Doctor Reacts to HOUSE M.D #2. | “Three Stories” | Medical Drama Review
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Doctor Reacts to HOUSE M.D #2. | “Three Stories” | Medical Drama Review


– I’ve told you in the past that I take your comments seriously. Well now I’m putting my
money where my mouth is and watching an episode
that you asked me to watch. Here we go, House M.D.,
episode “Three Stories.” (upbeat music) (static bristles) (upbeat music) (static bristles) – [House] Three guys walk into a clinic. Their legs hurt. (film squeaking) In less than two hours, one of these three will be tossed out of the hospital because they were faking
it to score narcotics and one will be very close to death. (film squeaking) Where is the pain localized? – It started just above my
ankle and it’s radiating up. – So, what should we do first? – Family history? – Indicative of leg pain? That’s a very short list. Any history of bone cancer,
osteogenesis imperfecta, or multiple myeloma? – It could be a blood issue. We should run a CBC and a d-dimer. – And get an MRI. – MRI or a PET scan? – They’re asking him
questions really out of order. In medical school you’re taught
to go with the OPQRST model. O being onset, P being
provocative palliative Q being the quality of the pain, R radiation of the pain, S
as the severity of the pain and T timing which could
mean like time of day or if they’ve ever had
this issue in the past. You don’t just randomly start asking family history out of nowhere. Because if you start asking that, it could lead you down
a line of questioning where you’re gonna spend a lot of time and not get any valuable info. You want the high-yield stuff up front. – Sorry, thanks for playing. Patient’s dead. You killed him. – We had no time to run any tests, there’s nothing we could do. – You had time to look at the leg. (film squeaking) Puncture. – [Female doctor] Snakebite. – That would be my guess. – So a lot of times when
you have an open wound like this farmer’s presenting with, you have to think,
obviously, about bug bites, animal bites that sort of thing, because we’re in the northeast coast, we always jump to Lyme disease, ticks. *patient grunting* – Too much pain to be a slipped disc, could be herniated and
appending the nerve root. – Or it could be referred
pain from his groin. – Sir, are you getting pain anywhere? – He’s curling, it’s not the back. – Sir, where are you getting pain? – Help me! – Hey, he’s not gonna tell us anything if we don’t get him out of pain. Give him 50 milligrams of Demerol. – We have no history. He could be allergic. – What do I do? – We can’t diagnose him while he screams. – Better than killing him
with painkillers that- – There’s ways you can distinguish whether someone’s actually in pain or not. If someone’s in horrendous pain, their heart rate’s gonna go up, you can’t fake that. You can’t make your heart rate go up while you’re faking pain. Second of all, you can, when you’re doing your physical exam,
there’s ways to test if someone’s really having pain. I do this all the time in the hospital. I’ll put pressure on the area while the patient is looking at me
and I’ll ask if it hurts. If they’re screaming in pain, I’ll change the subject or I’ll ask them about something else that’s going on, but leave my hand on the area where they’re still having pain. And while I’m talking to them, I’ll gently start increasing
pressure on that area. If they’re not jumping in pain, it’s either not as bad as they say it is, or they may be pain seeking, exhibiting pain seeking behavior. This example doesn’t look
like a person’s faking pain. – You did exactly what his attending did. – [Male Doctor] And
that was the proper way to handle the case? – Yeah. – The guy used him as a dealer. – You’re gonna see a lot
of drug seeking behavior in your practice, and
there’s a reason- it works. (film squeaking) – [Dr. Cameron] This will start making you feel better really fast. (monitors beeping) He’s having an allergic reaction. Bag. Paddles and epi. – His heart’s fine. – It’s not gonna stay that way. – The reason you give
the epi is not because his heart’s about to about to stop, it’s because his airway’s closing from having an anaphylactic attack to what looks like the snake anti-venom. So you need to give
epinephrine immediately, usually to the upper thigh
or some other muscular region where it can get well
absorbed very quickly. – Let’s say we take five. Get some coffee, go pee. – It’s funny, like he’s fine
with the medical students going out to do that. Nowadays, all the medical
students would be buried in their phones, trying to
Google what the answer is or Google what the possibilities are. What a good doctor means
in medicine has changed from those who know the most to those who can get the best information in the most efficient way possible. Because there’s so much information. It’s being updated so quickly. It’s almost impossible to be up-to-date on every single study
on every single subject. I’ve heard that there was five studies coming out per minute
in the scientific field, so it’s impossible to stay up-to-date with every piece of literature, but if you’re very good
with internet research, you’re very good with verifying sources, you’re very good at
reading journal articles and understanding which one’s
the quality one versus not, you can make a good decision and possibly the best decision for your patient from being able to research. – [Patient] Oof. – [Dr. Foreman] The patient
responded to epinephrine and the allergic reaction was arrested. Unfortunately, the patient
continues to deteriorate. – [Dr. Chase] Maybe the snake wrangler was wrong about the type he caught. – He faxed us the venom tests and confirmed it’s a timber rattlesnake. – No, it’s not. Notice the volume? – I skimmed over that and the gender and the coloring, jumped right
to the name of the snake. *Dr. Mike laughs* – 200 milligrams. Our guy got bit less than four hours ago. There’s no way a snake regenerates that much venom that quickly. – We’re supposed to know how
fast makes make the venom? – Nope, unless you get
a patient bit by one. – Okay, that was just ridiculous. I mean, I get that
House has to know a lot, but he doesn’t know how fast
snakes regenerate their venom. That’s just insane. I don’t know, I guess now I know that too, but where does he get that? Snake’s venom, regeneration? – It hurts again. – [Female Doctor] He came back? – On average, drug addicts are stupid. (film squeaking) – We’re gonna put this hard rubber tube up your urethra and into your bladder. It may be a little uncomfortable. – Will I be getting
some sort of anesthetic? – We’re concerned about
allergic reactions today. *groaning* – If the guy can handle a rod in his penis for a half an hour, he’s really sick. – Okay, you don’t just put a catheter in because you want to
see how serious someone is about getting medications. There are ways to check for
people who are malingering. Malingering is basically when a person is trying to act sick in order to get some sort of secondary gain like drugs, like a day off work, like disability. These things do happen and
you need to consider them. Not first and foremost in your mind, but they do need to be in your thought process, in your differential. – Wrong snake? – Tried every other antivenom we had. – Or too late? – Yep. He’s dying. (film squeaking) – You’re dying. *Dr. Mike laughs* In a few hours. There’s nothing we can do
except deal with the pain. – Well, I need to go home. – You’re not going home. – But my dog. What will happen to my dog? (film squeaking) Neighbors don’t like him. – So the Humane Society,
take him in, find him a home. – No, they won’t. Yeah, but maybe maybe my aunt. – It wasn’t a snake bite was it? (film squeaking) I assumed that Cujo bit one of
your neighbors a while back. You tell me that he bit
you and I gotta report it. Cujo’s got a record, he gets the chair. *Dr. Mike laughs* – I don’t know if that’s how it works. – The good news is, you might just live, the bad news is your dog’s gonna die. – Why are the residents doing this? Residents don’t go to people’s homes and steal the dogs and swab the mouth. This just doesn’t happen. They would call the local dog catcher, I don’t know the someone
from the Humane Society, to come and get the dog, bring it in, test the mouth and then they’ll
deliver them the results. Residents don’t do this because then their employment insurance
would be through the roof, because they’re always
undergoing these crazy risks. It would be too nuts. – What’d you call that? – [Male Doctor] Ball of yarn. (film squeaking) – What color is your pee? – Yellow. – What color’s your blood? – Red. – What colors did I use? – Red, yellow and brown. – And brown, what causes brown? – Waste. – Which means the kidneys
are shutting down. Why? – Trauma. – None that his history would indicate. (film squeaking) What are you missing? – [Female Doctor] Muscle death. – Rhabdomyolysis. – Not your case. – Nothing wrong with a consult. – Dying muscle leaks myoglobin. It’s toxic to the kidneys. – Medical students were
saying that it was trauma or damaged, they just weren’t
saying it the right way. So he’s being really mean to them. I don’t condone this kind of pimping. – Dog’s mouths are pretty filthy, but they have natural
antibodies to fight off most of the stuff, we don’t. That’s why dog bites can be so nasty. – He’s right, dog bites can be nasty, but actually human bites are worse. If you look at the infection rate from an untreated human bite versus a dog bite, human bites are actually
more likely to get infected, and that’s because
human mouths have a much greater range of bacteria and viruses that live in our human
mouths as compared to dogs. – We may need to remove the leg. – I still don’t know what
this gentleman’s problem is. He has a muscle damage from what? I don’t, I’m not following. And what did the MRI show? – His MRI showed that the leg pain was caused by the self-injection. It wasn’t caused by an infection. – Compartment syndrome? – It was an aneurysm that
clotted, leading to an infarction. – God, you were right. It’s House. – [Female Doctor] We
have to do the surgery. – Now I get why you guys
recommended this episode. I was wondering what happened to House, unless this is a whole thing is a farce. It would probably take a
few days to diagnose it because it’s such a
unique and rare condition, that it wouldn’t appear
at the top of your list. If you’re thinking of aneurysm
at the top of your list, you’re gonna be doing a
lot of unnecessary MRIs and missing a lot of problems
that are much more common. So you need to think horses, not zebras. But I know since this House M.D., zebras are usually the
first thing they talk about. – Do a bypass. Restore the circulation. – Amputation is safer. – For you or me? – The blockage of blood flow- – Four day blockage. – Yes. It caused muscle cell death. When those cells die, they
release cytokines and potassium. – To restore the blood flow
instead of just lopping it all off then all that
crap gets washed back into my system and cytokines
can cause organ failure and the potassium could
cause cardiac arrest. On the other hand, can we just
get the use of my leg back? – This is really interesting. So, whenever you have a part of the body that doesn’t have blood going through it for a very long period of time, that body, the part of the body, dies. Becomes necrotic, that’s
medical term for it. Because of ischemia,
lack of oxygen, it dies, because blood is bringing
oxygen to those areas. When a muscle dies, for example, it releases these inflammatory
cells called cytokines. It also releases potassium
because when a cell ruptures, the first thing that releases or the most important thing that it
releases, is potassium. And having too high of a potassium in your bloodstream is very dangerous. It can be lethal. And having too much of inflammatory cells can also be lethal and cause organ damage. So you have that problem going on because his muscles
have been without blood for a long period of time in his leg, but then as you restore blood flow you have reperfusion of that area. You can also get even
more inflammation going and inflammatory markers going, because he’s bringing healthy
blood into damaged blood, and that sparks to even more inflammation. And that’s why Dr. Cuddy’s actually encouraging him to go for the amputation, to leave all those cytokines and inflammatory cells and
potassium in the leg and not cause even more
inflammation and pain. But I also understand
what he’s coming from, where he doesn’t want to lose his leg. It’s risky what he’s saying. It’s not advisable, what he’s saying. And I could see a lot of surgeons turning down this procedure because they don’t see that this is ideal for him. As a doctor, you always want to do what’s best for the patient and let the patient decide
what’s best for their bodies, but if they’re telling
you to do a procedure that you think is very
risky and unnecessary, you’re well within your means to try and convince them otherwise. – If you were right, the
pain would be subsiding. You’d be getting better. – It’s just taking longer. – No, it’s not. We’ve got to let them cut the leg off. – It’s my leg. It’s my life. (film squeaking) – The middle ground you
were talking about – – We go in, take out the dead muscle. There’s still some risk of
reperfusion injury, but- – Give me the forms you need signed. – If I were House, I’d
be pretty mad about that. But then again, this is
why the bioethics committee comes into play because you’re technically doing something the patient doesn’t want, it is explicitly said he doesn’t want, but you know it’s better for them. It’s such a thin line. I’m not sure what the right call here is. But as medical proxy,
she does have say over what happens to his body right now. – Because of the extent
the muscle removed, utility of the patient’s leg
was severely compromised. Because of the time delay
in making the diagnosis, the patient continues to
experience chronic pain. – A lot of people don’t realize this, but when you’re on chronic
opioid medications, which is just essentially it’s
a masking agent for the pain, it’s not treating your
pain, just hiding the pain. When you’re on that for
a long period of time, it changes the chemistry of your brain, and actually makes you feel
something known as hyperalgesia, where you feel more pain and
are more sensitive to pain, so that sometimes in a
patient who has chronic pain, you have to reduce the amount
of pain medications they take for them over time to feel less pain. It’s a paradoxical, complicated concept, but I’ve actually had a patient that, he was 81 years old,
30 years of back pain, he’s been on opiate
medications for two years, he’s taken morphine and
when he came to me said, “Dr. Varshavski, you’re my last hope”. And when I talked to him about it, I said that I know this
is gonna sound crazy, but I have to lower your dose and eventually get you off
of your narcotic medications if you want to improve this pain. And actually, right now we’re at a point where he’s not taking any
narcotic medications for his pain. He’s going to the gym, he’s golfing, he’s felt better than ever. Narcotics aren’t always the right answer. They have a place, there’s
definitely a role for them, but they’re not always the right answer. They definitely have harms and sometimes those harms outweigh the benefits and we need not lie about that. – [Female Doctor] She
had no right to do that. – She had the proxy. – She knew he didn’t want the surgery. – She saved his life! – We don’t know that, maybe
he would have been fine. – It doesn’t matter,
it’s the patients call. – The patient’s an idiot. *Dr. Mike laughs* – Little do they know! – They usually are. (film squeaking) (film squeaking) – It wasn’t clear to me in the episode if they understand that it’s him, because they were still talking smack at the end of that episode. I do think that sometimes
he crosses the line and is a little rude,
but that’s Dr. House. He’s just got this
personality that’s like angry and wants everyone to
see him as the bad guy, when in reality, he wants
to do the right thing and he wants to help people, but he comes off harsh at times. I feel like whenever he
says a patient is dumb or doesn’t do the right thing, he’s essentially thinking that because he’s thinking about the mistake he made of not amputating his leg
and going through all those surgeries and procedures and
having this chronic pain issue, when if he just would
have gotten an amputation, got a replacement, you
know, there’s so many ways to get a prosthetic nowadays. If you have another episode
in the later seasons, season two maybe season three, drop it down below in the comments. I’ll watch that episode. I want to watch more of this series. I like watching House. It refreshes a lot of my knowledge that I know I studied back in the day, but I haven’t really utilized. This is a great way for me to learn and for you guys to learn at home. So keep those comments coming. Subscribe if you like my content, and most importantly, as always, stay happy and healthy. (upbeat music)

100 Comments

  • Lunar Games

    As someone that is a massive giggler it's hard to convince people im in pain; I also smile while talking so yeah. . several doctors called me malingering before when I was in the ER on several occasions. Rarely do I smile when I talk only if I can barely thing straight and at that point i'm to far gone, i'm the kinda person that when I get sick it hits me like a truck it'll be maybe one symptom two nothing major then maybe within an hour or two i'm unable to stand, puking, dazed it's a crap show.

    It's a hassle to convince every doctor I go to that i'm not faking it because no one wants to be in the ER at 2 am (usually I get massively sick when the sun goes down). Always good to know most doctors I saw as a kid fucking thought I was faking it; assholes.

  • CCRASHY

    About the human vs dog bite comparison I feel as if the reason why humans bites are also worse is because most people that bite other people are pretty fucking weird,

  • Amit Kini

    12: 30 Exactly the reason why one should check cardiac tissue damage, before going to bypass/Angioplasty to prevent repurfusion injury… Angioneogenesis in real

  • DanteEightSix

    I'm glad I can't get addicted to medication. I was once offered morphine for pain and I accepted just to try it. It was definitely an experience, but I can do without it if I don't need it.

  • Lachlan Farrell

    I know you probably havent gotten any requests for this however i just watched this for the second time and it still looks like the closest thing to real life i have seen in television. You might like it. The Fall season 3 ep 1 :Silence and Suffering. It can be found on Netflix.

  • keysha Méndez🐷✨

    keep making "Doctor House" reactions at the end "Dr. House ”almost always discovers diseases, I have always loved how it works even if it is fictional

  • ojasav sehrawat

    @Doctor mike Medical proxy does not have a say in this matter because the patient specifically mentioned what his wishes are to the doctor and the proxy. So he could have sued his wife for this.

  • Alegost1

    there is actually an episode where house changes his mind and recommends amputation to a patient. sadly i don´t know which season/episode it is

  • Jordon Wu

    Dr. Mike has made me find a new interest. I just look up diseases, and it's kinda relaxing. I also like doing a bit of the history of medicine and stuff. Thank you Dr Mike, you helped me appreciate my body and the medical community a little more!😘

  • Jordon Wu

    Or also I can definitely say, that it is possible to know some random and absurd facts like the snake bit. My cousins are like that, one knows about animals, another knows about the countries and their location, political state and climate, the last one is on the gaming end and computer side, and I am with the body and mythology. So…it's not to hard to believe.😂

  • Wrist disabled Writer

    I don’t know the ep name but I would love for you to watch his ep where he is doing clinic duty and has an antivax mom come in

  • Greg Fulton

    Is hyperalgesia from long term narcotic use typically isolated to the site of chronic pain, or is throughout the entire body?

  • Harry Nicholas

    he knows how quickly snakes regenerate venom cos IT'S IN THE SCRIPT. once you accept this is a comedy that explores human nature you can relax. either that or i have lupus.

  • Anne Harrison

    your patient going to the gym, golfing etc. is probably far more of he reason he's not taking opiates now than hyperanalgesia, which would be unlikely to develop in just two years

  • Rr Ss

    I truly like your injection of reality into Hollywood medicine. You might want to do a quick voice-over edit: where your pop-up shows "drug-seeking behavior", you say "pain-seeking behavior.

  • Ethan Farmer

    The medical student says "D-Dimer" waaaaay early at the very beginning. She would have found it, or at least that there was a clotting issue.

  • beerprayer

    @doctormike for the dogs the ACO would be called. If the dog shows symptoms of rabies are shown then you have to do a decapitation and send the head to get tested for rabies. A dog bite does not necessarily mean euthanasia but a lot of shelters will do it quickly, there has been a recent movement to reduce that and there are county shelters now who will adopt out dogs who have bitten but its 100% a case by case basis and it depends heavily on severity of the bite and cause of it. (You hit a dog multiple times and it bites you but it's still a friendly dog overall and the bite wasn't major then he can be adopted out)

  • Penni Hazzard

    House is a brilliant doctor, cynical and a drug addict himself. That's the entire point of the show. But I do enjoy your breaking it down in honest medical terms and explanations.

  • Toni Subklewe

    PLEASE react to House's 2 part season 4 finale… episodes are titled: "House's Head" and "Wilson's Heart." It's riveting TV ( the best of the series IMO,) and I think you will find it medically fascinating!!

  • JDines

    You don't grasp the concept of House. You repeatedly say "you don't do this … doctor's don't do that" but that is the whole point of the show! House isn't like other doctors; he is a loose cannon and a wild card … One that gets played because regular methods haven't yielded results.

    The show doesn't suggest that it is typical for residents to break into homes or for doctors to use a catheter to see if a patient is really in pain or faking it. Only House and his team do these things. That's what makes House House. He ignores the rules, eschews the typical, and usually gets results nobody else would as a result.

    In one episode he gives himself a migrain, tries a supposed new drug for them, verifies it doesn't really work, then drops LSD to bring him out of it.

    If you think this is ER except the limping doctor is male instead of female you couldn't miss the point more.

  • TheAdekrijger

    I know it's just a TV series but some people have trash brains that are really good at storing a bunch of random facts.

  • Lori Owens

    I'm a major fan of house. But this intriguing to see this from a doctor's point of view. Absolutely fascinating, awesome ♥️

  • Trevor Page

    "How does he know how quickly snakes replenish their venom?" … "Where does he get that?" The script-writers… you know this

    House was an entertaining show for however many seasons it was on, no doubt. I don't know what episode or season it is, but there was one that I think would serve as relevant for reaction since gender-identity came into the spotlight. There was one where a professional female teen model got brought in (i don't remember why)…obviously there's the expected drama…red herrings and theatre aspects making it a quality TV show, but in the end, it was revealed that she had actually been born a male, but her genitalia hadn't descended right or something…and she was put on hormone therapy, etc…
    Anyway, react to that one…maybe bring in a transgender guest to co-react…

  • Destiny

    Fun Fact: The show is wrong about how fast snakes regenerate venom. It depends on species. And snakes only use a portion of their venom when inflicting bites, they only “run out of venom” after consecutive bites producing large doses of venom.

  • Clara Cerqueira

    I'm a 3rd year med student (Brazil) and I'm learning a lot from your videos, also having lots of fun! Loving it, glad I found It (:

  • SlimRat

    Awesome series and awesome review! You definitely gotta check out the "Detox", season 1, episode 11.. one of my all time favs

  • Smudolini the Great Dragobear

    Of course House knows those things. He is the Chuck Norris of medicine. He read all medical websites and studies in the blink of an eye.

  • E Ryuu

    No offense, you're wrong. He never wanted to amputate his leg or regretted his decision. He's still made at his ex about her going against his wishes.

  • luke53285

    Hey mike, not so fun fact about the dog: that is roughly how it works. If it bites twice they can be put down. At least its that way in ny.

  • Lolu Oresegun

    I don't get how doctors knowing about snake bites is such a big deal. Back in my med school we were actually taught that shit. Viperidae and elapidae and shit, and how to use that info to get a close enough guess as to which type of envenomation occured.

  • adriann k

    when i got bit by a feral cat they wouldn’t just swab it’s mouth, they had to send it’s brain to a lab… is my hospital just old-fashioned or something? also i have a immunodeficiency and before they tested the cat they were immediately going to give me rabies vaccines, and i had to fight the doctors until i could talk to my PCP.

  • Mohsin Abbasi

    Oh my god.. i think i m in love with dr. Mike..
    I love what u do man… it really helps me alot.. keep it coming.. 😉

  • Larissa Barbosa

    I really like the episode of a deaf kid of with hearing problems that doesn’t want treatment, so he’ll be accepted among the deaf community and house does the procedure anyway saying that anyone with a disability that has the chance to get better should do it because it’s not fair to all the other disabled people that can’t get better. It’s a very controversial episode specially because at the end the kid likes to be able to hear

  • Heather Rowles

    If elevated pulse is your metric for pain, someone like me, in advanced heart failure and taking 200mg of metoprolol each day, is stuffed……even with dobutamine during a stress test they had trouble raising my heart rate above the level the metoprolol allows.

  • James

    The whole snake venom thing is a really simple question of the body mass of the snake, and it’s low metabolic rate because they’re cold blooded which means that it couldn’t process that volume of water based solution. 250ml is probably about a 1/4 of the total body volume of the rattlesnake so its not really that much of a jump if you know how big a snake is, and how much 250ml is

  • John Short

    I’d like to see your take on Season 5 Episode 20 of House called “Simple Explanation”

    If you do decide to do it please watch it without researching it at all and fans no spoilers pls, if you haven’t ever heard of it that is..

    It was a pretty big statement at the time especially for a major broadcast network.

  • Joyce Elias

    PLEASE watch House md season 2, episode 18 "sleeping dogs lie"! and do not spoiler yourself beforehand, the case is just crazy as Heck, loved that episode!! (btw love your Videos, highly entertaining AND educational)

  • Brian Mo

    I love how as the episode progresses the theater continues to fill up with more people since they know how much knowledge house has

  • Pia Tuomainen

    Mike, after watching several of your videos, let me tell you this. You're an amazing doctor! I wish I had a doctor like you. And as a registered nurse, I wish that I had more doctors like you to work with. Your patients and colleagues are LUCKY! 🙂

  • Kebein

    yeah, obviously you dont just put a catheter into your patient just to find out if hes trying to get some drugs, and obviously you dont send your residents to a patients home, but house does, and thats why hes so special in the series. 😛

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