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CMAJ - December 15, 1998JAMC - le 15 décembre 1998

D'oh! An analysis of the medical care provided to the family of Homer J. Simpson

by Robert Patterson, MD; Charles Weijer, MD, PhD

CMAJ 1998;159:1480-1

Robert Patterson is a general surgeon from Leamington, Ont. Dr. Charles Weijer is Assistant Professor and Bioethicist at Dalhousie University, Halifax. Both spend way too much time watching cartoons.

A solicited editorial beginning on page 1476 discusses the issues raised in this article.

© 1998 Canadian Medical Association

These are hard times for physicians. Governments blame doctors for spiralling health care costs as they slash spending. Ethicists decry medical paternalism. Our patients — sorry, our clients — demand to be treated like consumers. And political correctness has changed the way we speak. It's enough to give your average doctor an identity crisis. Who are we? Who should we aspire to be?

Homer Simpson Working on the premise that life imitates art, we searched for and found a role model for physicians to follow in these difficult times. We found him in a long-running cartoon series, The Simpsons, and spent many hard hours in front of the television, collecting and collating data for analysis. We hope readers will give our conclusions the attention they deserve.

In the quiet town of Springfield,1 noted for its substandard nuclear power plant and eccentric citizenry, Drs. Julius Hibbert and Nick Riviera frequently come in contact with Springfield's everyman, Homer J. Simpson, and his family. Homer, who works at the power plant, is known for his love of donuts and Duff's beer.

Like the forces of good and evil battling for the soul of medicine itself, these 2 physicians are polar opposites. Julius Hibbert is an experienced family physician with a pleasant, easygoing manner, while Nick Riviera is an ill-trained upstart who is more interested in money than medicine. Knowing that appearances can be deceiving (and first impressions rarely correct), we explored this question: Which of these 2 physicians should Canada's future physicians emulate?

We briefly entertained Hibbert as a potential role model. He is a trusted family physician who provides care not only to Homer but also to his spouse Marge and their 3 children: Bart, Lisa and Maggie. He delivered all of the children and has weathered many a Simpson medical crisis, from Bart's broken leg to Lisa's primary depression.

Generally the quality of care he provides is solid, although there was an incident when he accidentally left the keys to his Porsche inside a patient. We decided to ignore this incident, since such a mishap can befall any physician.

Hibbert has diagnostic acumen of Oslerian proportions. He uses this regularly to identify a variety of baffling conditions, from Marge's alopecia areata to Homer's unique form of hydrocephalus.

"Don't worry, it's quite beneficial," he told Homer about the latter condition. "Your brain is cushioned by a layer of fluid one-eighth of an inch thicker than normal. It's almost as if you're wearing a football helmet inside your own head. Why, I could wallop you all day with this surgical 2-by-4, without ever knocking you down."2

Another positive trait is Hibbert's sense of humour, which he uses to put patients and their families at ease. When Homer was critically injured and rushed to hospital after opening a can of beer that spent some time in a paint mixer thanks to Bart, Hibbert's levity helped relieve an otherwise tense situation.

"Mrs. Simpson, I'm afraid your husband is dead," he said.

"Oh my god!" Marge responded.

"April Fools!"

Deeper analysis, however, reveals that Hibbert is no Semmelweiss. He treats the health care system like his personal cash cow by taking time to talk to his patients and distributing lollipops to children. No wonder the US system is so expensive. Worse yet, he stocks his office with patient education materials that either contain value judgements or are poorly written.

When Homer first courted his bride-to-be, Hibbert gave a pamphlet entitled So You've Ruined Your Life to a pregnant but unmarried Marge. Fair enough. But later on, when Homer was poisoned after eating an incorrectly prepared blowfish at a Japanese restaurant, Hibbert handed him another brochure, So You're Going to Die. By giving away the conclusion in the title, Hibbert ruined the surprise ending. What fun is that?

Another gross violation of ethics occurred when Bart stuck various objects to his skin with Crazy Glue. In a scene reminiscent of the Spanish Inquisition, Dr. Hibbert showed him the instruments of surgery, thereby frightening the poor youngster so badly that he began to sweat, causing the objects to fall off.

Obviously, informed consent and truth-telling mean little or nothing to this medical Machiavelli. Any ethicist worth her salt would flail him for such an act of unbridled paternalism. Perhaps worst of all, Hibbert shows about as much sensitivity to politically correct language as Howard Stern, as demonstrated by this conversation with Lisa.

"Yes, I remember Bart's birth well," he said. "You don't forget a thing like Siamese twins!"

"I believe they prefer to be called 'conjoined twins,' " Lisa replied.

"And hillbillies prefer to be called 'sons of the soil,' " Hibbert responded, "but it ain't gonna happen."

No, the true medical hero for whom we search is Julius Hibbert's foil, the enterprising Dr. Nick Riviera, an international medical graduate who attended the Club Med School. He practises with an enthusiasm that is matched only by his showmanship. Unfortunately, this has led to 160 complaints from Springfield's narrow-minded Malpractice Committee, but artists like Riviera are rarely understood in their time. Dr. Nick, as he is known, may be a tad weak on anatomy. "What the hell is that?" he asked after making the incision for Homer's coronary artery bypass. However, he does possess all the requisite traits for the doctor of tomorrow: he is resource conscious and he gives the customer what she wants.

Ever resourceful, Dr. Nick finds innovative new uses for underutilized medical materials, such as cadavers. By placing several of them in his vehicle, he can drive in the car-pool lane and get to work more quickly. This commendable behaviour is also environmentally conscious.

And he's no shill for the medical establishment. Knowing that physicians' fees are the real cause of the health care funding crisis, Dr. Nick produced a TV ad in which he offered to do any surgical procedure for just $129.95 (Can$193.95 at time of writing). Cost-effective and consumer conscious, Riviera would never let quality of care interfere with discount-rate fees.

His greatest asset, though, is his willingness — no, his mission — to satisfy every whim and fancy of his patients.

He is acutely aware that many patients actually want to be sick and, like Albert Schweitzer, he compassionately helps them. When Bart was run over by a car but appeared unhurt, his parents considered a lawsuit against the driver. Dr. Nick was very eager to assist them. "Your son is a very sick boy," he said. "Just look at these x-rays! You see that dark spot there? Whiplash. And this smudge here that looks like my fingerprint? That's trauma."

In another touching moment, Homer discovered that he would qualify for disabled benefits and be able to work at home if he weighed more than 300 pounds, and immediately sought a way to increase his weight. Dr. Nick was there in his time of need.

"You'll want to focus on the neglected food groups, such as the whipped group, the congealed group and the choc-o-tastic," he advised. "Be creative. Instead of making sandwiches with bread, use Pop-Tarts. Instead of chewing gum, chew bacon."

Being so burdened with his patients' wishes, Riviera often sacrifices his personal needs. Every now and then, however, he manages to think of his own well-being. "The coroner — I'm so sick of that guy," he told Homer as he prepared to perform cardiac surgery on him. "Now if something should go wrong, let's not get the law involved. One hand washes the other."

In these turbulent times, we need a hero to guide us into the next millennium. As a profession, we must shed the dark past embodied by Dr. Hibbert — a wasteful, paternalistic and politically incorrect physician. Instead, the physician of the future must cut corners to cut costs, accede to the patient's every whim and always strive to avoid the coroner. All hail Dr. Nick Riviera, the very model of a 21st-century healer.

"See you at the operating place!"

  1. It is unclear where Springfield is located. According to Webster's Ninth New Collegiate Dictionary, it could be in Illinois, Massachusetts, Ohio, Missouri or Oregon.

  2. All quotations taken from our TV screens were checked against those from Richmond R (ed). The Simpsons: a complete guide to our favorite family. New York: HarperCollins Publishers; 1997.

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