Arguably, the show is set in New Jersey, at a teaching hospital, so you would expect that the standards of practice as well as the hyper-specialization seen in the practice of medicine in the United States would be the template for the doctors on the show. However, if you were to look at the model of practice in other, less developed nations, it wouldn’t be as far fetched an idea that doctors would be more multifaceted and would have to be able to practice a variety of different disciplines in the care of their patients. While you may not have an Infectious Disease, Nephrologist, General/Cardio-Thoracic/Neurosurgeon, you are more likely to see situations where, out of necessity a doctor will need to improvise in order to save the life of the patient before them, as there are no consults and no other options available. A good telling of this can be found in Better: A Surgeon’s Notes on Performance by Atul Gawande, where he tells the story of the surgical department of a district hospital in Nanded, India. A surgeon there has to be a surgeon and more than likely will have to do it all and even improvise; and yet in some cases these practitioners are able to out innovate their more specialize colleagues in the developed world. I am not saying that it is necessarily optimal standard of care, but it isn’t so unthinkable that there could be doctors who could do more than just their narrow focused specialty, as portrayed in House.

Also here is a plausible explanation as to why the young guns could have been proficient in running laboratory tests. Several undergraduate programs around the country offer a Bachelors degree in Medical Laboratory Sciences. Technically the degree trains students to enter the healthcare field as Clinical Laboratory Scientists or Medical Technologists. Some programs offer joint Masters in Biotechnology, which give the student training and understanding in Molecular Biology and Genetics. Some people will go on to work in a laboratory environment as technologists, but this course of study also gives you all of the foundational courses to take the MCAT’s and apply to medical school. So it is in the realm of possibility that the young guns could have had this type of training for Pre-Health, even doing internships at labs to gain practical experience and thus be proficient in running their own lab work. I understand that it would then be a stretch to think that they can also be proficient in operating an MRI and a CT and performing Fluoroscopic procedures, but chalk that up to a 45 minute television drama ending up being diluted if you have too many different players in the mix.

We were told in Pharmacology class that talking hallucinations are usually a sign of schizophrenia, that drug-induced hallucinations are usually more simple and rarely have voices. I haven’t checked the literature on this, but if it were to be true, then it would be a strong case against Irina’s hallucinations coming (strictly) from ergot poisoning.

To support this theory, I’ll quote an earlier comment from someone named Andrew:
“But a consistent, stable hallucination/delusion without any behavioural change (except for trying to grab a little Big Love) or distortion of thought would be extremely bizarre under the effects of ANY hallucinogen.”

Also, we have no information about the follow-up on Irina. Who’s to say that her hallucinations never came back?

We don’t get information about how long Irina’s hallucinations have been going on, either. She appears very much at ease talking to her dead mother, which you probably wouldn’t expect if her mom had appeared just days/weeks ago after 20 years of being dead. And I suspect that if she’d been on ergot alkaloids for a long time that she’d have noticed the other side effects earlier by herself.

Plus, we don’t ever see Irina talking with or even mentioning any real people in her life, just her dead imaginary friends. So we can also assume that she’s not a very social person. Not a diagnostic feature, but also tends to support the idea of schizophrenia.

And maybe her mother was genetically very unlucky or she injected herself with MPTP at some point in life, but full-blown Parkinson’s disease at 25 is really rare. I have an idea that we could justify the parkinsonisms as being an adverse effect from antipsychotic medications. At the age of 25 psychoses are much more probable than Parkinson’s disease – and can also be heritable, so Irina could be at risk.

In general, I think that we could add a diagnosis of schizophrenia on top of the ergot poisoning… If anybody’s still reading this, I’d be interested to hear other thoughts on the matter.

Ok, sorry, I will stop thinking out loud in the comment section now. Bye!

I can’t figure out why they gave Irina L-dopa and bromocriptine. I mean, sure, her mother most probably had Parkinson’s (classic symptoms described), but that was 25 YEARS AGO, and let’s see what Irina had: hallucinations, delusions, and one tonic-clonic seizure. No tremor, no hypokinesia, no classic Parkinson’s symptoms whatsoever. If anything, those sound like schizophrenia (minus the seizure) and L-dopa and bromocriptine would’ve made it worse, not better.

So I disagree with the medicine being called “decent” in this episode. You don’t just go diagnosing something 25 years post mortem and then giving the medication to the deceased person’s offspring out of a whim. Vitium artis.

I too will miss Ridiculously Old Fraud. He is the fake doctor grandfather I never had.