This post is part of a series on the Anatomy of a Medical Drama.
The first thing to know about House, MD is that Dr. Gregory House is One Cranky Jerk.
The second thing to know about House, MD is that it isn’t a medical drama.
Oh, sure, it pretends to be. We get all the furniture of a medical drama: the dying patients, the worried family members, the gruff attending physician, the compassionate and sensitive younger doctors. We get death and we get life and we get medical miracles.
But that’s not the true genre of House.
House is a detective show. In fact, it’s a medical adaptation of the classic Sherlock Holmes.
Instead of a doctor, I want you to consider Greg House to be a detective. (Even the name House is supposed to get you to think of Holmes.) He’s arrogant, he’s rude, he’s problematic — and he’s brilliant.
Instead of a disease, I want you to consider whatever improbable virus, condition, or disease to be a criminal, a devious mastermind out to do harm. The symptoms, the actual disease process, are thus its crimes, and the patient is its victim. The loving family members are witnesses to the crime with valuable information for our detective, while the junior doctors, House’s intrepid fellows, are the junior detectives.
Lisa Cuddy, the hospital’s chief administrator, plays the role of obstructor and leader. She’s the less-than-brilliant chief who’s supposed to see things done the “right” way. She is the Lestrade to House’s Holmes; she’s there to get in his way.
And what would a Sherlock Holmes be without a Watson, or in this case, a Wilson? A best friend who enables and supports our main character not because he doesn’t see his flaws, but because he loves him in spite of them?
House, my friends, is a crime drama.
Thus we’ve discovered House, MD‘s Content Genre: Crime Drama (Medical), also known as a Diagnosis Drama.
The Reality Genre of the show is aimed to be Realistic, grounded in reality and the cutting-edge medicine of the day. The rules of the world are ostensibly the same as the one you and I live in: magic, elves, and science fiction take no part in this show. That said, the show’s connection to actual realistic medicine is tenuous at best, as we’ll discuss below.
What Makes House, MD Great?
There are a number of things that contributed to House, MD‘s success over its eight-year run.
First, the acting was great. Hugh Laurie brought depth and a tremendous amount of weight and poignancy to the character of Greg House. The supporting cast, including Lisa Edelstein (Cuddy), Robert Sean Leonard (Wilson), Jennifer Morrison (Cameron), Omar Epps (Foreman), and Jesse Spencer (Chase) made the first few seasons absolutely riveting, and adding in talent like Olivia Wilde (Hadley / “13”), Kal Penn (Kutner) and Peter Jacobson (Taub) in later seasons only improved things.
Second, House’s mindset is absolutely fascinating: Everybody Lies. (The question that makes things interesting is how they lie, to what degree they lie, and, most fascinating of all, why they lie; this is part of the fun of House, MD as a show.)
House has been criticized for being formulaic, and I can definitely agree that it is, and yet something in the formula that drove the show was incredibly compelling. House was always doing something absolutely crazy that we knew was wrong (because the episode was only half over), Cuddy and his staff were always trying to keep him on the sane and level path, and what’s even better, the show recognized it. It was acknowledged in multiple episodes, and even by House himself, that his colleagues were the reason House could stay sane and keep from killing his patients.
In fact, House and Wilson fall into (or at least adjacent to) the “Buddy Cop” trope, what Roger Ebert called a “Wunza” relationship: one of the pair is a calm, competent, mild-mannered oncologist, while the other is a dramatic, abrasive, neurotic, brilliant critical care doctor. It doesn’t contain all aspects of the traditional Buddy Cop relationship — we don’t see them hate each other in the beginning like we do with most buddy cops — but the relationship is there; we see it after it’s stabilized.
And that drama, that tension between the egomaniac with a syringe and a helpless patient and those who want the best for both of them, made House an incredibly tense show. That tension carried us through to the inevitable end — that House would solve the case, the patient would get better, and because the patient got better, all would be forgiven.
House also had consequences for the character’s actions that played out over multiple episodes. At the end of Season 1, House is shot because he was such a jerk — which resulted in his getting a certain kind of anesthesia (ketamine) which eliminated his pain and gave him the ability to walk and run pain-free again for a limited time at the start of Season 2.
House’s unorthodox treatments (such as prescribing cigarettes for Irritable Bowel Syndrome) landed him in hot water with Medicare, which threatened to pull his license. His constant abuse of drugs, a cornerstone of his character, landed him in rehab more than once, and addiction is a theme that plays its tune throughout the show.
All in all, House was a very good show with a lot of strong qualities.
Where Does House, MD Fail?
First, we need to get something out of the way: we get a lot of racism, sexism, homophobia, transphobia, etc. from House himself — he is, in a sense, the show’s social villain. He’s portrayed as a man so offensive that the only reason he keeps his job is because he’s too brilliant to fire for his childishness and gruff exterior.
That said, hearing some of the awful and offensive things he’s said come from a “medical professional” and the show’s protagonist is damaging and hurtful. There were ways the showrunners could have made House a jerk without resorting to insults based on someone’s identity.
(It’s also worth considering its place in time; the show ran from 2004-2012, an era in which minority voices were far less recognized in TV than they are even five years after the show’s end. )
The show fails the realism test on several fronts. In fact, speaking as an ICU paramedic, the medicine is often laughably inaccurate or hyperbolized. Things progress at a pace that suits dramatic storytelling, not reality; diseases layer that are astronomically unlikely; hell, House’s entire specialty — “Diagnostic Medicine” — doesn’t exist, because all doctors diagnose and all doctors treat.
But that’s not the big problem with the show. The biggest problem with the show are its ethics.
The number of unethical and outright illegal measures House takes to “get the job done” would have gotten any real doctor fired in their first year. They are, frankly, a scary thing to normalize in the minds of non-medical viewers.
Speaking of getting fired, fun fact: while medical staff who come to their employers and admit addiction to a substance are generally treated well — [estimates of substance abuse among nurses run from 10-20%] — they’re not allowed to practice stoned. Many employers will give time off for rehab, but staff must be compliant to practice.
Moreover, the repeated displays of unpunished bad behavior lends itself to a mindset that “the ends justify the means,” which is incredibly dangerous. A great many awful things have been “justified” in this manner.
Is It Good TV?
This is the most irritating part about House. Because with as many inaccuracies and flaws and mixed messages and damaging representations as the show has, as many bad stereotypes as it engaged with — it was still damn good TV, at least for the first 4 seasons. Characters changed, at least a little; the stakes were constantly escalating; House the Bully was often, let’s face it, hilarious in his cruelty.
House might have been bad in a great many senses, but it was damned compelling TV, and for all its faults, that fact is undeniable.
In short: House is great to watch, but don’t try to be a Greg House.
How Can We Write Like House?
If you wanted to produce a book, movie, or TV show along the lines of House, MD, my first suggestion would be to get very, very comfortable with the genre conventions and obligatory scenes of the crime drama, and consider how they can translate into medicine.
If we truly want to classify House, MD, we would likely call it a diagnosis drama to differentiate it from a crime drama, though really all that’s changed is the furniture.
Here are some of the Obligatory Scenes and Genre Conventions for a diagnosis drama, and the parallel scenes in a crime drama:
The Disease Strikes. (The Crime) Whether something has been building up for a while or comes to a head, we need to see a character felled by a disease or injury. This must occur early in the story/plotline and is essentially the Inciting Event.
The Doctor & The Team. (The Detective & Sidekick(s)) We must have a lead character, usually a doctor, trying to solve the medical puzzle, usually working with a team. The interpersonal dynamics of the team are crucial to establishing drama and hooking the audience.
Gather Symptoms and Information. (Interviewing Witnesses; Red Herrings.) The doctor must try to gain as much information as they can to solve the case. In House this often involves burglary for reasons not entirely clear.
Diagnose / Treat / Fail / Repeat. (Red Herrings & False Accusations) As the drama wears on, the patient gets worse, often by the hands of the doctor treating them. The team iterates over their work, trying new approaches that must get riskier and more dramatic as time goes on.
It Gets Personal. There must be some reason the doctor (and thus our audience) becomes closely entwined with the outcome of the case. Either the patient and doctor or team must form a personal bond, the doctor’s reputation must hang in the balance, or the rising tension between the team (who must think differently from the doctor) can only be resolved by solving the case and helping the patient.
The Final Diagnosis. (J’accuse!) The doctor must make a final diagnosis that will either save or kill the patient.
A Life Saved or a Life Lost. (The Justice Theme) Our story must end with either the patient’s life being saved or their life being lost. This may come with an ironic twist: the doctor may save the character at the expense of a relationship they value dearly.
If you’d be willing to take a piece of advice, though… check the misogyny, racism, homophobia, transphobia, etc. at the door. Take the best things from this show, not the worst.
For more reading on genre conventions and obligatory scenes, I recommend Shawn Coyne’s excellent guide to editing, [The Story Grid], and Blake Snyder’s [Save the Cat!], both of which are excellent books on storytelling from wildly different, and yet similar, perspectives.
What Medical Drama Should I Analyze Next?
Drop a comment or reblog and let me know!
xoxo, Aunt Scripty
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Anatomy of a Medical Drama: House, MD was originally published on ScriptMedicBlog.com
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I really just wanted the knights to apologise to Merlin.
I know that they weren't in their right mind when they said all those (stupid) things to him, but constantly telling Merlin that he's of no importance, that his opinion doesn't count, that he's just a servant... I think those comments above all hurt Merlin most, and usually his friends are there to defend him. This time, though, it was his friends attacking him. Of course, the knights would never really say those things to Merlin, but that's exactly why I wanted them to apologise. To let Merlin know that they don't believe those things. That he is much more than just an unimportant, do-as-your-told servant.
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