The patient had an extensive workup. The imaging, labs, and other studies were resoundingly negative and reassuring. The patient’s symptom of concern was a real experience yet, having no identifiable cause, it could not be treated with modern medicine. The negative workup and their medical stability indicated that the patient should return home because the hospital had nothing to offer them. Further, their life was thankfully not in danger from a medical problem. Of course, they needed to follow up with their long-term providers like their primary care physician and outpatient specialists.

We discharged the patient. The patient appealed the discharge. That gave them several extra days in the hospital. Days where we did nothing for them because there was nothing for us to do. Right before their appeal was denied and they left the hospital, the patient stated, “We’ve gone to so many hospitals about this issue. No one has found anything. We thought you would be like Dr. House from TV and figure out what is going on.”

Popular TV shows about medicine like Dr. House and Grey’s Anatomy are undoubtably enjoyable to watch. Yet, as riveting as they may be, they are fiction. They are neither scientifically accurate regarding disease states and medical treatments nor are they real representations of any role in medicine from doctor to nurse or patient to family member in the hospital.

Medicine is constantly changing and advancing. We do incredible things. We can put new livers, hearts, lungs, and kidneys in people thereby giving them years to live. Before we could transplant organs, people simply died when their heart or liver failed. We can restart people’s hearts, put them on breathing machines for short periods while their bodies fight severe illness, and use machines to do the work of kidneys (that’s what dialysis is). We have medications that can lower people’s risk of heart attack and stroke. And that’s just the tip of the iceberg in terms of what medicine can do. But as much as medicine can do, it has real limitations. And while we can answer many questions, we also leave many questions unanswered.

As a physician I love solving mysteries and helping people feel better. Several of the hardest things to learn when I started the Doctorhood Quest were that not all mysteries have answers, not all symptoms have a well-defined cause, and not every discomfort a person experiences can or should be treated with medications or interventions. My job as a physician is to investigate symptoms thoroughly for causes that I can treat, ensure people’s lives are not in danger from a medical condition that I can intervene on, and offer symptom relief if it’s available and if the benefit of treatment outweighs the risks of treatment.

Not every symptom has a clear-cut cause. A runny nose might be from a virus we can’t test for. It might be from allergies. Aches and pains might just be explained by normal life, or they might be a sign of something treatable or serious. Minor lab abnormalities might be nothing or might be the beginning of something – if the subsequent workup is negative, they’re likely nothing. The list goes on.

I think it would be cool to solve medical problems with the flair that Dr. House on TV does. He’s portrayed as brilliant – all of us in medicine aspire to be geniuses. But when I think of Dr. House, I recall that he is incredibly rude to patients. These days, patients don’t put up with that kind of treatment (and they shouldn’t either). When I think of Dr. House, I recall how many scenes show him misusing drugs right before work. In real life, that behavior would lead to him losing his medical license. When I think of Dr. House, I think of how poorly he treats fellow. Physicians who treat fellows like that get negative evaluations and are encouraged to change or not teach. Dr. House is a fictional character. Medicine, conversely, is incredibly real. As much as I wish real-life medicine could solve everything fiction can solve, we can’t. Sometimes, when the tests are negative and a patient’s condition is stable, it’s best for a patient to accept medicine can’t answer their question or cure their challenge. It’s incredibly dissatisfying. But, sometimes, medicine has nothing to offer, and no additional testing will change that.