The Merits of Nitpicking: A Doctor Diagnoses House

My son and I are both big fans of the television series, >em>House. I watch the show for the characters and their interactions — especially for Hugh Laurie’s performance but also for his interplay with the other doctors. My son has shown a bit more curiosity about the medical dimensions of the series and in search of information, he stumbled onto a fascinating blog, Polite Dissent, which offers medical insight into House, superhero comics, and a range of other popular culture texts. The blog promises us “Comics, Medicine, Politics, and Fun.” Its author, Scott, describes himself as being part of a large family practice in Southwestern Illinois.

Scott’s blog is a good illustration of a mode of fan criticism which sometimes goes by the name of nitpicking. Nitpickers examine their favorite programs through a particular lens — in this case, medicine — in which they have developed expertise. I became very interested in nitpicking when I did research for Science Fiction Audiences about the reception of Star Trek at MIT. What I found at that time — the late 1980s — was that MIT students were often drawn to our school because of an early interest in science fiction and used science fiction — especially debates about the lines between known science, reasonable speculation, and implaussible technobabel — to work through their own mastery of core scientific concepts. The pleasure was in being able to prove to each other what was “wrong” with the science in a particular Star Trek episode and to explain a more plausible or realistic way of dealing with the same themes. Indeed, they classified the ST:NG episodes by discipline, often using the numerical codes (“Course 6”) which are most often used to refer to majors within the MIT Context, suggesting just how much the shows functioned in parallel with what they were learning in their classes.

These scientists and engineers in training were not being obnoxious in trying to show their superiority to the program: part of the pleasure for them came in sorting out the differences between real and bogus science. In some senses, this was to look at the series through a realist lens but that’s too simple a way to understand what is going on since all science fiction fans recognize that science fiction involves speculation and about social commentary, not simply about reproducing the world of known science but pushing beyond it to explore alternative possibilities. There were just “rules” that governed how far outside known science science fiction “should” stray and in what directions.

The classic nitpicker has a love/hate relationship with their favorite program: the show has to be good enough to stretch the outer limits of their knowledge at a regular basis and yet at the same time, it has to be flawed enough that they can catch it when the authors “fake it” in a particular domain of knowledge.

So, Scott takes House apart in terms of hospital procedure, medical tests and equiptment, and the specifics of the various ailments they appear in the speculations surrounding a particular case. Taken as a whole, Scott seems to enjoy the speculative aspects of the series but to be displeased by the various shortcuts the writers take to get us through a complex medical process in under an hour of screentime. Scott recognizes the tension between story telling and communicating actual medical knowledge but remains frustrated, as he puts it, “when House does a “character show,” the medicine suffers.”

Here, for example, are some of the key concerns he raised about “TB or Not TB”, a second season episode about a grandstanding doctor who works on the medical problems in the third world and who provokes special ire from the series protagonist:


f the patient is suspected of having TB, why is no one treating him wearing a mask? Why he wandering around the hospital and not in isolation? Why is he not in a negative-pressure room?

PPDs are not read by sight, but by feel. It doesn’t matter how red it looks, but instead how indurated it is.

TB is slow growing. How did the team know almost immediately that it was resistant TB? How did the antibiotics kick in so fast?

A nesidioblastoma would explain most of Dr. Charles’s symptoms, but *wow* that’s a convenient tumor. Small enough that it can’t be seen on x-rays or MRIs. Intermittent, so it only releases insulin periodically. And yet strong enough to lower the sugar level in his CSF. It’s more of a deus ex machina than a diagnosis.

When Dr. Charles coded, why did no one in a room full of doctors start CPR while waiting for the paddles to charge?

I’m certainly no surgeon, interventional radiologist or endocrinologist, but the scene where the team is trying to induce the tumor to release insulin seemed wrong. Injecting calcium directly into the pancreatic blood supply may be a legitimate procedure, but I doubt those four are qualified to perform it. Also, since they expected the blood sugar to drop to dangerous levels, they should have had the D50 ready to inject and not scramble for an IV setup

Frankly, most of these questions never crossed my mind: for me, the medical language on >em>House is as much technobabel as anything heard on Star Trek, but I found I had to stop watching Jack and Bobby a few years ago because I got so frustrated in how they dealt with academic life and I am starting to get more frustrated with Veronica Mars along similar lines. It all depends on where your expertise and interest lies but that’s part of the value of creating a space where shared texts get examined through multiple lens.

It has been widely observed that procedural shows like House or CSI can play an important role in exciting the American public about the professions being represented. They are often accompanied both by an increase in sales of nonfiction works on the same topics and by increased applications to colleges which offer programs in those areas of specialization. The obvious parallel here is to the MIT students who got turned onto science through Star Trek. In such a context, sites like this one play an important role in providing a corrective to some of the more hairbrained ideas that find their ways into dramatic television or simply to provide further background on the medical conditions and practices discussed on the program.

I wonder how we can incorporate something like the nitpicking process into the educational system. What is the value of getting students to apply their knowledge to deconstruct a popular representation? What is gained by the process of walking through such critiques and then trying to verify competing truth claims through reference to concrete evidence and information? What gets added when we move from a single knowledgible critic like Scott to the incorporation of a larger community of interested people who might bring slightly different expertises to the table or who might have competing interpretations and evaluations of what is represented in the program (as occurs in the comments section of this site)? The key point is that the procedural shows themselves do not have to be 100 percent accurate as long as they offer problems for students to work through and solve and as long as a spirit of playful debunking is built into how they get discussed in the classroom. Indeed, the shows may be a better basis for such an experiment if they are good enough to capture the imagination but ultimately flawed or compromised in their representation of real world practices. Such an excercise would seem to be a great way to introduce media literacy concepts into the biology classroom.


  1. amazing to read this today, when yesterday I read this post by David Pollinchock over at Marketing Strategy and Innovation blog – – he predicts that it’s not consumer generated media that’s big – it’s that we will be critics. Your example of Scott’s blog is right up that alley. I love that students turned their love of Star Trek into a love of science – I loved Star Trek too as a kid, but i could have cared less about the science – i only had eyes for Mr. Spock.

  2. Very interesting post. I’m also a huge fan of House, largely for the same reason you are. I stumbled upon Polite Dissent halfway through watching Season 2 and, at least for me, it breathed new life into the show.

    With regard to this specific form of criticism, do you believe that House (or a similarly themed show like CSI) has any value in the classroom, particularly at the high school level? Being so popular in America, I think it would be an interesting and potentially rewarding exercise to spend a lecture dissecting the medical aspects of House (forensic science of CSI, etc.) in the same fashion as Scott. I feel as though this would be a welcome departure from the conventional textbook examples students are regularly presented.

  3. “What is the value of getting students to apply their knowledge to deconstruct a popular representation?”

    I can think of a lot of reasons.

    First of all, it would serve as another reminder that not everything you hear is necessarily accurate. It’s surprising how naive people can be.

    Memory also benefits in two different ways. By examining a non-scholarly subject from a more scholarly perspective, the brain is trained to use knowledge. The ability to apply knowledge and skills out of the context in which they were learned seems to be one of peoples’ weakest areas. (At least from my experience; it’s probably different at MIT than in public high school.) Students always complain, wondering where they’ll need whatever they’re learning in the “real world”- maybe this will satisfy them.

    Probably not.

    Besides practicing application, this activity would help students remember the subject being learned/applied better. Memory works by linking ideas, and any extra connections will help keep the subject in mind. It’s the same principle that drives mnemonics- the more roads that lead to an idea, the faster it’s recalled, the better it’s retained, and the easier it is to get to.

    Also, taking a message apart can aide in understanding it. For example, finding medical inaccuracies in House can help to reveal the reason for the misrepresentation. Maybe by not following true medical procedures, a plot can be created which better potrays a character as was intended, evokes an emotion, or teaches a lesson. The way medicine is represented in House is akin to the colorization of NASA photos- if the purpose isn’t scientific or educational, and it makes the message clearer, why not? If it is effective, it would be useful for a learner to examine why the compromise was made and how it affected the message.

    Finally, and most obviously, it would make learning more interesting. Would you rather learn about, say, heart disease by watching House and then going over how close it is to real life or by studying some diagrams, reading a textbook, or hearing a lecture?

    Ding, ding, ding– House for the win!

    By the way, I hate to be.. uh.. nitpicky.. but you messed up your em tags a couple of times. It’s , not >em>.

  4. To be quite honest, nitpickers give me the screaming heebie jeebies. I tend to prefer to take the text as a whole and to focus on character – that word Scott seems to dislike so much. In my opinion, focusing on often minute details in such a negative way is counterproductive, ignores the gestalt and does not allow any room for the concept that the creators have a tale to tell and limited time to do it. I know the nitpickers say they appreciate the constraints of story telling, but frankly, I don’t think they always do.

    This comment is a lot less volatile than the one I put in my LJ.

  5. Good Idea!

    But high-school and House????I wonder!

    It is too specialized,and for a med school student,maybe,it comes as a help,but then,again,he has it all written in his text and presented in the form of patients in all possible permutations.

  6. >> I wonder how we can incorporate something like the nitpicking process into the educational system.

    I know that there is a “Philosophy and Star Trek” class taught at Georgetown University that does this, getting interest and understanding of philosophical issues (like Bryant said above, and I think s/he pinned it) through deconstructing Star Trek (link). There are people experimenting with this sort of education, and I find that truly fascinating. I wonder what the results are.

  7. dr venables preller says:

    A very interesting line of discussion. I have long felt that lack of knowledge of learning processes has been the impediment in educational establishements at many levels. Certainly interest through some form of participation needs to be aroused and maintained for optimum results for students. I remember from my student days the example of the Catcher in the Rye being quoted as being a classic illustration of posssible behavioural outcome at a significant time of development following sibling loss. Many tv programs now use negative examples as an effective tool in how not to do something well. Learning together empirically does add meaning to the concept of lifelong learning

  8. L'adder de Noir says:

    An excellent set of observations.

    Conversely, of course, inaccuracies in these programs propagate into real life: witness the number of people who believe police can run a DNA test at the drop of a hat.

    The Simpsons (TM) offers a range of similar opportunities for kids to identify social errors, flawed logic, invalid stereotypes, poor decisions etc. Some kids show a surprising capacity to learn from this (and others have no idea, as with adults)

    One aspect of learning is building a schema of how the world works, testing the schema against the world and looking for exceptions in order to refine the schema. That fits with nit-picking.

    We have to be a little cautious in generalisations like “Finally, and most obviously, it would make learning more interesting”. We’ve all had teachers whose interests appeal to other kids in the class but bore us witless. Many never seem to realise.