Why do people find medical TV shows so fascinating? I know I do, having become addicted to ER at the age of 14 (may God have mercy on the dearly departed). As a medical student, I must be honest and say there were moments when I wondered if putting “DN002: Medicine” at the top of my CAO form was over-influenced by the antics of the staff and patients of County General Hospital. It was definitely a factor in my decision.

I didn’t like Scrubs so much when it first came out, but I started watching it again when I was in Pre-Med. Now I love it. I also watch House whenever I can, and I guiltily enjoy Grey’s Anatomy. I’ve even been known to watch Private Practice and The Clinic on occasion.

Most medical students watch medical dramas. We all know they aren’t especially realistic – even if we hadn’t always known, the scales fell from our eyes on the first day of clinical rotations. Unlike House, no single real doctor is capable of performing genetic analyses, looking at samples under microscopes, delivering babies, and operating on every part of the body while simultaneously diagnosing every disease known to man. Real emergency departments aren’t always as exciting as they are on ER, and real-life janitors are much scarier than they are in Scrubs. All the same, most of these shows – yes, even Scrubs – do portray a decent approximation of a hospital environment, and contain a few medical facts.

Is Patrick Dempsey – ‘Dr McDreamy’ – the reason why medical TV is so appealing?

It should be added, for the sake of assuring those who might need medical attention at some point in the future, that medical students don’t rely on these shows as revision for exams, and certainly don’t advocate taking them as gospel. After all, Dr Neela Rasgotra described the kidney’s blood vessels backwards once, and Dr House got his bacteria confused in one episode, mixing up Clostridium perfringens and Pseudomonas aeruginosa. It can happen to the best of us.

Like all TV shows, medical dramas are meant to be escapist. Viewers – including med students – watch them for their entertainment value and not necessarily for their dubious educational content. However, med students feel like we should understand what’s going on, as our friends and family keep asking “what’s wrong with him?”, “why did she just collapse?”, “what does ABG mean?”, and so on ad infinitum. (People also expect us to know Latin, for some reason.) As the years go by, we gradually do come to recognise the acronyms and obscure diseases – in many ways, our comprehension of medical dramas acts as a barometer of our progress through medical school.

In fact, some med students are eventually turned off by these programmes, precisely because they understand them too well – when you understand everything that’s going on, some of the thrill factor is lost. After you’ve seen a real surgery, televised blood and guts aren’t quite as awe-inspiring as they were before.

Escapism explains why everyone loves ER (it’s exciting) and Scrubs (it’s hilarious). But what about House? This programme features extremely detailed conversations about pathological processes, genetics and molecular biology. It’s all well and good for me to enjoy it – I’ve been studying the stuff for four years. I understand… well, most of it. While I don’t want to seem patronising, I’m intrigued that “lay viewers” enjoy it too – what is it that people find so fascinating about this show?

There are, of course, many TV shows with science-based plots; I know that audiences aren’t stupid. The CSI series have a huge following and have opened peoples’ eyes to what forensic investigators can achieve, even if these programmes do exaggerate radically. All the other medical dramas I’ve talked about deal with complicated diseases and moral issues. However, unlike Grey’s Anatomy or CSI, House doesn’t simplify things very much. Perhaps non-medical viewers approach House from a different angle.

I’m sure much of the show’s appeal lies in its protagonist’s comedy value. The character of Dr House is undeniably excellent – Hugh Laurie’s character is abrasive, unpleasant and often completely unethical. House does everything that med students are taught not to do with patients. Real doctors have even written articles complaining about what a bad example he’s setting.

The other unique thing about House is the mystery-solving nature of the show. More than any other doctor on TV, House is a detective. People love detective stories – especially when the detective is a maverick, loose cannon employing unconventional methods, but who always gets his man. House is the medical Dirty Harry. We don’t need to understand the science behind House’s thought process any more than we need to understand the inner workings of a .44 Magnum – it doesn’t interfere with our appreciation of a good adventure.

In fact, detective stories have now come full circle. Joseph Bell, a 19th century Scottish surgeon, was famous for his powers of deduction. He could glean all manner of information about a person after briefly observing their appearance and mannerisms. He later became the model for a great detective who pioneered “scientific” techniques of investigation: Sherlock Holmes.

Perhaps it’s the human angle of everyday medical life that the world finds so appealing, or perhaps it’s the eye candy of George Clooney or Patrick Dempsey. Either way, it seems the enduring allure of medical TV is unlikely to flatline anytime soon.

Caster Semenya’s success in the women’s 800 metres world championships was thrown into controversy immediately after her victory last month, as observers suspected the 18-year-old South African of being a man.
An Australian newspaper recently leaked the preliminary results of her gender verification tests, apparently stating that she has internal testes, and no womb or ovaries. A number of South African public officials – who really should know better – have since made increasingly provocative comments in the media, as have Semenya’s relatives.
Sports journalists have been providing most of the coverage of this extremely complex topic, but have not always been entirely accurate. We will not know the definitive results of the tests – or whether Semenya will be allowed to keep her medal – until the International Association of Athletics Federations convenes in November.

Semenya’s athletic future remains in doubt, while her own sense identity will have suffered no end

To begin, it is important to point out that “sex” and “gender” are not synonymous. “Gender” is essentially a social concept, dealing with whether a person defines themselves as masculine or feminine. “Sex” is biological – as a rule, if an individual has two X chromosomes, she is biologically female; if an X and a Y chromosome, he is male.
This distinction may be considered pedantic, but the sex/gender concept is important, particularly in the context of this debate. If the leaked report is true, Caster Semenya could be a person of the male sex. Her gender is still largely up to her – having lived as a woman her whole life, she can choose to remain a woman, whatever the medical report says.
Many commentators have begun referring to Semenya as a hermaphrodite – this is not the correct term. True human hermaphrodites are exceptionally rare, and have both testes and ovaries. More common are pseudohermaphrodites – people who have the outward appearance of one sex, but the internal organs or genetic makeup of another.
What gives rise to such individuals? In human development, the “default body type” is female – left to its own devices, every embryo will develop ovaries, a womb and a vagina. If the embryo is genetically male, then the Y chromosome allows the production of several substances, including testosterone, which suppress the development of female organs and cause the embryo to develop testes and a penis.
Rarely, problems can arise during this intricate process. One example of such a problem is Androgen Insensitivity Syndrome (androgens are male hormones such as testosterone), occurring in one out of every 20,000 births.
These people are genetically XY and hence produce testosterone, but their bodies can’t respond to it. Thus, during development they follow the “default” pathway and develop a vagina. However, the development of internal sexual organs – either testes or ovaries – is controlled by more than just testosterone; people with AIS still produce other male hormones, and these successfully suppress the womb and ovaries and induce the formation of testes, which remain concealed in the abdomen.
Thus, these individuals look like women, but internally (and genetically) they are male. Interestingly, most experts recommend that they be considered female for the purpose of athletics competitions.
This is just one of a number of complicated conditions which can blur the distinctions between male and female. Many of Semenya’s relatives have asserted that, since they changed her nappies when she was a baby, they can swear that she is female. While they are undoubtedly sincere and well meaning, sex validation is unfortunately more complex than that.
Controversies of this nature first arose in the 1960s, when Soviet-bloc countries entered athletes who were biologically male, into female competitions. In those days, screening tests simply consisted of a chromosome scan – is this athlete XX or XY? Nowadays, a wide variety of tests and analyses can be conducted.
The International Association of Athletics Federations (IAAF) does not require complicated screening tests or compulsory gender validation – in fact, its medical manual simply advises a “visual examination […] during the delivery of a urine specimen in the women’s doping control station.” Obviously, more sophisticated tests can be requested if questions arise during a competition.
South Africans are understandably furious that their national heroine might be stripped of her medal – but their comments have been far from helpful. The minister for sport went so far as to threaten a third world war over the issue. (Clearly South Africa’s constitution confers all manner of powers on the minister for sport; imagine if Martin Cullen could declare war on Ireland’s behalf.)
Meanwhile, the Youth League of the country’s ruling African National Congress party stated that they “will never accept the categorisation of Caster Semenya as a hermaphrodite, because in South Africa and the entire world of sanity, such does not exist.”
While I don’t want to paint a picture of South Africa as a backward, narrow-minded nation, this inflammatory rhetoric is incredibly insensitive. Caster Semenya needs and deserves her nation’s support, but this has been delivered in a manner that could end up causing her a lot of pain.
Semenya herself has maintained a dignified silence during the whole affair, saying “I see it all as a joke, it doesn’t upset me.” A South African fashion magazine gave her a makeover and put her on its cover – a much nicer gesture than anything done for her by government officials.
Ethically, Semenya’s case is extremely tricky – there is no reason to suggest that she is guilty of deliberate wrongdoing. All she ever wanted to do was to run, but now her most intimate personal details have become fodder for gossip and speculation. Given the poor levels of awareness and understanding in South Africa of conditions like AIS – let’s face it, most of the world’s population is poorly informed when it comes to these conditions – it seems likely that she never suspected she was anything but female. Now she is at risk of stigma and humiliation.
Let her keep the medal, and leave her alone.

Recent years have seen a points’ race among students applying for places in one of Ireland’s five medical schools. Like other aptitude tests, the HPAT is said to test skills and attributes that are underrepresented in curriculum-based exams like the Leaving Cert, which has been accused of over-reliance on rote learning. Entry to medicine – previously requiring at least 575 points – is now based on a combination of Leaving Cert points, essentially capped at 560, and a HPAT with a maximum score of 300.

Be that as it may, this new approach raises many important issues. Disappointment is built into the CAO process – there will always be more students applying than there are places available, particularly for courses like medicine. In an ideal world, exactly 400 Leaving Cert students each year would possess the right ‘aptitude’ for medicine, and a method would exist to identify such students and extract them from the crowd. In reality there are more than 400 such students, but only 400 places – and our selection methods are imperfect.

Much of the public’s ire has focused on the gender balance of the current Foundation Year, as its female-to-male ratio – traditionally a pleasant 60:40 – falls to an unimaginative 50:50. Some commentators have suggested that this is a deliberate design implement of the HPAT, either to neutralise women’s supposed advantage in the Leaving Cert, or to rebalance the medical profession in favour of men – perhaps as a way of reducing the number of doctors taking maternity leave.

The country’s deans of medicine – including UCD’s Prof. Bill Powderly – refuted these suggestions in a letter to The Irish Times in August.

“Any suggestion that men are incapable of competing with women without having their grades artificially inflated by the HPAT is rather insulting”

Whether a 50:50 gender balance is desirable in medicine is an entirely separate argument. Folk wisdom has always stated that the reason the majority of consultant doctors are men is that women take time off to raise families. Ideally the whole system would be made more family friendly, with male doctors being offered paternity leave. Any suggestion that men are incapable of competing with women without having their grades artificially inflated by the HPAT is rather insulting.

Quite apart from accusations of social engineering, many continue to question whether the HPAT is necessary at all. Proponents of the HPAT claim it measures qualities not tested by the Leaving Cert, such as empathy and spatial reasoning.

Classically, surgeons have been described as lacking in any ability to relate to their patients, but this is not always the case in real life. In any case, interpersonal skills grow and change during a six-year degree. As for “spatial reasoning”, it might be considered necessary in a surgeon, but students with poor spatial reasoning can simply chose to go into a non-surgical specialty after graduating.

The points race for medicine benefits nobody, and the adoption of the HPAT was recommended by experts, who presumably knew what they were talking about. Whatever the ramifications of the selection method, the class of 2015 will undoubtedly make a great contribution to the medical profession, and we should take this opportunity to welcome them to UCD.