'House' goes under the medical microscope

By Ann Oldenburg, USA TODAY

Two babies are sick.

Dr. Gregory House and his team of residents don't know what's wrong. House orders MRIs on both, but the tests show nothing.

It's a race against time at the Princeton-Plainsboro Teaching Hospital. Finally, House decides he has no choice but to take a different course of treatment with each baby to determine what's wrong — knowing that one will likely be fatal. In the end, one baby dies. ( Related story: Dr. House is on the case )

"That would never happen," says Marc Siegel, an internist and a member of USA TODAY's board of contributors. "You'd be disbarred. That's completely unethical."

Baffling medical mysteries are the hallmark of Fox's hit House (Tuesdays, 9 p.m. ET/PT). The series premiered in November, but its vital signs were weak until American Idol gave it a ratings transfusion in January. Since then, House , which follows Idol , has been growing stronger, hitting a high of 18.3 million viewers in March. A second season has been ordered.

But many of the cases on House come under fire each week on the show's message boards. Viewers hash out, very specifically, the intricate and obscure medical situations presented on the show — even including House's own medical problem, which hasn't been fully explained. The character takes painkillers and he limps, requiring him to use a cane.

"It was a big issue early on about which hand he holds the cane in," says executive producer and series creator David Shore. "The thought was he should hold the cane in the opposite arm from the injury. That is basically true — most people use the opposite arm. But some people feel more comfortable with a cane in the dominant arm, and that is acceptable." House's injury — and cane — are on the right.

Shore says details never escape fans' attention. Medical criticisms concern him. "A smart, realistic show doesn't work if the medicine is a joke," he says.

Hospital shows always face the challenge of portraying illness and treatment as accurately as possible within the confines of a drama.

"That's a battle I have fought forever," says Linda Klein, a medical consultant who has worked on other TV shows and movies for 24 years (though not on House ). "This pilot I'm on now, every time it comes to surgery and scrub-room scenes, they want to play these actors doing all this dialogue at the sinks without masks on. I tell them there isn't a surgeon in the world who would scrub their hands before surgery without masks on."

She's also working on ABC's new Sunday hit Gray's Anatomy. She tells producers what's accurate; then, she says, it's up to them to decide what to do. "We're not doing documentaries, we're doing dramas."

David Foster, a House staff writer and medical consultant, says NBC's ER raised the bar. "It has created an atmosphere where audiences demand a certain amount of realism from their medical shows."

On House , the accuracy presents a particular challenge because the show is built around a doctor who is so brilliant only the most difficult cases are sent to him. Four medical advisers are listed in the credits.

The cases "are the spine of these episodes," Shore says. "Usually we come up with the disease first and work the episode around it. We try to look for ways to hide what it is. You can have the weirdest disease in the world, but if you can stick the guy in an MRI and find the answer, you won't have an episode."

Paul Offit, chief of the division of infectious diseases at The Children's Hospital of Philadelphia, finds the show "entertaining." The House character, who is blunt and often seems uncaring, is a doctor other doctors find intriguing.

"The crustiness, the edge, is not unusual," Offit says. "He has that American sense of confidence, sarcastic sense of humor in the face of danger, but he goes over the edge."

Like Siegel, he found an error in the medicine in a recent episode, but it didn't matter. "It made it a little intellectually unsatisfying, but I loved the hunt," Offit says.

Harley Liker, an internist on the faculty of David Geffen School of Medicine at UCLA, is a consultant for the show. His job is to help guide the writing staff through the medical mystery each week. He says case studies in the New England Journal of Medicine are mined for ideas. Foster says the Web and media provide cases for episodes.

Liker works to make the scenes realistic. "I want any doctor, even a specialist in any area — to be able to watch the show and say, 'Wow, yeah, that could happen,' " he says.

But he says doctor friends are "more interested in what's going to happen with Vogler," the overbearing new chairman of the board of the hospital. "My medical friends don't call me up and say, 'Gee, you didn't intubate that guy?' "

What drives the show, the writers say, is the characters, not the medicine. Sela Ward will guest-star in the last two episodes: May 17 and the season finale May 24. She plays a woman from House's past. "There's a reason we're telling the medical stories," Shore says. "You want that emotion. You want that interesting and touching payoff."