There’s A Doctor Behind ‘House’: Internist Lisa Sanders

Yale internist Dr. Lisa Sanders makes no apologies for being a big fan of one not-always-realistic medical drama.

She regularly tunes in to the award-winning FOX television series "House, M.D.," which features Hugh Laurie as its title character, Dr. Gregory House.

In much of his behavior, the famously cranky House is the antithesis of a good doctor, says Sanders, who describes the fictional character as someone who is "in many respects, a loathsome human being." But she loves his talent for diagnosing illness, and the Sherlockian diagnostic sleuthing that takes place on the show makes "House, M.D." a "cool detective story," says Sanders.

Entertainment, however, isn't the only allure of the show for Sanders, assistant clinical professor of internal medicine and education. She is one of three technical advisers to the producers of "House, M.D.," which was inspired by a monthly column called "Diagnosis" that Sanders has written for The New York Times Magazine since 2002. In her column, she describes — on a case by case basis — the detective-like art of diagnosis that is, she notes, "at the heart of medicine."

Sanders has been a technical adviser for "House, M.D." since its start in 2004. She recently talked to the Yale Bulletin & Calendar about that role. Here is what we learned.

‘It's elementary' (the story, that is): When mulling over their ideas for a television drama, "House, M.D." co-creators David Shore and Paul Attanasio had a difference of opinion about the plot. Shore wanted to produce a series about Sherlock Holmes, while Attanasio hoped to create a show based on Sanders' "Diagnosis" columns.

They ended up with something in between, says Sanders, noting that the keenly intelligent but curmudgeonly, drug-abusing House shares many similarities with Sherlock Holmes, including having a sidekick (in House's case, a Dr. Wilson).

The producers asked Sanders to work with them and the show's writers to check the medical accuracy of cases portrayed. They also turn to Sanders for help in coming up with potential maladies to feature.

"I get e-mails from ‘House' writers that say, ‘I've got a 26-year-old cop who's undercover. What can happen to him?'" explains Sanders.

To help make her job easier, she collects stories — some that come from medical literature and her colleagues as well as ones inspired by her own practice — that have dramatic potential for "House."

"Coming up with wacky, wonderful diagnoses is my favorite part," says Sanders.

Stories, her first love: Sanders, who majored in English at the College of William and Mary, was an Emmy Award-winning broadcast journalist (for ABC's "Good Morning America" and later for CBS News) before she became a doctor. She was particularly drawn to stories about medicine, and eventually decided to pursue a career in the field.

After completing the two-year Post-Baccalaureate Premedical Program at Columbia University, she was accepted into the Yale School of Medicine, graduating in 1997 at the age of 41.

As a doctor, she has never lost her love for both language and for stories.

"I think a love of stories is universal," says Sanders. "It's what drove me into writing and journalism and medicine. Developing a story that makes sense is basically what medicine is all about. Diagnosing a patient is like solving a mystery: You pull all the little strands together in a way that makes sense."

In her new book, "Every Patient Tells a Story: Medical Mysteries and the Art of Diagnosis," Sanders shares patient stories to convey the clue-seeking that is required for a doctor to make a correct diagnosis.

"So often this crucial linchpin of medicine goes unnoticed and undescribed, yet it is often the most difficult and most important component of what physicians do," she writes in her book. "As pervasive as medicine has become in modern life, this process remains mostly hidden, often misunderstood and sometimes mistrusted. On television it's the contemporary version of Dr. McCoy's (‘Star Trek') magic diagnostic device (his tricorder) that sees all, tells all. But in real life, the story of making a diagnosis is the most complex and exciting story that doctors tell."

A process revealed: One of the positive attributes of "House, M.D." for Sanders is that, unlike most television medical dramas, it focuses on the diagnostic process.

"In most dramas, there's a one-liner like ‘You have leukemia,' and the rest of the show revolves around what happens next. In ‘House,' they are taking this moment and opening it up — showing how that diagnosis gets made. I love it because they are doing what I do as a doctor," explains Sanders, who works as an attending physician at Waterbury Hospital and trains medical residents in Yale's Primary Care Residency Program there.

She also appreciates the way "House, M.D." portrays the errors that can be made by doctors in diagnosing or treating their patients.

"They show doctors making mistakes all the time, and that is how medicine works," says Sanders. "There are any number of diseases that could go with a set of symptoms, and we usually pick the one that is the most common, the most likely. But it's not always the most likely thing." (On ‘House' patients never have the most likely ailment, she points out.)

Sanders believes that real doctors could learn something from the way doctors' misdiagnoses and mistakes are portrayed on "House."

"The show acknowledges to some extent that being wrong is part of getting it right," she explains. "If only real doctors would normalize their errors! Instead, we have a system in which making errors on the way to making the right diagnosis is a source of shame and embarrassment. Rightfully so, of course, in cases where you never get the right diagnosis and the patient suffers as a result."

The flawed doctor: For all she loves the show, Sanders says that she is shocked when someone tells her they wish they had a doctor like Gregory House.

"He's an arrogant doctor who doesn't like patients," she says. "He thinks all of his patients lie, and he rarely touches them. He's a jerk. He is the exact opposite of the kind of doctor I try to be. You want to trust your doctor, and House has a lot of issues with trust."

That viewers even like the character is a testament to the acting skills of Hugh Laurie, Sanders believes.

"He's a wonderful actor," she states. "I love the complexity that he brings to this character. I can't imagine another actor being able to play this role. The way Hugh plays him, people feel they can see beyond to his tender self."

Dramatic stretches: Occasionally, Sanders' colleagues tease her about the medical inaccuracies on "House, M.D."

"Sometimes [the show's producers] take my advice and sometimes they think it works better their way," says Sanders. "They remind me that this is a drama. I don't take it personally."

Nevertheless, as someone who loves the language of medicine and what the language conveys about a disease, she has, on a few occasions, been "impassioned" in her criticism of particular scripts.

"I recall one where this boy is depicted as having a rash in his mouth that they were calling ‘bacterial vaginosis,' says Sanders. "That's a total violation of language. You can't get that disease in your mouth. I wrote a long e-mail to the producer and he wrote back to say, ‘Yeah, but it's funnier my way.' It made me crazy. But, of course, he was right: His way was funnier."

A perfect fit: In addition to research interests in diagnostic decision-making and medical errors, Sanders also teaches about and studies obesity, particularly how access to food affects obesity. She is the author of the books "The Perfect Fit Diet: Combine What Science Knows About Weight Loss With What You Know About Yourself" and "The Perfect Fit Diet: How To Lose Weight, Keep It Off and Still Eat the Foods You Love."

She compares her career combining work as a physician, educator, writer and "House, M.D." adviser to a juggler trying to balance rows of plates on sticks.

"My life feels like that sometimes. Those moments when all of the plates are spinning perfectly are very transient. Still, I do have the world's best job. No question."

— By Susan Gonzalez