Performance Reviews: The Department of Diagnostic Medicine

Performance Reviews: The Department of Diagnostic Medicine
This analysis was designed to examine the performance of House and his team: doctors Chase, Cameron and Foreman (listed in order of hiring). Only patients treated by the entire team are considered. With a few exceptions, this made for one patient a week. Only the performances of House and his team (the Housepets) are evaluated here. When another character made a diagnosis s/he is given credit, and I have noted some occasions when Wilson or Cuddy contributed to the diagnosis simply for interest’s sake. The performances of Wilson and Cuddy are not reviewed here, however. Each episode was broken down by working backwards, that is, from the correct diagnosis. Each character’s actions were considered in hindsight. Wrong diagnoses are excluded as a result. This simplified things greatly, but left out a lot too. Essentially, what was considered was how the case in question was solved. Credit was awarded for a diagnosis when the malady was specified enough to be treated. For example it’s not enough to say “an infection”, the character had to say where the infection was in the body and what bacteria, fungi or virus was causing it. Errors by a team member, such as Cameron failing to spot the patient's lack of a cervix during a pelvic exam in Skin Deep, were also not noted because most seemed to be due to errors by the writers, not the characters. Errors were noted only when 1) the error was pointed out by another character and 2) the error delayed diagnosis. This included refusals to treat ill patients, which would have resulted in the patient not being diagnosed if the other characters did not intervene, and in some cases other failures to properly perform their duties as a physician. The correct diagnosis was awarded to the first character to suggest it. Many times House would come up with the final solution, but would present it to his fellows in such a way that one of them would be the first to say the words. In these cases, credit was still awarded to House. Suggestions by the characters that contributed to getting the correct diagnosis and/or later proved correct were given credit. Demonstration of obscure knowledge and suggestions for creative treatments and diagnostic methods were also given credit. These were included only if it appeared that no one else was going to think of it; because I am not a medical expert, I may be wrong in some of my interpretations. Credit was given when a character spotted something on a test that other characters couldn't see. Again, House would sometimes spot something and point it out; credit here was given to House. These occasions were noted only when the others (or most of them) looked at the same test and failed to see the significant result. Initial Symptoms are the symptoms the patient had when the case was assigned to the team, and does not include symptoms developed later. They may not fully tally with the final diagnosis as a result, but were listed just for record-keeping purposes so it doesn't matter. Final Diagnoses are the final diagnoses relevant to the patient's condition. For example, the patient in Heavy admitted to using diet pills, but in the end her condition (and symptoms) had nothing to do with diet pills. Diet pills were therefore not considered a final diagnosis. Information from Polite Dissent and the House transcripts sites were used in my evaluations, completely without permission I should add.

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Let's get started! 1.01 Pilot Initial Symptoms: Woman with seizures + inability to speak Diagnosis: Tapeworm in the brain (House) Contributions by Team House (2): Diagnosis for tapeworm, idea to use x-ray on leg instead of brain Chase (1): Idea to use x-ray for diagnosis Cameron (1): Recognizes allergic reaction to MRI dye Foreman (1): Catches Wilson's lie about his "cousin", leading to revelation that patient ate ham

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1.02 Paternity Initial Symptoms: Boy with double vision + night terrors Diagnosis: Subacute sclerosis panencephalitis (House) Contributions by Team House (2): Spots blockage on MRI, diagnosis for measles virus in brain Chase (0): None Cameron (0): None Foreman (2): Tests CSF, idea to biopsy retina to confirm diagnosis Notes: It wasn’t clear which Housepet had the idea to test the patient’s spinal fluid, but it wasn’t House’s. I’m saying it was Foreman because he was the one to tell House that they did it.

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1.03 Occam's Razor Initial Symptoms: Boy with rash + cough + low blood pressure Diagnosis: Cold (House) + wrongly prescribed colchicine (House) Contributions by Team House (4): Realizes patient has two conditions at once, diagnosis for gout medication, diagnosis for cough, tracks down gout medication to find out how patient was given it Chase (0): None Cameron (0): None Foreman (0): None Notes: Foreman received an error for screwing up a heart catherization.

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1.04 Maternity Initial Symptoms: Two newborns with fevers Diagnosis: Epidemic (House) caused by Enterovirus infection (Foreman) spread by a hospital volunteer Contributions by Team House (5): Diagnosis for the epidemic, idea to give different antibiotics to different babies, recognizes illness is viral, idea to test mothers too, tracks down source of virus Chase (1): suggests a virus Cameron (1): Idea to let parents hold baby (part of patient treatment) Foreman (1): Diagnosis for Enterovirus because he was the first to suggest it Notes: Cameron received an Error for failing to tell the parents that their baby had died. It’s not part of the diagnostic process, it’s true, but it is part of treating patients. Foreman also because the first Housepet to get a Diagnosis.

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1.05 Damned If You Do Initial Symptoms: Woman with skin rash + reaction to epinephrine Diagnoses: Allergy to copper IUD (Cameron) + tea/epinephrine interaction (House) + herpetic encephalitis (Foreman) Contributions by Team House (2): Diagnosis for tea/epinephrine interaction, idea to do full body scan for diagnosis Chase (1): Tells House to talk to Mother Superior to learn more about patient Cameron (2): Diagnosis for systemic allergy, idea to put patient in clean room to diagnose her Foreman (1): Diagnosis for herpetic encephalitis Notes: The herpetic encephalitis diagnosis got lost somewhere in the middle of the episode.

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1.06 The Socratic Method Initial Symptoms: Woman with schizophrenia diagnosis + blood clot Diagnosis: Wilson's disease (Cameron) + liver cancer (Chase) + vitamin K deficiency (House) Contributions by Team House (3): Diagnosis for Vitamin K deficiency, idea to shrink tumor for surgery, realizes original schizophrenia diagnosis is wrong Chase (1): Diagnosis for liver cancer Cameron (1): Diagnosis for Wilson's disease Foreman (0): None Notes: If Chase hadn’t ultrasounded the patient’s liver to look for cirrhosis, the liver cancer wouldn’t have been found. Chase therefore gets credit for the diagnosis even though he didn’t expect to find cancer; he was the one who suspected a liver problem.

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1.07 Fidelity Initial Symptoms: Woman sleeping 18 hours a day Diagnosis: African sleeping sickness transmitted by sex (House) Contributions by Team House (2): Diagnosis for African trypanosomiasis, realizes that illness was sexually transmitted Chase (1): Suggests a parasite Cameron (0): None Foreman (0): None

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1.08 Poison Initial Symptoms: Boy with severe bradycardia + nausea Diagnosis: Organophosphate poisoning (Cameron) from stolen pants (House) Contributions by Team House (2): Suggests pesticide was organophosphate, idea that poison came from pants Chase (0): None Cameron (1): Diagnosis for pesticide poisoning Foreman (1): Idea to use experimental Army treatment Notes: The focus of this episode was finding where the patients had been exposed to the pesticide, not diagnosing the poisoning.

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1.09 DNR Initial Symptoms: Man with paralysis + pneumonia Diagnosis: Stroke (Cameron) + arteriovenous malformation (AVM) (House) Contributions by Team House (2): Insisted patient didn't have Lou Gehrig's disease, diagnosis for AVM Chase (0): None Cameron (1): Diagnosis for stroke Foreman (1): Idea for embolectomy to treat blood clot Notes: The AVM was found on the MRI, without House knowing it would be there. He was the one who ordered the team to redo the MRI, however, so he gets credit for it.

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1.10 Histories Initial Symptoms: Woman with arm twitch + seizures Diagnosis: Abdominal tuberculoma (House) + insulin overdose (Foreman) + rabies (House) Contributions by Team House (4): Idea to ID patient from surgical pin, diagnosis for tuberculoma, realized patient was tasered by cop, diagnosis for rabies Chase (1): Suggested ice bath to treat fever Cameron (0): None Foreman (1): Diagnosis for insulin overdose Notes: Foreman gets an error for initially refusing to treat the patient. Putting the patient in an ice bath doesn’t seem particularly exceptional to me, but no other character suggested it so it counts as a creative treatment. House gets credit for realizing why the patient collapsed in the park because otherwise it would have been considered a symptom.

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1.11 Detox Initial Symptoms: Boy with hemolytic anemia Diagnosis: Naphthalene poisoning from termite nests (House) Contributions by Team House (2): Idea to autopsy cat, diagnosis for naphthalene toxicity Chase (1): Idea for procedure to remove clot from eye Cameron (0): None Foreman (0): None

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1.12 Sports Medicine Initial Symptoms: Man with osteopenia (thinning of bones) Diagnosis: Cadmium poisoning (House) from marijuana (Chase) Contributions by Team House (2): Realizes illness is environmental because the wife has it too, diagnosis for cadmium poisoning Chase (1): Diagnosis for cadmium poisoning from marijuana Cameron (0): None Foreman (1): Suggests metal toxicity from environment Notes: From the scene it appears that House was the first to realize the patient had cadmium poisoning and was leading the Housepets to the same diagnosis, so House was awarded the diagnosis even though Chase said the actual words. Chase received credit for realizing where the cadmium exposure had come from. Wilson diagnosed the digitalis overdose, which would have been considered a symptom otherwise. House received an error for putting the patient on Lupron to treat steroids even after he tested negative for them, causing respiratory system damage. (Props to Poeia for pointing this out.)

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