Richard Fogoros, M.D.  

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Why Does America Love Dr. House?

Apr 19, 2009 - 55 comments





medical ethics


dr house


doctor house

DrRich thanks the Cockroach Catcher (http://cockroachcatcher.blogspot.com/2009/03/house-md-95-vs-5.html) (his favorite retired child psychologist) for pointing him to an article (by Mark Wicclair, a bioethicist) and an accompanying editorial (by Deborah Kirklin, a primary care physician) in the peer-reviewed medical journal, Medical Humanities, which deconstruct the television show “House MD.”

A TV show may at first glance seem a strange subject for a medical journal, but this is, after all, a journal whose subject is the “softer” side of medical science. (DrRich hopes his friend the Cockroach Catcher will take no offense at this characterization, and directs him, in the way of an apology, to the recent swipes DrRich has taken at his own cardiology colleagues for their recent sorry efforts at “hard” medical science.)  Besides, the Medical Humanities authors use the premise and the popularity of “House MD” to ask important questions about medical ethics, and the consequent expectations of our society.

DrRich does not watch many television shows, and in particular and out of general principles he avoids medical shows. But he has seen commercials for House, and has heard plenty about it from friends, so he has the gist of it. The editorial by Dr. Kirklin summarizes:

    “[House] is arrogant, rude and considers all patients lying idiots. He will do anything, illegal or otherwise, to ensure that his patients—passive objects of his expert attentions—get the investigations and treatments he knows they need. As Wicclair argues, House disregards his patients’ autonomy whenever he deems it necessary.”

Given such a premise, the great popularity of “House MD” raises an obvious question.  Dr. Kirklin:

    “… why, given the apparently widely-shared patient expectation that their wishes be respected, do audiences around the world seem so enamoured of House?”

Indeed. While it has not always been the case, maintaining the autonomy of the individual patient has become the primary principle of medical ethics. And medical paternalism, whereby the physician knows best and should rightly make the important medical decisions for his or her patient, is a thing of the past.

It has been formally agreed, all over the world, that patients have a nearly absolute right to determine their own medical destiny. In particular, unless the patient is incapacitated, the doctor must (after taking every step necessary to inform the patient of all the available options, and the potential risks and benefits of each one) defer to the final decision of the patient - even if the doctor strongly disagrees with that decision. Hence, the kind of behavior which is the modus operandi of Dr. House should be universally castigated.

So, the question is: Given that House extravagantly violates his patients’ autonomy whenever he finds an opportunity to do so, joyfully proclaiming his great contempt for their individual rights, then why is his story so popular? And what does that popularity say about us?

To DrRich, the answer seems quite apparent.

The notion that the patient’s autonomy is and ought to be the predominant principle of medical ethics, of course, is entirely consistent with the Enlightenment ideal of individual rights. This ideal first developed in Europe nearly 500 years ago, but had trouble taking root there, and really only flowered when Europeans first came to America and had the opportunity to put it to work in an isolated location, where rigid social structures were not already in place. The development of this ideal culminated with America’s Declaration of Independence, in which our founders declared individual autonomy (life, liberty and the pursuit of happiness) to be an “inalienable” right granted by the Creator, and thus predating and taking precedence over any government created by mankind. And since that time the primacy of the individual in American culture has, more or less, remained our chief operating principle. Individual autonomy - or to put it in more familiar terms, individual freedom - is the foundational principle of our culture, and it is one that is perpetually worth fighting and dying to defend.

So the idea that the autonomy of the individual ought rightly to predominate when it comes to making medical decisions is simply a natural extension of the prime American ideal. Of course, most think, this ought to be the governing principle of medical ethics.

But unfortunately, it’s not that easy. There’s another principle of medical ethics that has an even longer history than that of autonomy - the principle of beneficence. Beneficence dictates that the physician must always act to maximize the benefit - and minimize the harm - to the patient. Beneficence recognizes that the physician is the holder of great and special knowledge that is not easily duplicated, and therefore has a special obligation to use that knowledge - always and without exception - to do what he knows is best for the patient. Dr. House is a proponent of the principle of beneficence (though he is caustic and abrasive about expressing it).  DrRich believes House is popular at least partly because the benefits that can accrue to a patient through the principle of beneficence - that is, through medical paternalism - are plain for all to see.

Obviously the principles of beneficence and of individual autonomy will sometimes be in conflict.  When two worthwhile and legitimate ethical principles are found to be in conflict, that is called an ethical dilemma. Ethical dilemmas are often resolved either by consensus or by force. In our case, this dilemma has been resolved (for now) by consensus. The world community has deemed individual autonomy to predominate over beneficence in making medical decisions.

DrRich’s point here is that Dr. House (the champion of beneficence) is not absolutely wrong. Indeed, he espouses a time-honored precept of medical ethics, which until quite recently was THE precept of medical ethics. There is much to be said for beneficence. Making the “right” medical decision often requires having deep and sophisticated knowledge about the options, knowledge which is often beyond the reach of many patients. And even sophisticated patients who are well and truly medically literate will often become lost when they are ill, distraught and afraid, and their capacity to make difficult decisions is diminished. Perhaps, some (like House) would say that their autonomy ought not be their chief concern at such times. Indeed, one could argue that in a perfect world, where the doctor indeed has nearly perfect knowledge and a nearly perfect appreciation of what is best for the patient, beneficence should take precedence over autonomy.

It is instructive to consider how and why autonomy came to be declared, by universal consensus, the predominant principle of medical ethics. It happened after World War II, as a direct result of the Nuremberg Tribunal. During that Tribunal the trials against Nazi doctors revealed heinous behavior - generally involving medical “research” on Jewish prisoners - that exceeded all bounds of civilized activity. It became evident that under some circumstances (circumstances which under the Nazis were extreme but which were by no means unique in human history) individual patients could not rely on the beneficence of society, or the beneficence of the government, or the beneficence of their own doctors to protect them from abuse at the hands of authority. Thusly was the ethical precept which asks patients ultimately to rely on the beneficence of others starkly revealed to be wholly inadequate. The precept of individual autonomy, therefore, won by default.

Subsequently, the Nuremberg Code formally declared individual autonomy to be the predominant precept in medical ethics, and beneficence, while also important, to be of secondary concern. Where a conflict occurs, the patient’s autonomy is to win out. It is important to note that this declaration was not a positive statement about how honoring the autonomy of the individual represents the peak of human ethical behavior, but rather, it was a negative statement. Under duress, the Nuremberg Code admitted, societies (and their agents) often behave very badly, and ultimately only the individual himself can be relied upon to at least attempt to protect his or her own best interests.

DrRich will take this one step further. When our founders made individual autonomy the organizing principle of a new nation, they were also making a negative statement. From their observation of human history (and anyone who doubts that our founders were intimately familiar with the great breadth of human history should re-read the Federalist Papers), they found that individuals could not rely on any earthly authority to protect them, their life and limb, or their individual prerogatives. Mankind had tried every variety of authority - kings, clergy, heroes and philosophers - and individuals were eventually trampled under by them all. For this reason our founders declared individual liberty to be the bedrock of our new culture - because everything else had been tried, and had failed. In the spirit of the enlightenment they agreed to try something new.

There is an inherent problem with relying on individual autonomy as the chief ethical principle of medicine, namely, autonomous patients not infrequently make very bad decisions for themselves, and then have to pay the consequences. The same occurs when we rely on individual autonomy as the chief operating principle of our civil life. The capacity of individuals to fend for themselves - to succeed in a competitive culture - is not equal, and so the outcomes are decidedly unequal. Autonomous individuals often fail - either because of inherent personal limitations, bad decisions, or bad luck.

So whether we’re talking about medicine or society at large, despite our foundational principles we will always have the tendency to return to a posture of dependence - of relying on the beneficence of some authority, in the hope of achieving more overall security or fairness - at the sacrifice of our individual autonomy. In DrRich’s estimation the popularity of “House MD” is entirely consistent with this tendency. (Indeed, the writers almost have to make Dr. House as unattractive a person as he is, just to temper our enthusiasm for an authority figure who always knows what is best for us and acts on that knowledge, come hell or high water.)

Those of us who defend the principle of individual autonomy - and the economic system of capitalism that flows from it - all too often forget where it came from, and DrRich believes this is why it can be so difficult to defend it. We - and our founders - did not adopt it as the peak of all human thought, but for the very practical reason that ceding ultimate authority to any other entity, sooner or later, guarantees tyranny. This was true in 1776, and after observing the numerous experiments in socialism we have seen around the world over the past century, is even more true today.

Individual autonomy will always be a very imperfect organizing principle, both for healthcare and for society at large. Making it an acceptable principle takes perpetual hard work, to find ways of smoothing out the stark inequities, without ceding too much corrupting power to some central authority. This is the great American experiment.

Those of us who have the privilege of being Americans today, of all days, find ourselves greatly challenged. But earlier generations of Americans faced challenges that were every bit as difficult. If we continually remind ourselves what’s at stake, and that while our system is not perfect or even perfectable, it remains far better than any other system that has ever been tried, and that we can continue to improve on it without ceding our destiny - medical or civil - to a corruptible central authority, then perhaps we can keep that great American experiment going, and eventually hand it off intact to yet another generation, to face yet another generation’s challenges.

*This blog post was originally published at the Covert Rationing Blog. (http://covertrationingblog.com/)*

Post a Comment
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by Quixotic1, Apr 19, 2009
Personally, I think people just like curmudgeons.

Quix, MD

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by missy142, Apr 19, 2009
House is hot thats why:)

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by jimi1822, Apr 19, 2009
Love Dr House Big Time =0)

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by Lulu54, Apr 19, 2009
Q - as always, you rock girl !!

DrRich, this was entirely too deep of an analysis for a show that is based on fun characters and strange medical twists and diseases.  Watch an episode and then you'll get the appeal.  

Avatar universal
by Salamander2, Apr 19, 2009
On the show, House's coworkers are exposed to the majority of his inappropriate behavior.  The patients see only slightly less of it.  As entertainment it's fine.  If he were a real physician,  I would run (not walk) the other way!   He is a actually a sad character.

Avatar universal
by VaBreeze, Apr 19, 2009
I'm sure House would be flaunting his ego at the thought that everyone is dependent upon him making the correct decision for them (as he pops another Vicodin or two).  

I would much prefer having a doctor who is a rude old grump informing me about my condition with words I can understand, than to have one with polite airs whom accomplishes nothing more than leaving me befuddled with their medical jargon.  The most impressive thing about House...he refuses to give up on a patient.  He will stay with them until he browbeats himself to the point of finding the cause of their illness.  With him a patient never hears "I don't know."  In the end, he always discovers the hidden culprit...and actually helps the patient get well.  It's nice to get what one pays for.

People are quite capable of being autonomus in their decision making when they are presented with all of the information necessary to do so.

Avatar universal
by KAYMI, Apr 19, 2009

Avatar universal
by Ufrustrated2, Apr 19, 2009
To quote VaBreeze, "The most impressive thing about House...he refuses to give up on a patient."

can you say the same Dr. Richard Fogoros regarding yourself?  why not read more on the MS forum, regarding real people, real situations, real frustrations? i bet your analysis would be shorter then, yes?

what no votes for Dr. Cameron?

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by Nancy T, Apr 20, 2009
Interesting analysis and even more interesting history.

I think some people just want a doctor who "knows best"--at least until the doctor decides something that the patient doesn't like! Autonomy rules. Doctors may have deep insight into what's best for a patient, but perhaps only in a narrow sense. They don't know a patient's life, history, motivations, needs, fears, and deepest thoughts and struggles.

As for "House," let me state a heretical opinion and say that I think it's a really lame show (based on my having watched a few episodes).

Nancy T.

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by Khiba, Apr 20, 2009
Dr House is a consummate "jerk" as a character but he always finds a solution to the patients problem with his team and doesn't send the patient home till there is a definable and treatable diagnosis, which he finds in a short amount of time. Of course!

I watch it with wishful thinking that my Doctors would stop being "specialists' for a few minutes and consider there might be some other underlying cause of my pain and suffering. Like maybe the reason I have trouble walking is a herniated or degenerated disc in my low back or pelvic inflammation and not blow it all off to the "MS" and "Transverse myelitis," leaving me to do research from my house and find other avenues to try and help myself get better, which seems to take forever. Wouldn't it be nice for Doctors to actually care enough to follow up and suggest other solutions than just their "specialty?" We could all get better sooner and keep off the endless stream of medications that cover the symptoms.

I recall being a child and my pediatrician directed all my medical care and even made "House" calls. ;)


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by missy142, Apr 20, 2009
I agree with you, House is totally Hot!  and the posts are so funny to read.  I think maybe people are missing the humor of the show and how absurd he is, thats what so great about the show, its not supposed to be any profound commentary on medicine or how md's function within the scope of medicine, or  how they interact with their patients.  Its just amusing if you can appreciate it for what it is:)  Well to each his own:)


Avatar universal
by irfa5_more, Apr 20, 2009
I have to echo the above comment: you're overthinking the whole thing. Watch a few episodes before you try and analyze a show that's been successful for 5 seasons. :)

It's no accident that it's in syndication on USA, the network that proudly proclaims "Characters Welcome". Think of their many successes, Monk, the neurotic (but skilled) detective, Psych, featuring an affable oaf (who is a skilled investigator), or House, a completely narcissistic (but skilled) physician.

Being a fan of the show (and Hugh Laurie, watch some of his other work, then watch a few episodes of House, you'll have a better appreciation of his skill as an actor) I can share with you that the show's creator intended to create a mystery/drama of some sort, and just had the epiphany that instead of being a police setting, it would be a medical setting. The medicine is really only a prop to support the psychopathology of the very interesting ensemble cast. It's the people that make the show successful, the medical roller coaster each episode is just the icing on the cake.

I'll further echo another comment, I suspect the slavish devotion that Dr. House shows for solving a given medical conundrum is appealing to a great many people. Realistically, the body is quite capable of healing minor issues all on it's own, it's the intersection of illness and complication where a skilled medical practitioner is essential. And yet that's where we currently fall down in outcomes, partly due to a broken medical system, partly due to limited medical knowledge. Doctors don't have the time or resources to practice medicine the way House does, nor is there any model in the US for his department of diagnostic medicine. It's a shame, because with the ever-expanding universe of medical specialization, and the dearth of primary care providers, we've lost the skill of a generalist. People with rare or confusing disorders can be sent on a merry-go-round of visits to one specialist or another, none of whom can solve the problem, let alone treat it. Worse, they may be slapped with a label of one mental illness or another. Were there such a model of diagnostics, a department where an multidisciplinary team existed simply to eliminate many diagnoses at once and come up with some working hypothesis to test, we might measure the time to diagnosis for some of these disorders in years, not decades. Our fine institutions of medical education are particularly suitable for implementing such a model. I suspect it will happen at some point, but it certainly is slow to arrive.

For what it's worth, House shows great contempt for most, but not all of his patients. He thinks most patients are untrustworthy because they are. That's hardly a secret to physicians, people tend to be complacent about their health until the day they get a wake up call. Better physicians than House don't let that color their view of the patient. House has been known to defer to a patient on more than one occasion. Those are the rare patients he respects as a human, as an equal even. He admires their well-considered logic, even if he passionately disagrees with it.

Avatar universal
by essdipity, Apr 20, 2009
One way to understand the House character is to realize that the whole premise of the show is a take on Sherlock Holmes. The creators actually acknowledge that. Even the name 'House' is a play on 'Holmes.' Sherlock has his Watson, House has his Wilson. Holmes is narcissistic too. Holmes is a drug addict too. Holmes has no real relationships with women; neither does House. Both solve mysteries.

If this show had a good guy main character, it would be just like dozens of others that have faded into history. It's meant to be entertainment, period. It doesn' merit deep analysis or psycho-probing. Sometimes a cigar is just a cigar.

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by margypops, Apr 20, 2009
I think we all wish we had found someone like that in the field of Medicine so may of us havent, but he may be nasty but hey he gets the job done , doesnt he , and yes you have to see that it is a tv movie and his partners get most of the flack /truth? It is very cute I adore the show..he is English his American accent is brilliant

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by Tuckamore, Apr 20, 2009
Dr. Fogoros thank you for bringing us a very interesting thread.

This is television!!! DrRich need not launch into this lengthy over analyzation of House MD. This series is doing a great job of what we expect television to provide us with, entertainment.

I believe many of us would not tolerate Dr House's bedside manner. As one poster put it, "I would run, not walk" away from this man if he were a practicing physician. The viewers are not stupid, who wants the pill popping, self serving, arrogant *** for a physician? But we all have a fantasy that he could cure our pain or illness or if we were to become ill, he would be our answer. We all know House is not real but don't we hope their are brilliant diagnosticians out there to save us!

The writers and acting are superb. They know some of us are looking for the human and loving side of House. They give us a glimpse of that every now and again. We watch episode after episode searching for the reason that we love this very unlovable man. I love House MD and haven't a clue why!! And you know what, the why doesn't matter.

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by sam811, Apr 20, 2009
I believe that most people watch to see what will happen with the relationships on the show.  I also think people are interested in house's attitude toward life and death.  I think a lot of people can relate to him because America is full of depression and sicknesses and most want to find some comfort in knowing they are not alone.  A lot of people watch because they are hypochondriacs and they think that they have those medical problems shown on the show.  I watch because its nice to see doctors who are so good at what they do, even though it is not real.  I sort of fantasize that maybe one day I'll have such an awesome doctor to actually give a damn and take care of any problem I might have.  

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by sam811, Apr 20, 2009
i left out the part that it is one of the funniest and most entertaining shows that i've seen in a long time.:)

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by kiddthekatt, Apr 20, 2009
I agree with you all. He is a total jackass, but if he were in my corner, fighting to find a cure for fibro/cfs, he could be all the jackass that he wanted, Those of us here with chronic illnesses, chronic diseases, we need someone like House to take our minds off of what we have to look forward to day after day. No one could pull off the nastiness, the pill popping goof like house. I just love the guy!!

Avatar universal
by dr_cameron, Apr 20, 2009
You're correct. The show goes against all modern day medical ethics and codes.

But like I said - the *show*. You're really overthinking this. It's not meant to represent the medical world as it is, it's meant to be a fascinating television show that draws viewers in - and quote Lisa Cuddy, "He may be a son of a *****, but he's the best doctor this hospital has." Hence, the admiration for Dr. House. He's the anti-hero, the bad (not even) guy that you just can't help but love.

Also, the relationships and dialogue between the characters is astounding. Many people watch the show for that as well, not the medical aspect of it.

Relax, drink a beer, and watch an episode.

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by Melissa0116, Apr 20, 2009
I like House because I used to have a doctor like him when I was a teenager.  He was very sarcastic and he also was totally commited to every patient he took care of.  He had a small office and he was the only doctor in that office.  Unlike now, when you must go through 5 - 10 doctors in order to be looked at especially when you go to the gynecologist.  Dr. House actually does care very deeply about his patients.  He just is very sarcastic about it but when he does realize what the problem is, he lights up.  Not just for himself but for the patient as well.  My old doctor was always around whether in the office or making house calls.  I just wish there were more doctors that were like my old guy.  He was a true gem.  

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by margypops, Apr 20, 2009
hey Dr Fogorus you look pretty cool yourself ... are you are closet Dr House.......

Avatar universal
by kanthos, Apr 20, 2009
I can say I love house, a great show.

I would have loved to have a doctor like him after my injury at the warehouse.

Told me it was a slipped disk, a year later and a car accident I found out what it really was.

Spinal Stenosis, genetic back disorder.

If I had a guy like Gregory House who would have asked me why I was being an idiot, and badgering me I would have

know what I had and been in PT to make it better.

My dad has the same thing, took them almost twenty years to tell him what was wrong.

Avatar universal
by kanthos, Apr 20, 2009
As Melissa

I too had a doctor like that when I was younger.

He would take the time to find out what was wrong with his patients and wasn't afraid to ask the hard questions or embarrassing questions until he got the answers.

great doctor, passed away 5 yrs ago.

He will be missed.

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by Joyce49788, Apr 21, 2009
HOUSE MD... hmmm interesting topic... i agree with many of the ladies on this topic, that House is very attractive, BUT although he acts like a total jerk at times, he doesnt give up and almost always finds a cure for his patients whether they want the lifesaving treatment or not.  if i were given the option of a doctor taking complete control and saving my life... OR be given the information and having to make the decision myself... i think i would want a jerk saving my life.

sarcasm doesnt have to be a negative thing, sometimes it just relaxes a person and lets them know that the doctor is just HUMAN.

but the show IS just a show... unfortunately there is NO doctor in the USA anyhow who would take on the full responsibilty of being a diagnotision (spelled wrong sorry) as well as the one to treat the disease or illness like house does... so what he doesnt have a wonderful bedside manner but he SAVES LIVES... just wish there were more REAL doctors who were THAT dedicated.

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by babygirl6152, Apr 21, 2009
I think we like the idea that Dr Gregory House tells the red tape "where to get sticked" ;-)

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by mum2beagain, Apr 21, 2009
I love the show, Hugh Laurie is a great actor, most British people will have known him for his comedy acting I think. I read about 1/2 of the origional post, and then it all just became blah blah blah......to much over analysing

It's just a show, it's a great show with great charatcers and great story lines, I am totally addicted!

P.S. I vote Jesse Spencer as Dr Chase as the hottest character on the show

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by suziesmomyy08, Apr 21, 2009
I love House because he is hot, lol, like a previous poster said, and I think sometimes his attitude makes him that way, :)  But no seriously, I am in a position where I wish my doctor was willing to do almost anything just to figure out the problem, although I know for House, it has to do with his ego and its almost like a game to him and if he doesn't figure it out then he loses, but at the same time he will go to the extremes to figure out what is wrong, and that is what I REALLY like about him, some of us are in situations where we wish we could have that feature in a doctor I think.  

Avatar universal
by nora006, Apr 22, 2009
Thank you for this. Very interesting!  I'm from Europe and suddenly the difference between european thinking and american thinking became more clear to me.
Personally I find House's quick and dirty sarcasm a bit annoying in the long run, but it's a great show though!

Avatar universal
by kat4, Apr 22, 2009
House is hot and smart, what's not to like :-)

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by semosig, Apr 22, 2009
I think the reason people love House is simple.  He gets results.  I have been going to doctors for two years due to tiredness and exhaustion.  Can't work.  All that is done is take my money and try a new drug or replace an old drug. Blood tests, etc., etc.  No one can figure it out. I need a Dr. House who has a team who won't give up.  The deductibles alone are breaking me, but if there was a real Dr. House and team like his, I would mortgage everything for his arrogant, can do abilities.

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by Dylan465, Apr 22, 2009
I would take a Dr. House at any given time. He could criticize me all he wants. If he could diagnose and treat myself and husband the way he does on his show (yes, I know he's fictional) I would jump for joy. Since moving to Arizona, oddly enough, both my husband and I have been sick. Not one doctor in 4 years has done much but throw pills at us. I would trade a smile (which many of these doctors don't do, they can't can't even diagnose, give deadly prescriptions, and I wonder if they didn' t get their degrees in Cracker Jack Boxes.) So yes, give me Dr. House anyday. The doctors we have met have been of no help and want to just get rid of us. We very often know much more than they do. I would take away their licenses away in a minute if I could. Give me a doctor that treats my symptoms, are there any left?

Avatar universal
by StopLookListen, Apr 22, 2009
The interest in the character House isn't so much about his role as a physician but rather his individuality. Regardless of his expertise, people connect with him because he illustrates what they themselves would like to do during the course of their work day.......regardless of occupation. Minus his personal flaws he reflects a continuing desire for knowledge, to do a job and to do it well and most importantly, he receives respect from others for the work he does despite being disliked. Being proud of yourself and having confidence that you have done your best is a very satisfying feeling.

Avatar universal
by RCinNYC, Apr 22, 2009
Hugh Laurie is not only a great actor, he is indeed "hot"!  I'm 75, and I have had some great loves in my life, and Dr. House is a combination of all the wonderful men I have known and loved.  Last Feb. 2008, I was taken to the ER for a rapid heart beat of over 200 beats per minute, and as I waited on a gurney for someone to attend to me, and tell me what was causing this awful, sickening feeling, and watching the doctors and nurses hurry past me one after the other, I waited till there was a lull in the hectic ER, and when it got quiet, I called out, "Where's Dr. House?  I WANT DR. HOUSE!"  Well, one young doctor limped over to me and said "Me?  You want ME?" and everyone in the ER laughed and suddenly everyone (including me) felt good for a few minutes, laughing released everyone's tension!  So, DR. HOUSE did it again.  I was soon out of there (after a few medical tests) and my doctor prescribed Cardizem CD and I'm fine ever since.  I watch HOUSE on every channel that carries the re-runs in preference to any of the other garbage they put on TV.

Avatar universal
by ravenwing, Apr 22, 2009
It can be an entertaining show, however some of the medical stuff is so inaccurate and extreme. For example, in the case about the boy with leprosy, they were discussing if he had Chlamydia Pneumoniae as a result of being sexually active. Cpn is a respiratory disease!

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by matisse808, Apr 22, 2009
The article is based on a false premise; Hose does NOT "extravagantly violate his patients’ autonomy." The guy should have watched the show, instead of making presumptions based on what other people have said about the show. Sure, he is an "A-" hole, but he never does anything the patients tell him not to. It may be up to House's crew of qualified underlings who end up educating the patients about they are making, but the rules House breaks are those of the hospital and insurance companies, and people love him for that. They also love him because he is competent, which will always win out over congeniality if there has to be a choice between the two. However, I don't love House, I don't watch it any more, because being so uncaring and unsympathetic is ONLY worth trading competency for when you have one of the strange and rare maladies featured, which most people never get.

Avatar universal
by Chrysippus, Apr 22, 2009
People seem to be missing three key points:

First, House is always right, courtesy of the show's writers, and always has his patients' interests at heart, for the same reason. This does not happen in real life. Instead, equally self-confident and insensitive but determined physicians will sometimes plug their own—wrong—diagnoses against the evidence; and/or will class a recalcitrant patient as psychosomatic, psychologically disturbed. etc. The same kind of lack of realism rules House as characterises the various CSIs. As has been pointed out several times, these shows are for entertainment purposes only and are not to be confused with reality. There will never be a doctor who is always right all the time, has all the relevant information, and always cares solely for his/her patients.

Second: House doesn't have to worry about who pays the bills. Real patients do, in the US.

Three: the House audience is watching what happens to someone else (who's fictional). We are all terribly good at encouraging other people to do or get what's good for them, regardless. Things are different when it happens to you (in real life).

Two other points: since when did the USA have a monopoly on capitalism? I seem to remember this began in Europe, and was exported thence to what would become the US, where slave-owning continued until the 1860s as part of this country's capitalist system, despite its Enlightenment principles; and capitalism is still doing as well as can be expected there—not very well right now, admittedly. Finally, patient autonomy didn't exactly triumph in the US, again despite all its Enlightenment principles, at least if you were poor white trash or black, before the Nazis gave euthanasia a bad name. Let's not get carried away in sentiment here.

Avatar universal
by deecee2, Apr 22, 2009
Memo to DrRich...find a REAL topic to "explore" (or deplore)...it a friggin' TELEVISION show who's popularity is based on it's characters and the interesting stories they share. That's all it is, and with your windy and overbearing analysis of an, again, TV show, to me, makes it seem like you need more subject matter.
Daniel Carlson

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by HVAC, Apr 22, 2009
I find most of the medical stuff far fetched. There is always an LP and the paddles and projectial bodily fluids.

I have had jerks for Doctors but they don't care to solve the mystery. Who would not want a team who won't stop until they figure out a cure?

House is complex and unpredictable.

I loved the BLACK ADDER

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by Dylan465, Apr 22, 2009
House is my absolute favorite show. Not only do I wish I had a doctor like him but the show is hilarious. The relationship with House and Wilson is great, House and Cuddy great, all the cast actually. I love his absurdness, he is "hot" in his own way, Wilson and Chase are adorable. The acting is great on this show and my dream is to find a doctor that wouldn't give up on me and my spouse, the way "real" doctors do. All of the "real" doctors that I have met are the worst. They can't diagnose or even write a prescription. I feel I know more than them and probably do with somethings, b/c I research so much and most doctors hate that, it appears.

Avatar universal
by richardjbaker, Apr 22, 2009
I agree that "the principles of beneficence and of individual autonomy will sometimes be in conflict."

But I don't agree that "the doctor must (after taking every step necessary to inform the patient of all the available options, and the potential risks and benefits of each one) defer to the final decision of the patient".  The doctor can just refuse to
perform a procedure that he thinks is wrong or just plain bad medicine.   (President Obama might change that for pro-life doctors.)  

For example, doctors refuse to perform gastric bypass surgery on patients who are only a little bit over weight.  Many refuse to perform plastic surgery on a patient, who has had too many plastic surgeries in the past.  Many dentists refuse
to pull too many teeth at one time.  A friend shopped dentists until he found one willing to pull all four of his wisdom teeth
in one sitting.

In most cases, a patient can refuse a procedure that the patient doesn't want, but not always.  
Sometimes, medical professionals go to court to force medical care on individuals (usually minors).

In an urban environment, where there are large numbers of medical professionals and patients, the system works fine.

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by nuggetone, Apr 22, 2009
Yea he is Cocky but he can back it up as Kid Rock says!!!!!!!!!!!  He doesnt give up or go with the firt thing that comes to mind.   He is interesting and stops at nothing.  He has that pesonality you either like him or u dont.  That is your decision. Hr can be a jerk but he loves his job and most people cant say that.  Can You?

Avatar universal
by nikitabe, Apr 23, 2009
I understand DrRich's point of view. It is not about the TV show. It is about an important issue of patience autonomy vs beneficence, as DrRich explained in this article. This is food for thought, and I agree with DrRich here.

Avatar universal
by nikitabe, Apr 23, 2009
read 'patience autonomy' as 'the patient's autonomy'

Avatar universal
by lumaelha, Apr 23, 2009
I think he is shown to be vulnerable beneath his churlish exterior, women love a vulnerable man and men just love the fact that he gets away with being so rude to everyone.

To any women who think he is HOT...... watch Black Adder... British comedy...the second series where he is a homosexual prince from the 15th century wearing tights....you won't think of him as hot ever again...

He is one of our most intellegent and esteemed men in Britain. We are extremely proud of his accomplishment with house.

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by AireScottie, Apr 23, 2009
Years of my own experience have shown that MANY doctors don't give a @#&* about patient autonomy and can't be bothered to share the (illogical) path by which they arrive at their conclusions.  About half of my doctors have had all the bad qualities of House with none of the intelligence.  It would be a shock, except I saw so many med school students fail out of my organic chemistry and math classes in college.  A lot of doctors seem to have an IQ just above average but think they're the most intelligent people in the world.  I'd rather have House any day!  (disclaimer - yes I know some doctors are wicked smart; there just aren't enough of you)

Avatar universal
by Briarpipes, Apr 23, 2009
Before we through House's character under the bus, let us consider our own lives.  I've been chasing down a mysterious illness for almost a year.  Many other people have too, bouncing from one specialist to another.  You have to play not only the sick patient, but the middleman between doctors who don't consult each other before writing a script.  Watch a few episode of Mystery Diagnosis on Discovery Health and you'll see how long these people had to suffer because they were deemed to be nutcases or the doctors simply missed it.  I got to a point where I didn't care what by what method a diagnosis was made.  Just figure out the problem and fix it.  THAT'S WHY I LIKE HOUSE.  

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by R Glass, Apr 23, 2009
First, we have to agree Dr. House is a fictional character.
Second, we would like to believe that most Doctors with their arrogant attitudes know more about our ailments than what our bodies are actually telling us.
So, we accept this fantasy and eat whatever pills the salesman with the most “perks” offer.
Yes he is this “Fictional Super Doctor” that seems to figure everything out but in reality, this is what we expect when we go to see our Doctors.  House only puts a face to this fictional character.  

Avatar universal
by Gwynnn, Apr 23, 2009
I have to agree with the women here.  I have found over the years that in order to get answers, I have to be my own advocate, as most docs look at women as neurotic, hypochondriacs, etc, so no one really listens to us.  I also love Scrubs, and always think about one episode where JD mentions that doctors spend an average of 15 seconds listening to their patients- they're trying to find out why one of their high-strung patients (a woman) has organophosphates in her system.  They run some basic bloodwork, find nothing, release her, only to figure out that she probably swallowed them herself in an attempt to commit suicide.

The writing on House is very formulaic for the most part and Hugh Laurie makes the show (I agree with someone else- check out his other work- Love the Black Adder series he did with Rowan Atkinson in the 80s).  However, I really think House plays on our hopes for docs who will really advocate for us and not make us feel like we're nuts.  As a patient, we can see when the curtain starts to descend over the docs eyes, the instant they're making the judgment about us.  It's almost like you have to apologize for coming in.

To that end, I agree with Briarpipes (BTW, I hope you find some answers soon).  I've seen the Mystery Dx show and it's frustrating to see that people who are clearly sick have to drag themselves from doctor to doctor, submit themselves to test after test after test, only for docs to send you off.

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by swampcritter, Apr 24, 2009
Dr House is popular because 1) it is good television, 2) one or more characters resonate with people.

But the health care part of the show's message -- that the hospital will keep you until you are cured or die, that all the equipment is ready to go and can be scheduled in a moment, and that you'll have 4 doctors looking over you as their only case until they solve the problem -- a fantasy in the extreme.

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by Nancy T, Apr 26, 2009
What Gwynnn said is so true--"As a patient, we can see when the curtain starts to descend over the docs eyes, the instant they're making the judgment about us." To me it's not a curtain, it's a certain tiny little smile that comes over their face, and their eyes relax, they start fidgeting a bit--you can just SEE the transformation take place-- a change from attentive listening to "Oh, I get it NOW--one of THOSE patients..." and their mind is made up, so you might as well stop talking.

That was a great "Scrubs" episode, except it's unrealistic, too--most doctors, once their mind is made up (often in those 15 seconds), usually don't go back and give any more thought to a patient, especially not over dinner! I love "Scrubs", though--it's a VERY intelligent and clever show, as well as great fun.

Avatar universal
by vhaldez, Apr 28, 2009
Let's face it. House is smart, witty and funny. I don't think he is meant to know he is charming; he just is. I think that's what people love about him. What you see is what you get. Who else do we know like that? I don't think he's rude; that is how people perceive his honesty.Most of us are afraid of that kind of honesty. I would feel perfectly safe with him. Most people actually do lie, as he says. So, why do we feel better/ safer with someone telling us "no, you don't look fat in that red dress" when we look absolutely stupid? So maybe it's us that cannot handle the truth, so we safely label it as rude. The rest of us walk around getting phone calls from people we don't even like because we didn't want to tell the truth. No, it's not okay to call me. Maybe we should examine ourselves before we decide the difference between being a jerk or being phoney. We know we all wish we could be a little more like him without feeling guilty offending. I believe that all doctors should take their practice that seriously. Just as the baker down the street. And we all want great health care and a great donut. Love his WIT!

Avatar universal
by K1253, May 08, 2009
"House M.D." is a popularized case of "Physician, heal thyself." House can heal his patients, solving rare and incredible cases, yet has let muscle death and a limp cause him to be dark and cynical. I have watched every season, and in the beginning, it appeared he was just a pill-popping, manipulative, blasphemous, sometimes-humorous, jerk but the more the show develops, so does his character. **spoiler**He learned his father was not biologically his father at the age of 12, to his great relief since the military man had always been especially cruel and abusive to him. Failure was severely punished with no meals, being locked up or sleeping in the yard without a blanket. In the episode where his father dies, his baggage is especially apparent.**spoiler**He lost his love due to his pride and his fear of vulnerability, and he nearly lost his best friend as well since he comes off as a user in more ways than one.
I suppose the show is compelling for two reasons: the cases, and the hope that House will be able to heal himself.

Avatar universal
by mikerockstar, May 10, 2009
house is a tv show, and a good one at that, thats why america loves it, it has to do with stuff that happens in the real world, some people are addicted to stuff like vicodin, an it shows sometimes the struggles tryin to gett off it, also america is always watchin dr or medical shows,like er was big, and its funny,so people will watch that. i dont watch alot of tv unless its sports but house is by far one of the best tv shows out there. it is so much better then the reality shows that grace us today, thats why america watches it

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by ginger_4_2, Jul 23, 2009
Thank you for presenting this analysis.  For me, it makes me long for a doctor who actually takes his job as seriously as this character does.  At times, I think I could put up with a doctor’s rude manner, in order to have answers for what is wrong with me.  Instead of being passed around like a hot potato because they cannot figure my situtation out.  However, in reality, I don't think I could.  

My analysis insists that Dr. House is allowed to behave in this manner and usually get away with it because he is excellent at what he does.  He can take all the time (with his bouncy ball) to connect the dots in order to figure out what is wrong with his patient, and he doesn't have to deal with insurance companies on the show.  

However, in "reality world", real doctors have to keep patients in their offices by being as cordial as possible or they aren’t paid.  Take as little time with their patients as feasible, so they can see 50 or more patients that will follow the previous patient or they don't make as much money that day.  Finally, they have to deal with the insurance companies that contract them, rule them, and code their office to death.  

Dr. House is a character that every patient wants in their life, but will more than likely never get.  

Avatar universal
by LionChick, Jul 20, 2014
I'm fifteen, and I love doctor house for very simple reasons.

1) He's a genius. Yes, he's egotistical and arogent, but he earns it. And, to quote Dr. Wilson, "He saves people that no other doctors can save. Over all, he's a positive force in the universe."

2) He's heavily based off of Sherlock Homes, one of my all-time favorite literary characters.

3) He's hot: he has gorgeous blue eyes and a scruffy cuteness that only he can pull off. These traits are amplified by the fact that I have a weakness for insane geniuses who save people.

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