豪斯医生第一季06剧情回顾和较真

京东互联网医院·慢病小病不排队,名医专家在身边。
秒懂健康
分享健康分享爱

  Like always~豪斯医生大叔的故事总是有一个不一般的开始,抽搐的头,疯狂的眼神,她就是我们今天的主角:一个失业的女人。被“看起来很年轻”的儿子带着领取失业救助。

  症状一:

  
 
血块在小腿形成,短暂的血管堵塞造成了病人的小腿疼痛。
 
  
 
从儿子的口中得知病人患有精神分裂症(Schizophrenia)
 
 
 
小腿的血块被血流冲开
 
  
 
病人开始幻听(一只放在桌上的青蛙)
 
 
 
趁工作人员走开倒水,儿子给了母亲烈酒,希望能够支撑母亲签字拿到失业救助。
 
 
 
血块顺着血流到了肺里,剧烈的胸痛让病人倒地不起。
 
 
 
到了医院,急诊医生正在向儿子介绍病情:肺栓塞。并且质疑为什么患者体内酒精浓度如此之高。

  听见儿子向医生大声说肯定不是酒精的问题(他母亲只在必要的时候喝他给的酒),接下来豪斯大叔就出现了,一如既往的刻薄风格,三两下就把本来急诊医生准备出院的病人弄成了自己的。和他的“小鸭子”们在白板上讨论起了病情。

  House抢病例的原因,就是他觉得:

  症状二:

  患者住院期间出现了呕血,实验室检查考虑是维生素K缺乏引起的凝血时间延长,这让医生把目光放在了她的肝脏上。为了找原因,他们去了她的家,发现她只吃汉堡,大家以为是偏食引起的维生素K缺乏。

  豪斯这一集做出一个引起肿瘤科医生质疑的举动:酒精缩小肿瘤。骗了外科医生做了肿瘤切除术。(下图)

  症状三:

  太理智。母亲得知自己患有癌症,打电话给儿童福利机构带走了自己的儿子。豪斯虽然一直被儿子误会是他举报的,但是还是从这个症状看出了端倪。

 

  结局:

  裂隙灯下,角膜铜环清清楚楚的显示本集病人的得病原因:肝豆状核变性(Wilson病)

  经过去铜治疗,从一个抽动的神经质的幻听的“疯子”变回如此娴静和理智的母亲。算是HOUSE里小编比较喜欢的结局了。

  但是本集的bug也被人爆了出来。

第二页:国外剧评(英文)

第三页:我国剧评

回到专题页面请点此

回到专题页面请点此

先有外国网站的剧评:

  原文:

  House – Episode 6: “The Socratic Method”

  A schizophrenic woman develops a blood cot and is admitted to the hospital. While there, she starts bleeding from her gastrointestinal tract and then is diagnosed with liver cancer. Ultimately, it is discovered that she is not schizophrenic, but instead has a rare condition known as Wilson’s Disease.

  I was disappointed by this episode. The pathos element — the poor son, struggling to help his mother — was greatly overdone. Worse, the medicine was not up to its usual high standard. I’m pleased that the team was not dashing from diagnosis to diagnosis this episode, but I found it hard to believe that five brilliant doctors (six if you count the Chief of Staff) missed the obvious fact that the patient did not have schizophrenia. Simply put, 36 year-olds do not develop new-onset schizophrenia; it is a condition that typically starts in the late-teens and early-twenties. This information was telegraphed in the first scene, so I spent the rest of the episode waiting for Dr. House to finally decide that she wasn’t schizophrenic.

  Wilson’s Disease, like kuru, is one of those conditions I call a “med school disease.” While it’s true the condition is very rare, it is mentioned over and over and over again in medical school, so it’s unlikely to be missed as long as it was.

  There were a couple of other medical problems this episode as well, most dealing with bleeding and clotting — flip sides of the same coin:

  1. The patient was low on clotting factors because of her liver failure therefore so she bleeds too easily. If her blood is so thin, then how did she develop the blood clot?

  2. A patient with a pulmonary embolus would not be sent home from the Emergency Room on blood thinners. While someone with a deep vein thrombosis can be treated successfully as an outpatient, any patient with a pulmonary embolism is going to be admitted to the hospital, at least for overnight observation (the clots have a tendency to increase in size).

  3. Why do the doctors keep running every test themselves? What do a critical care specialist and an immunologist know about performing and interpreting an ultrasound of the liver? That’s what ultrasound technicians and radiologists go to school for.

  4. Call me a cynic, but I don’t think someone would get better from Wilson’s Disease that quickly.

  This was the second weak episode in a row. So far, the series is ahead 4-2, but seems to be losing some of its early steam.

(以下为此剧评的回复)

  The medical aspects of this episode were incredibly silly.

  1) The patient has a pulmonary embolism. Fine. But the standard of care for pulmonary embolism is anticoagulation (blood thinners). First heparin(or lovenox) then coumadin. This means that when she started throwing up blood, it would hardly come as a surprise that her blood was “thin”. You would not have to go reaching for cirrhosis.

  2) All those fancy test (Protein C, Protein S, Factor V Leiden, Antithrombin III) are of very little use once you start treatment for the embolism. They will all be abnormal due to both the clot and the medications.

  3) About the Wilson’s Disease, how the heck did she escape diagnosis for so long? She somehow developed the neurological complications, developed cirrhosis while skipping entirely the acute hepatitis-like stage? And Wilson’s usually presents earlier and women with this disease are commonly infertile.

  4) So this is the sequence of events that this episode would like us to believe.

  Woman is born with a genetic disease that causes her to accumulate copper in her brain and liver, but somehow is completely fine into adulthood and is able to get pregnant and raise a child into the teenage years.

  Woman develops severe neurological and hepatic deficits due to this copper accumulation which causes her to be diagnosed as schizophrenic and thins out her blood but somehow never develops jaundice(turning yellow), ascites (fluid accumulation in the belly), or any of the other signs of end-stage liver disease.

  Woman mysteriously develops a blood clot even though her blood is thin.

  ER decides to send this woman home. (Malpractice)

  House and company are completely surprised when she starts throwing up blood. Somehow the treatment of the blood clot and the blood clot itself completely disappears from the script.

  After they diagnose her finally, they somehow reverse years of cirrhosis and brain damage overnight.

第三页:我国剧评

回到专题页面请点此

回到专题页面请点此

更不用说我们中国的犀利肿瘤科医生的剧评了:

  (以下文字由bigqi发表于天涯社区)

  第六集出现了我最喜欢的结果——一个病得一塌糊涂的病人被治好了,怀着感谢的心离开了医院。这一集里,一位精神分裂症并发深静脉血栓、肺栓塞、胆囊癌的患者被发现误诊,经过House的治疗,完美出院。治疗过程中还演绎了催人泪下的母子情深。出院时,House还很爷们地承受了小男孩的误解。这些都让我看得很爽。这一集我还看到了传说中的角膜铜环,那个激动啊,书上的描述、插图都不如这个镜头来的清楚。

  House的团队继前几集操作MRI、X光、B超、检验、活检、介入、尸检以后,这一集又操起了裂隙灯,亲自看眼睛。让人感叹,他们几年的医学是怎么学的,怎么什么都会?如果医院的规模小一点,什么科都不用设了,买几台设备,找这几个万金油去就行。

  看我的评论的朋友,如果对医学没有兴趣,那就不要再往下看了。因为我觉得这一集在专业方面有bug,下面我要较较真。

  从医学的角度来说,这一集,剧组的医学顾问睡着了。如果没有睡着,那么这位顾问的专业肯定不是精神病学或者肿瘤学。

  导致House怀疑病人并没有精神分裂症的直接原因是:那位母亲为了儿子的前途,给福利院打电话,这件事实在太有逻辑了,不应该发生在精神分裂症的患者身上。

  这个情节很有问题,错在认为精神分裂症就是疯疯癫癫不干正事,干了正事就不是精神分裂症。事实并非如此。精神分裂症患者在发病的时候,会有妄想、幻视、幻听或者其他幻觉。如果他有被害妄想,就可能会认为你在害他,甚至会反击,这就是我们见到的患者攻击别人的事件。但是,换个角度,当一个人来害你,你去反击,这不是很正常的逻辑吗——精神分裂症受损的只是一部分思维,他完全可以有正常的逻辑思维或者其他思维能力。在广州,在脑科医院治疗的只是很少数有攻击性、发病期间,新发病或者调整用药的病人。大多数患者都在医院外生活,并没有什么问题。纳什就是精神分裂症患者,但是这不影响他的思考,他依然是最伟大的数学家之一。

  不过这个bug问题不大。第一,因为精神病人正常的思考,而对他的诊断产生怀疑,虽然不严谨,但是也还算靠谱。就好像我们看到某个公仆买了宝马车,就怀疑他贪污腐败一样,虽然逻辑上他也可能买得起车,但是一查,估计十有八九是个贪污犯。第二,剧中House还提出来,停药以后,病人的思维清晰了。这是一条有用的线索,因为治疗精神病的药用在正常人身上,是会把人变傻的。第三,我也不是精神科的医生。

  但是,下面的情节就错得很离谱了。难道因为我是肿瘤科医生?

  病人患了胆囊癌,而且很大,超过了手术允许的范围。House为了救她,在肿瘤中注射酒精,使肿瘤缩小,然后骗过外科医生,做了手术。

  第一,肿瘤超过一定范围不能手术,这并不是外科医生见死不救,而是这个肿瘤已经失去了手术的价值。手术并不能使她治好,而只会增加她的痛苦。第二,一个肿瘤,即使很大,如果没有转移或者其他严重的侵犯,经过化疗或者放疗甚至介入,使肿瘤缩小,然后手术。这不是House的发明,而是医疗常规。剧中这个病人,完全应该按照医疗常规来进行,先进行全面的评估,然后制定治疗方案,方案可能会很复杂。而不是头一天做个穿刺注射酒精,第二天上手术台。第三,剧中的这种穿刺,会破坏肿瘤的包膜,释放癌细胞,引起腹腔、穿刺孔道的播散。临床上对于这种穿刺,都是非常谨慎。House哪是在救病人,这分明是在害病人。

  较真不代表我不喜欢这部剧。恰恰相反,我很喜欢这部剧。影视作品不是现实生活,认真起来没有完美的情节,没有bug的剧情是枯燥没人看的。以情节制胜的《越狱》,正是在情节上bug最多。以后我还会继续看House,继续较真。

回到专题页面请点此

本文由作者上传,文章内容仅供参考。如有相关事宜可联系jdh-hezuo@jd.com
反馈
*本站内容仅供医学知识科普使用,任何关于疾病、用药建议都不能替代执业医师当面诊断,请谨慎参阅
广告图片 关闭icon
0
0
0