maybe the writing staff of House? Are you involved in any script decisions?

Dr. Scott: I have worked with a handful of comic book writers since I've started the blog. Most notable has been Gail Simone, current writer of Wonder Woman and past writer of Birds of Prey and Action Comics (the original Superman comic). I answer medical questions and provide convincing medical dialogue. I am thanked in the credits of Birds of Prey #85, and if you search my site for "Gail Simone" you'll find more (and some comments from Gail herself). I haven't talked to any House writers (that I know of anyway), but I have advised several writers in spec scripts for House as well as other series.

Dr. Genes: I have to ask about your inexhaustible thirst for nitpicking. I think it's great, and I still learn from your critiques. But I would not be able to sustain a site like yours for too long. Do you do it to stay sharp? Is it just fun? Or are you worried about people getting the wrong ideas from mass media?

Dr. Scott: Nitpicking is fun, to an extent (reading comics and watching TV is fun; nitpicking comes naturally), but you hit on one of my other goals: education about the realities of medicine. I've had patients come in referencing House, and sure, they've got what they saw on TV ("It's copper allergy! I know -- I saw it on TV!") It's amazing where people will get their medical information nowadays.

It all started about 5 years ago when I got back from a 6-month deployment to the Middle East. When I returned, I had a huge stack of comics to read. One day, I ran across 3 comics with horrible medicine and decided to create a site to medically critique comic books as well as provide advice to aspiring writers. I fiddled with the site but was never happy with it until I discovered blogging, and then it all came together. Critiquing TV shows just came naturally after that.

Dr. Genes: This week, Scott gives his critical appraisal of the best in online medical writing when Polite Dissent hosts Grand Rounds. Join Scott as he collects and organizes stories and opinions from doctors, nurses, students, healthcare professionals, and patients. Maybe you can find something to nitpick, too.

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