HouseBMJ 2005; 330 doi: https://doi.org/10.1136/bmj.330.7499.1090 (Published 05 May 2005) Cite this as: BMJ 2005;330:1090
At only 45, Hugh Laurie is well on the way to becoming a national treasure. His credentials are impeccable. Old Etonian, member of a losing Oxford and Cambridge Boat Race crew, hilarious portrayer of upper class twits in Blackadder. And in the 1990s, playing Bertie Wooster to Stephen Fry's Jeeves, he was lovable Englishness personified.
So when the BMJ sent preview tapes of his new show on a satellite channel, I was looking forward to a cheerful evening. OK, it was a US series, and OK, he was playing a doctor, but the theme would surely be Gussie Fink-Nottle meets Malibu Beach, and I was going to enjoy it.
Never very adept with the video player, I watched the first few minutes with no sound. First surprise. This was Laurie unshaven, in 101 Dalmatians mode. Remember how scary he was as Cruella de Ville's henchman, intent on drowning those puppies? Then I mastered the remote. Second surprise. He had an American accent.
I sat mesmerised by the transformation. It was as if your best mate had changed sex. He seemed to be doing it awfully well but what would the Americans make of it? The third surprise came as I actually listened to the words. Boy, was he being rude.
But not in a Graham Norton-style sexual innuendo way. His lines were cynical, clever, and hurtful. He was like Humphry Bogart playing Philip Marlowe but without the niceness. By way of explanation, his character, Dr House, is in constant pain and walks with a stick (very convincingly)—the result of damn fool colleagues' failure to diagnose a thrombosis.
Gregory House is a brilliant diagnostician who regularly solves cases that leave ordinary doctors baffled. He heads a team of three good looking young MDs of mixed gender and ethnicity, including a floppy haired Englishman who says at one point, “Actually, I'm Australian.” House snaps back: “You put the Queen on your money. You're British.”
The plots are complex, drawn from the smallest print in the largest medical textbooks. Differential diagnoses of mind-boggling obscurity are hurled back and forth without a hint of irony among the frowning team until House stops them with another flash of grim insight.
Occasionally the jargon is clarified for the viewer, who doesn't really want explanations. Watching Miss Marple or Midsomer Murders we soon lose track of the details, preferring to rely on the detective to sort it all out. The difference here is that even at the very end, House never smiles. “Humanity,” he says, “is overrated.”
He belongs to a long tradition of cantankerous heroes, going back to Ironside, Dirty Harry, and, before them, Sherlock Holmes (who was of course modelled on a medical teacher). UK viewers will hear echoes of Sir Lancelot Spratt, though House is more shocking: “Treating illness is why we became doctors. Treating patients is actually what makes most doctors miserable.”
Not a good role model, then, for today's new doctors, educated to be touchy-feely people persons. Or are we getting it slightly wrong? Medical schools are starting to wonder if the anti-Spratt pendulum has swung too far. They are beginning to suspect that a profession may need a few brilliant but difficult people.
Believing as I do that politeness costs nothing, why didn't I hate the show? Mainly because it makes no claim to unmask reality. Created by a team of non-medical writers (with diligent researchers, clearly), it sets its crusty hero amid a caring team and gives him all the best lines. To emphasise that this is unreal, the camera occasionally zooms inside the patient's body, letting us see neurones at work.
But, like so many top-class US series, this is fantasy with a knowing edge. It is a rebellion against blandness—ratings were tepid until House was scheduled immediately after American Idol, a talent show in which Britain's Simon Cowell lacerates wannabe pop stars. Verbal brutality sells these days.
Doctors may well enjoy watching a stubbly, tieless consultant who fights with hospital management (and wins), challenges patients to sue him if they dare, and unleashes vitriolic sarcasm on a trendy mum who refuses to have her child vaccinated. Laurie's father, a Scot, was a general practitioner in Oxford (and nothing like House, of course) but Hugh thinks Dad would have liked the show.
It is a hit in the US—as good as Desperate Housewives, says the Washington Post. Umpteen episodes have been ordered and Laurie, having pulled out of the next Superman film, is working endless 16-hour days. The accent is flawless but hard work: “Saying something like ‘coronary artery' gives me a nosebleed. I have to lie down in a dark room for 20 minutes.”
Perhaps, like Conan Doyle, he will tire of his creation before the public does. Or a reputed £240 000 an episode may keep him going. Either way, it's good to see him doing well. Being a national treasure in two countries is pretty cool, even for an Old Etonian.
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