House - so bad it's good.

I've been watching House on Channel 5 since it started, and it's grown on me, over the weeks. Mr. Huge Lorry is up for an Enema award for it, even though his cod American accent seems to borrow freely from one of his sketches with Stephen Fry. And yet Americans, so we're told, didn't realise he was English. Still, most Americans wouldn't recognise an English accent these days; they just think you're Australian, because they think English people talk like the Queen of Englandland.

Anyway, back to House, which I wanted to say something about. At the end of episode two, the formula was starting to look obvious, and it was hard to see how it would sustain interest.

If you haven't watched it, here's the formula:

1. A patient is admitted to the hospital with puzzling symptoms that defy treatments. Either that, or an existing patient being treated for Disease A comes to the attention of Dr House, who becomes fascinated by something that everybody else thinks has Nothing To Do With Disease A.

2. House is consulted, and he reluctantly agrees to get involved, often after being blackmailed or threatended by the hospital administrator. Either that, or he snatches the case away from whoever has it, claiming that they're killing the patient by administering incorrect treatment.

3. House has a brainstorming session with his team, and they enumerate the 6-12 things that could be causing the problem.

4. The first treatment they try nearly kills the patient.

5. They keep brainstorming and experimenting, and nothing seems to work.

6. House discovers something about the patient that everybody had previously overlooked.

7. New treatment successfully cures the patient. Very rarely they correctly identify the problem, but realise that it is too late to treat it successfully. All they can do is make the patient comfortable and wait for him/her to die.

So that's pretty much the pattern. To make it easier for the audience to accept that the so-called genius Doctor House can Get Things Wrong, he is given a Flaw, which in his case is a physical disability. His obvious limp is a sign that Nobody is Perfect. He treats his pain with pain killers to which he is addicted. He is nasty to everybody, making inappropriate and unfair remarks to all and sundry. He mistrusts patients and insists they always lie.

The light relief in House comes when he is forced to see patients in a day clinic. He is nasty to all the patients, with excellent withering sarcasm. Huge Lorry delivers these lines with gusto. The great thing about this bit is that House gets to be very sarcastic about people who have looked things up on the internet; or just people who think they know what's wrong with them in general. He makes wild guesses about what's really going on with them and is usually right. With one patient, he fills a pill bottle from a sweet machine and gives them to him (the patient later returns for a repeat prescription). With another, he cheerfully writes out the requested prescription for Viagra and tells the patient it will probably kill him because he probably has heart disease from ignoring his diabetes.

This is all good stuff.

The reason it's so good is that it's the only medical drama I've ever seen that even comes close to showing how bewilderingly difficult it is to identify the cause of any set of symptoms. I'd go further and say that it's one of the few pieces of drama that manages to show the scientific method at work - to show how it works and what it really means. Hypothesis, experiment, result, further hypothesis, and so on, until you arrive, finally, at a workable treatment. Science is crap, in other words, but it still better than doing nothing, or trusting in your god.


It reminds me, in a strange way, of the classic 70s James Burke series Connections.

Let's just pause for a minute to think about Connections and how good it was, and James Burke, and how good he was, and whatever happened to him, and why did he go so suddenly out of fashion? Not dumb enough, I'd say.

In my dim memory of Connections, I remember Burke taking us through a process, from someone discovering one thing, and how it leads to another, and another, and so on, until you end up at something that seems on the surface to be entirely unrelated to the first thing he talked about.

The other thing about House is that, as well as confronting the hypochondriac in us all and pouring scorn on our attempts to diagnose ourselves on the internet, it dares to point the finger at law and medicine and the interaction between them. House is outrageously rude to his patients and their relatives, and frequently threatened with lawsuits. He's dismissive of patients' wishes and rights, and behaves in the godlike and arrogant way that you might still find in France, say, but will no longer find in the running scared (of lawyers) American health system and, increasingly, in Britain.

Doctors have to be allowed to make mistakes, House argues, they will make mistakes, will almost kill you, will need to get things badly wrong before they get things right. Because this is how science really works. You don't just look in a microscope and say, "It's Lupus, give him an aspirin." At the same time, it argues, patients are not in a position to make meaningful decisions when they don't really know what ails them.

I especially love House's attitude about patients lying to him. Because you know it's true, don't you? Instinctively, you never tell the doctor the whole truth. My favourite bit so far is when House discovers that a patient's family cat had recently died. He looks at a member of his team and berates them for not taking a full family history. In other words, when you don't know anything, anything could be relevant.