AMA Journal of Ethics^®

A response to In search of obscure diagnoses: House.

I enjoyed reading the articles about medical shows on television in the March 2007 issue of Virtual Mentor. I am a pre-medical student at the University of Michigan and have watched some of these shows, with House being my favorite.

I was especially interested in the article discussing the obscure conditions portrayed in House, which the author appropriately calls "a show about zebras" [1]. The article focuses on the clinical aspects of a few rare diseases diagnosed by Dr. Gregory House, the show's brilliant medical detective. I was surprised that the article, which appears in a journal about medical ethics, gave no more than a fleeting reference to the astonishingly unethical behavior that this doctor displays in each episode of the show. House's unique diagnostic approach includes avoiding his patients, treating before testing, manipulating families, playing video games in his office, watching General Hospital in comatose patients' rooms while hiding from his boss, and—my personal favorite—having his fellows break into patients' homes to look for diagnostic clues.

One of the diseases discussed in the article is primary amoebic meningoencephalitis, which is caused by the waterborne amoeba Naegleria fowleri [1]. This disease affects a patient portrayed in the two-part episode "Euphoria"—named for the first symptom experienced by the patient in the episode. The illness occurs in a crooked, "euphoric" police officer who is shot and left with bullet fragments in his head, but presents with other symptoms. Dr. House—the Jack Bauer of medicine—sends his fellow, Dr. Foreman, to break into the police officer's home to check for bacteria, toxins, etc. While there, Foreman comes across a greenhouse where the officer was growing marijuana with stolen water and fertilizer. Foreman later contracts the same condition.

As the officer's condition worsens, House wants to see if he can do an MRI on a patient with bullet fragments in his head. So he buys a gun and bullets of the same type as those in the officer's head, goes to the morgue, shoots a corpse in the head, and throws it into the MRI machine. The machine breaks and the body is a mess. To treat the officer's latest symptom—unbearable pain—House puts him in a coma to control the pain and stop his screaming, but soon thereafter, the patient dies.

Desperate to save Foreman, House deliberately infects him with Legionella bacteria, because the police officer had legionellosis, which slowed the original infection for some reason. Later House heads back to the officer's flat, where he discovers the stolen drainage water used by the officer for his marijuana, riddled with Naegleria. After House cures Foreman of his amoebic infection, he delivers his moral message: "Don't cut corners when growing your pot."

Obviously it is House's ridiculous methods and countless acts of malpractice that make the show amusing. As a medical student's essay explained, "To build and maintain storyline intrigue, medical dramas almost always develop a tangled web of personal romances and professional rivalries that frequently violate the ethical and professional codes by which the overwhelming majority of physicians operate" [2]. But I worry that this show and other medical programs on television give the audience a warped view of medicine, because, as noted in another essay in Virtual Mentor, "society's image of medicine is probably most defined by medical dramas" [3].

To discuss the lack of ethics in House would be like discussing the lack of realism in Star Wars; it would span 100 pages or more. House's misbehavior would, in real life, lead to newspaper headlines, multimillion-dollar lawsuits and severe (and probably career-ending) disciplinary action against him, but that misbehavior is most likely the key reason for the show's popularity. People enjoy powerful figures in movies and TV shows and watching House allows viewers to vicariously feel his power as a physician—power that is immeasurably amplified by reckless and repeated violations of the mores of medicine.