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Ever wonder if those bizarre cases Dr. Gregory House cracks every week on TV really happen? Like many med dramas, the Fox series has MD consultants, and like another successful franchise, Law & Order, the plots from House are ripped from the headlines — in this case, out of medical journals.

David Foster, an internist who's a writer and producer on House, tells today's Wall Street Journal that he gets some of his best plotlines from the clinical problem-solving column in The New England Journal of Medicine (NEJM) — "one of the great gold mines of diseases," he tells the newspaper. Other ideas come from The Merck Manual, Harrison's Manual of Medicine (a textbook), friends, and (surprise) the Internet. "It's good for us but bad for humanity that there are so many ways that the body breaks down," Foster tells the Journal.

Back in the 1996, during the generation of TV medical dramas including ER, Chicago Hope and Rescue 911, doctors writing in the NEJM griped that those programs "fostered trust in miracles" by too often saving patients using CPR. Analyzed as a group, the 97 episodes from seasons 1994 and 1995 portrayed three-quarters of patients being successfully resuscitated, and two-thirds living over the long term. In the real world, zero to 30 percent of people survive cardiac arrest, depending on its cause and where they are when their heart stops, according to the study. "The misrepresentation of CPR on television shows undermines trust in data and fosters trust in miracles," declared the study authors from the University of Chicago, Duke University, and Durham Veterans Affairs Medical Center in North Carolina.

Is House, which premiered in 2004 and aired its 100th episode on Monday, any more realistic? Yes and no, says Andrew Holtz, author of the 2006 book The Medical Science of House, M.D.

"We're definitely not in the Ben Casey days when the medicine on the show was as fictitious as the people," Holtz says, referring to the 1960s drama about a hardnosed doctor. "The inaccuracies [now] are more global than specific."

In the 30 or so House season one and two episodes that Holtz analyzed, the characters pronounced the medical terms correctly, picked up  surgical instruments at the right time and described symptoms of real conditions. In the interest of plot, however, House did occasionally miss obvious symptoms that any medical resident would have spotted, Holtz says.

Where the show goes "off into fantasy land," he says, is its portrayal of patients as generally young and pretty, not old and riddled with chronic diseases, and of the healthcare establishment, with doctors filling typical nurses' duties such as giving injections and drawing blood. Not to mention House's ethically questionable behavior: He's addicted to painkillers and is willing to perform procedures that are in his but not the patient's interest, such as a nerve biopsy on a teen girl who's otherwise healthy but never feels pain.

But, like in the real world (physicians can now get help from medical societies for drug addiction), there are repercussions for the hero doctor. "They’ve confronted his bad behavior and made him pay for it," Holtz says of the grumpy Dr. House. "They're not oblivious to the flaws in his character."

Image of Dr. Gregory House (Hugh Laurie) courtesy of Fox

7 Comments

1. 1. pamelasm 08:10 PM 2/5/09

   there was a clinic storyline about an old woman with syphilis who was suddenly hypersexual (and in love with house). Later i read basically the same story in Oliver Sack's The Man Who Mistook His Wife For A Hat

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2. 2. Coracle 08:43 PM 2/5/09

   I was skeptical of the reality of House's medical TV antics and disturbed with the degree of hero worship/tolerance from even a fictional hospital. However, a few minutes after my husband was diagnosed with a GBM brain tumor (after a series of misdiagnoses) a neurologist was called in for a second opinion. Unfortunately, he was on his way home. I watched a man in his 50's throw his briefcase and coat on the floor and have a tantrum about this inconvenience. He was practically spitting. He's still employed by my HMO.

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3. 3. astrojetson 11:31 PM 2/5/09

   It's a little concerning to me that this show has such a large audience that is willing to subject themselves week after week to the cruel and ridiculous rantings of such a dysfunctional character. When the show first came out, I enjoyed it even with all of the medical mistakes mixed in with the plausible, and MD's performing nurse's duties, etc. When have you ever seen this many doctor's all working on one patient's problems, and for more than a few minutes in the room? I don't watch the show anymore because House never changes; his behavior is always the same and nothing that happens in his life stimulates him to emotional or ethical growth at all. That's not entertaining to me, it's just uncomfortable . Better to read the medical journals that provide the inspiration for the storyline, minus the jerk who never gets fired or sued for his misdeeds.

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4. 4. Doc199 12:39 AM 2/6/09

   I am surprised that a reliable scientific source like SCIAM would confuse physical dependence with addiction; drug researchers and scientists know that they are not the same. People who live with intractable pain do become physically dependent on opiates when taken regularly. Most, however, do not become "addicted." Physical dependence is simply a property of certain drugs and has no necessary relationship to "addiction" which is a compulsive pattern of drug seeking despite serious negative life consequences caused by drug use. Pain acts as a antagonist to the euphoric effects of opiates and most people who use opiates to manage chronic pain do not get "high" nor do they take the drugs for the euphoric effects.

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5. 5. phoghat 08:50 AM 2/7/09

   I'm a pharmacist and have worked in both community and hospital practice. I have known doctors, nurses and yes pharmacists that have had the same flaws as Dr. House. I know also that this is a TV series and must be entertainment before before being a medical lecture about disease and treatment.
   I think that means I'm safely grounded in reality and so basically is the show. It dwells on the fact that House is human and has the same foibles as a human and not some omniscient god in a white coat (and there are a goodly share of those in real life also).

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6. 6. shamad 09:15 AM 2/7/09

   astrojetson might be better off reading some science on the subject. Whilst the belief in peoples miracle turn-arounds is something that tv-land does foster, it's not reality. The latest SciAm Mind featured an article on just this subject, how after our late 20's we become more resistant to change in our habits. If House doesn't miraculously become a Wilson-esque character, this is not bad TV, but good science.

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7. 7. Blackpriester 07:05 AM 2/18/09

   Well said, shamad.

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