The Left Atrium

Media The doctor in this House: lessons from TV’s Gregory House, M.D.

obody likes Greg House, the title character of Fox’s ex- N traordinarily successful television show House, M.D. Played by British actor Hugh Laurie, the Vicodin- popping House insults his colleagues, demeans the medical fellows who work for him, disregards hospital pol- icy, ignores patient wishes and dis- misses as irrelevant both basic rules of medical ethics and the law. And yet, House is respected by colleagues, admired by underlings and trusted by the patients who appear on his service. Every Tuesday night, mil- lions of TV viewers watch as House struggles with a case whose sympto- mology appears to defy rational expla- nation and the best tests modern medicine can provide. “Is there a doctor in this House?” huffs one medical reviewer.1 Why love

the character whose medicine we would Global Television in reality reject? Television is the fMRI Greg House’s single most attractive characteristic is that while eager to be right he is of culture studies, the diagnostic by usually wrong, at least until the final minutes of an episode. which we see beneath the platitudinous assumptions of social and professional promise to the pulsing realities be- knowledge and logic, but an acuity that tient’s lifestyle and life choices. neath. Therein lies the show’s appeal. perceives symptoms others ignore. House, on the other hand, does not Greg House’s single most attractive This is the doctor as detective and the judge. But then, Gregory House is nei- characteristic is that while eager to be disease as a criminal, ultimately un- ther a paragon nor an exemplar. Nor right he is usually wrong, at least until masked and humbled. does he care about the patient. His sole the final minutes of an episode. The se- Implicitly, the show insists on med- focus is the unnamed disease that at- cret of House’s success lies in his re- ical knowledge as partial and uncer- tacks the man, woman, adolescent or peated acceptance of diagnostic fail- tain, the ability to categorize problem- child whose condition catches his at- ures and his unrelenting search for a atic conditions correctly as a struggle tention. The goal is not to address the better understanding of the disease it- worthy of rigorous effort. Richard patient but to find out what is wrong self. Like Sherlock Holmes, House Chamberlain’s Doctor Kildare, which and hopefully fix it. And even if he (whose house number is 221B, a bow to ran from 1961 to 1966, would not have can’t, at least the patient will know the the master’s Baker Street residence) fo- lasted an episode on House’s team. Dr. nature of his or her demise. House is cuses not on personalities but on the Kildare never worried about being aghast, in one episode, when a patient core problem. Like Holmes, House’s wrong. He knew the answer, and like says she does not care what the disease

DOI:10.1503/cmaj.071557 stock in trade is not simply superior House’s fellows, typically blamed a pa- attacking her might be; that she is

about to die is knowledge enough. Not Tom Koch PhD knowing, not caring to know, are Adjunct Professor of Medical FURTHER READING Geography 1. Holtz A. The medical science of House. New York: deaths to House, his secret fear. Penguin (Berkeley Publishing Group); 2006. Marcus Welby, MD, the kindly fam- Vancouver, BC 2. Challen P. The House that Hugh Laurie built. ily practitioner who treated prime-time Toronto: ECW Press; 2007. patients from September 1969 through REFERENCE a final episode in July 1976, rarely faced Tom Koch (http://kochworks.com) is a 1. Neely K. Atrium: The Report of the Northwestern medical uncertainty. His medicine Medical Humanities and Bioethics Program. Issue consultant in gerontology and medical promised care and kindness within a 3. Is there a doctor in Greg House? Chicago: The ethics at the Copeman Healthcare Centre in science that always knew the problem Program; 2006. p. 19-20. Available: http://bioethics .northwestern.edu/atrium/atriumissue3.pdf (ac- Vancouver, BC, and author of 14 books, most and how to fix it. So, too, did the doc- cessed 2007 Oct 23). recently Cartographies of Disease (2005). tors of St. Elsewhere (1982–1988) and Chicago Hope (1994–2000) for whom medicine’s real challenges, as it is on Michael Crichton’s ER, were economic and hospital bureaucracies within which the fictional doctors practised. House is the diagnostician for to- Poem day, a time when emerging infectious diseases are again ascendant and it has become clear to all that our The Script knowledge is often inadequate to eas- I watch you watch me, But it is part of the performance. ily identifying their nature or revers- As I open the door slowly, After all, there have been happy ing their effects. Medicine is again a Carefully, monologues partial science and House M.D. pres- As if drawing open the curtain Soliloquies of joy ents it at the frontier where diagnosis On the first act Wherein you sat and beamed is a rigorous art, a balance between Of this new chapter of your life. Proud of your accomplishments ignorance and knowledge. Your eyes drift from my face And the script was punctuated Working under House in his first 3 To the bright red file I hold By the footnotes of your life: seasons were attending physicians in Clutched tightly in my hand. Babies, milestones, triumph over pain, neurology (Dr. Eric Foreman), intensive Almost bursting at the seams, Personal goals realized. care medicine (Dr. Robert Chase) and The script, as it were… immunology (Dr. Allison Cameron). A running commentary on your life. I close the door behind me They tolerated his sarcastic bullying be- The office clock beats loudly in the cause, all said, he would make them It is a script you help write silence better doctors. He did this by insisting But never actually read. Like a drum roll preceding my they think beyond their sense of the All you see is the cardboard cover… opening words patient-as-person, and beyond the stan- The contents are for my eyes only. Should I set the stage dardized tests and easy answers, to the Yet I read the words out to you Or jump to the climax? nature of the disease itself. At each and every visit. You shift uncomfortably in your chair This is another reason for the show’s This is not the performance you success: Gregory House knows he can’t But today is different bargained for… do it alone. Holmes needed his Watson; Something unexpected in the plot… House needs his underlings and their A twist, a turn, But the script is by no means finalized easy answers if he is to find the hard Which occurred silently There is always room for revisions truths. When they are unavailable he’ll Deep within you. Your epilogue is yet to be written. take anyone available — in the first issue You provided the material We shall complete it together of the fourth season it is a janitor — as a But it was an inspiration no one And hope for better inspirations backboard for his thinking. Those who wanted… And more positive turns of plot. think House’s method is Socratic, misun- Sometimes the script As we navigate the story of your life. derstand his method. He does not teach Takes on a life of its own. what he knows but uses others to push past the easy and convenient answers to I, myself, do not want to play this part… Pari Basharat the real truths that lie beyond. House is This is a monologue I don’t want to Medical student the doctor of uncertainty, his diagnostics read London, Ont. an old medicine rethought and repack-

aged for a new age of advancing disease. DOI:10.1503/cmaj.071318

68 CMAJ • January 1, 2008 • 178(1)