Comments on: House – Episode 11 (Season 2): “Need to Know”

By: Ayman

Ayman — Thu, 22 Dec 2011 10:00:41 +0000

A very very bad mistake that was done, a muscle relaxant is never ever given just like that, that patient must be given 1st an antithetic, then a muscle relaxant … and should be intubated and ventilated during the procedure

By: Sammy

Sammy — Thu, 24 Nov 2011 22:06:14 +0000

You can definitely get 3 prescriptions in 3 weeks if it’s 3 separate doctors, she gets it filled at 3 different pharmacies, and pays cash for 2 of the 3 prescriptions (1 of them could be run through insurance). But there would be no way for House to determine that just from the bottle. CII prescriptions can’t have any refills on them, so there wouldn’t have been any listed on the bottle, and even if he had called the pharmacy in question, there is no way they’d have been allowed to fill 3 prescriptions for the same CII (or really any medication) in 3 weeks.

I guess if the doctor only wrote for 7 days at a time, then maybe that would work, but that would be ridiculous. Even the generic for Ritalin is expensive just paying cash, so she’d want to put it through her insurance, and they typically only pay for 30 day supplies at a time. And if he only wrote for 7 at a time, then it wouldn’t have been noteworthy for House.

The only way House’s statement would work is if off screen, the woman had admitted to prescription shopping and getting 3 refills in as many weeks. That seems unlikely, given her history of lying.

Given all the comments about how inaccurate the medicine is, I wonder what the point of having a physician to consult for the show is, if they’re just going to get everything wrong anyways.

By: Rewatcher

Rewatcher — Mon, 08 Aug 2011 12:41:54 +0000

I’m late to the party, but in the marijuana scene (just rewatched the episode) the implication is more that Wilson is doing it because he’s so damn much of a soft touch that he doesn’t just suggest marijuana for his patients, but he’ll even risk his job and a criminal record for them by stupidly rolling it at work – NOT that he’s actually prescribed it for them or that it’s a ‘valid’ (in this case, legal) treatment approach.

By: Sath

Sath — Thu, 26 May 2011 21:37:40 +0000

I don’t know this Occam’s Racor thing, as I never visited a med school or anything similar. Yet it seems to me like the writers use it in a Holmes-like way. “What remains after everything else has been ruled out and may it be totally impropable, has to be the truth.”

Which might be the meaning of the O.R. or not, I really don’t know, yet under this premise it makes sense, doesn’t?

By: TMA2

TMA2 — Wed, 07 Jul 2010 06:35:07 +0000

House says that the half-life of methylphenidate is 12 hours. While I’m sure everyone wishes this were true, it’s actually 2-4 hours.

By: Andi

Andi — Wed, 10 Feb 2010 18:33:53 +0000

Thanks Adam Bomb 1701 for that info!

Anyway, nobody answered Anna’s question re: use of salive to determine HIV infection. That was what I also have in mind. Is that possible?

Thanks for the blog!

By: Adam Bomb 1701

Adam Bomb 1701 — Sun, 07 Feb 2010 13:07:00 +0000

A follow-up to Emma’s comment of 10/20/08, regarding Wilson rolling a joint – Medical marijuana was legalized in New Jersey in January 2010. Long after this episode was made, however.

By: Marc

Marc — Fri, 31 Jul 2009 18:34:55 +0000

Another medical mistake here – the paralyze Margot with Vecuronium so that they can test her (MRI was it?) without her flailing about. But … ALL they give her is vec. Vec will paralyze your muscles, but it doesn’t sedate you. Without some benzos or narcs you’ve got a patient who is paralyzed but not sedated. She’d be wide awake AND paralyzed, and therefore (when the lawsuit was done) very, very rich. This is torture.

Also, they would have had a team ready with a crash cart when they paralyzed her, AND they would have intubated her (as well as pre-oxygenated her so they have longer to intubate). They just used a BVM to ventilate her once she was paralyzed … so … what did they do when she was in the machine? How did they get her to breath when she was paralyzed?

I’ve sedated, paralyzed and intubated patients. It’s pretty uncomfortable, if you don’t get that tube you’re screwed. Personally, I would have oxygenated her, snowed her with fentanyl and versed, a bit of lidocaine sprayed in the airway (just to be safe) and then intubated her with a crash cart and a bronch ready just in case. Once I was in and had good end tidal coming back and a secured confirmed tube, THEN I would have paralyzed her.

What they did was just crazy. It’s just TV, so I don’t really mind (at least they didn’t defib asystole again) but honestly, any anesthetist or ER doc (or RT, or Critical Care Paramedic, or Nurse Anesthetist, or PA or…) would have been able to give them better advice about this.

Love the show, love the blog.

By: Thomas

Thomas — Sat, 18 Apr 2009 08:21:52 +0000

About Occam’s Razor:
It does NOT say, the simplest solution might be the right one. That’s a common misconception.
It says the solution which takes the fewest assumptions is the most likely.
Very often that’s the same, but sometimes not.
If one diagnosis has too many ifs and stretches then it might be inferior to a 3-diagnoses solution.

By: Daniel

Daniel — Thu, 26 Feb 2009 19:14:18 +0000

Would methylphenidate (Ritalin) cause such wild limb flailing? I’m not sure, but it seems unlikely (unlike tremor, or perhaps occasional clonic jerks, but not the kind presented). Though it does fit a general trend of the show to greatly exaggerate the risks of drug use.