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  A doctor/writer in the 'House'Internist uses experience to help create Emmy-winning showBy Katrina Woznicki  Dr. David Foster works with other writers in a story meeting. HEALTH LIBRARYRELATED
YOUR E-MAIL ALERTS(MedPage Today) -- After teetering on the brink for years, Dr. David Foster abandoned the grit and grime of Boston inner-city medicine for the full-time glitz of Hollywood. A 40-year-old Harvard-trained general internist and clinical instructor of medicine at Harvard Medical School, Foster is not treating Hollywood actors. He is putting words in their mouths -- words that resonate with authority and realism. Foster wangled a job as writer and medical consultant for the hit Fox network TV show "House" by impressing the show's producers with his Harvard Medical School education and his work in the trenches at Beth Israel Hospital and the Harvard School of Public Health. He relies on that experience when he is devising medical scenarios that meld drama and the Merck Manual of Medicine. Dr. House's messageIf Foster does his job well, the words and stories he creates convey an important public health message. "I'm able to influence public debate and public thinking through the stories we tell on "House," he said. "I'm able to have a voice in public health and public policy and the medical world." Foster said his new life is less different than it might seem -- both are about storytelling. As a doctor, his job was to listen to his patients' stories and to solve their individual mysteries -- what was ailing them and what brought them to his office. In television, he steps into Dr. Gregory House's shoes to tell the characters' stories. In the first year of "House," there were 22 medical mysteries to solve. This year there are 24. "In television, we're writing stories about people and people's lives and the decisions they make," Foster said. And the imperfect House -- a brilliant but troubled diagnostician -- is an ideal character through which to channel these stories. "He's certainly a character who's dramatically very, very rich," Foster said. Doctors can identify with House because "physicians often feel pulled in a hundred different ways." Foster cites a recent show titled "Detox." In this episode, House attempts to kick his addiction to the painkiller Vicodin. Foster, who ran a detox program in Boston, drew from his professional experience in treating addicts to help shape the story and frame a debate about addiction versus the appropriate use of pain medication. "It's a topic that's not clear-cut," Foster said. "That episode explored the issue very nicely." Old school tiesFoster was lured into entertainment by his old Harvard medical school crony, Dr. Neal Baer, who is executive producer of the NBC show "Law and Order: Special Victims Unit." Baer, who was involved in the entertainment industry before medical school, became a writer for "ER" in his final year of school. Foster's contacts with his friend led to an early job as a consultant for a pilot called "Outreach," on the WB Network. At about the same time, he also worked as an expert consultant for a Hallmark Hall of Fame made-for-TV-movie "Only Love." Since then, Foster has written for or served as a medical consultant for "Gideon's Crossing," "Law and Order: SVU," and the WB children's show "Ozzie and Drix." Since graduating from medical school in 1995, Foster kept one hand in Hollywood while treating patients in Boston with the other. "I've always had a foot in both worlds, but I was always a doctor who did some TV work on the side and now I'm a writer doing some doctoring on the side. The proportions have flipped." Foster began writing for "House" part time when the show debuted last year. At the time, he was working full time at a neighborhood community health center in Boston treating patients who struggled with addiction, homelessness, HIV, and hepatitis. He decided to reduce his hours in Boston so that he could commute to Los Angeles and juggle TV writing and medicine. His wife, a statistician and fellow Harvard graduate, kept the household running and cared for the couple's two boys. Making the breakWhat started out as a part-time job eventually blossomed into a full-time passion. With the support of his family, Foster decided to leave medicine for Hollywood and uproot his wife and sons from Boston to a rented house on the Pacific Ocean. Earlier this year, he took his last flight from Boston to Los Angeles, saying goodbye to the city he had called home for the past 20 years, the Red Sox and long winters. His wife and sons joined him in June after his oldest son finished the school year. Now they live in Manhattan Beach and his eldest wants to learn how to surf. Foster cruises along the beach for the 12-mile commute to Fox studios where his job is to help a team of about a dozen writers, many without medical backgrounds, create still another medical puzzle for House to solve. Just like in Boston, however, the workday is 14 hours long, but it's a very different kind of work. He originally took a pay cut to get into showbiz full-time but his income this year matches what he made in Boston. Foster misses seeing patients, but he's enjoying the break from the administrative pressures that wear down many physicians. "It's hard work in a different way, but it's just as hard work as being a physician." Foster's biggest hope is that the show will last for several more years. That appears more likely now after "House" won an Emmy for writing this month. In the meantime, Foster is pursuing a California medical license so that he can be a TV television writer who practices medicine part-time. He said he wants to return to inner-city medicine, so that like House, he can help diagnose patients with complicated illnesses. The show, Foster said, "rekindles what a lot of people got into medicine to do." Writing and medicine are both passions he enjoys and they fuel one another, he said. "I hope I will never have to choose exactly one or the other." 
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