The Most Medically Accurate ‘House’ Episode Diagnoses a Rare Disease

The Big Picture

• House
  ‘s accuracy in portraying rare medical conditions is acknowledged by doctors, with Season 2, Episode 15 receiving high praise.
• The mysterious ailment in the episode turns out to be gold poisoning, accurately represented with symptoms matching real-life cases.
• While some of House’s medical decisions are questionable, the show still manages to present an accurate and relatable subplot for doctors.

The 8 seasons of House have given us spectacular medical cases with vastly varying degrees of realism and one of our long-standing favorite misanthropes. Dr. Gregory House (Hugh Laurie) is a genius at diagnosing rare medical conditions and, apparently, that gives him leeway to constantly cross ethical and legal lines while churning out apathetic yet witty one-liners. It also means the caliber of the medical conditions presented always borders on unheard of to plain unrealistic. However, a group of doctors who analyze each episode in their blog, Polite Dissent — namely Dr. Scott Morrison — have hailed House‘s accuracy. Of course, we’re not talking about the grossly misrepresented culture of doctors carelessly talking about dying patients over coffee or the endless cases of blatant and overlooked malpractice, it is the medical accuracy of rare conditions that deserves applause.

According to Dr. Morrison’s ratings, the most accurate rare medical condition reflected in the show was actually in an earlier season: Season 2, Episode 15, “Clueless.” Dr. Morrison rarely handed out As in his grading system, but the representation of the symptoms, diagnosis and treatment of Bob Palko’s (Eddie Mills) case deserved it.

What Happens in ‘House’ Season 2 Episode 15?

In the episode, Bob is rushed to Princeton-Plainsboro Teaching Hospital with an inflamed tongue that began swelling during rough intercourse with his wife, Maria (Samantha Mathis). Like every episode, there is a flurry of condescending remarks from House and an overly competitive debate over diagnoses. As each test is conducted and each diagnosis is undermined, Bob’s symptoms worsen, until House comes up with a ludicrous idea and solution, yet inevitably saves the day.

Many doctors were unable to identify Bob’s condition, and eventually he was referred to House, as many unwitting patients are. While House’s team, Cameron (Jennifer Morrison), Foreman (Omar Epps) and Chase (Jesse Spencer) come up with the preliminary diagnosis, House is more focused on Bob’s lungs. In Dr. Morrison’s review of Season 2, Episode 15, he confirms that House is correct — the test that was done, plethysmography (where the changes of volume around the body is measured), coupled with the CT scan indicated lung function issues. As Foreman starts conducting his investigation off of House’s lung findings, a big red itchy rash begins to form on Bob’s chest. This leads Foreman to consider lupus, whereas House is convinced it is heavy metal poisoning.

‘House’ Gets This Rare Condition’s Symptoms Right

As per usual, House’s theory takes precedence and treatment for lead poisoning commences, which is the most common type of heavy metal poisoning. However, the treatment fails to heal Bob so, naturally, Chase begins testing his own theory while House stubbornly pursues other pathways to prove his own. While it is definitely not accurate for doctors to conduct investigations to figuring out if their patient’s spouse is poisoning them, it is always a pleasure to see House making people unbelievably frustrated and enraged. Especially when it turns out he is correct.

The mysterious ailment that plagued Bob is gold poisoning from an arthritis drug administered by his wife. Dr. Morrison confirms that there is such a drug that contains traces of gold, but it is not commonly prescribed in the U.S. Each progressive symptom, the inflammation, peripheral neuropathy (Bob’s painful burning sensations in his feet), itchy rash, vomitting, and kidney failure, line up with the true diagnosis as described by the National Organization of Rare Disorders. According to Dr. Morrison, gold poisoning is a fairly creative and satisfying solution to this mystery (or as House says, “it’s almost… poetic”), for both doctors and non-doctors alike, and was surprisingly accurately represented as well.

‘House’s Treatments Are Sometimes Questionable

Overall, Dr Morrison agreed with each diagnosis and how the team approached the case, from the instant identification of lung issues via the CT scan and the plethysmography, to the tentative allergy testing by Chase due to the inflammation and rapid decline of Bob’s health. However, Dr. Morrison pointed out a few points where he would have done things differently, such as doing a biopsy on the red rash rather than assume lupus or heavy metal poisoning. However, he also admits that these are also perfectly acceptable theories, and it is more of a matter of personal preference for each doctor.

One of the bigger concerns, which admittedly is still minor, is starting the defibrillator at 360 joules. According to the American Heart Association, the type of defibrillator that was used in the episode should have been initially used at 120–200 joules at the first shock, then increased in increments as appropriate. Starting off at 360 joules is too high in real life, but in the show, it is just the right amount for the typical House dramatic flair. It also helps that Hugh Laurie completely sells the part, making us believe that it is completely acceptable to initiate a defibrillator at that degree in an emergency.

Even ‘House’s Subplot Is Accurate and Relatable to Doctors

Alongside the final diagnosis, the mystery of how Bob got ill is resolved. Initially, the doctors believed Bob had a sexually transmitted infection (STI), and since his wife wasn’t displaying any symptoms, the logical deduction was that he had an extra-marital affair. Funnily enough, this is actually a real life situation that doctors have to deal with sometimes. What is not so relatable is the irreverent attitude House has whenever he snarkily reveals this theory — fortunately for us, doctors are required to have slightly more professional bedside manners than that.

The plot ends with an interesting fun fact woven in between an outrageous anecdote by House about his trip to Egypt. Cornering Maria, he explains that when traces of gold are mixed with a certain chemical, it turns purple. This is actually true, and it is also how House managed to prove his theory while catching Maria red-handed — or purple-handed. While medical shows are most definitely not renowned for their accuracy, it might surprise viewers to know how medically-accurate House is (despite the more fantastical episodes).

House, M.D. is available to watch now on Netflix in the U.S.

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