Toronto — It's not the simplest of medical drama script-writing recipes.
Find an ailment that's hard to diagnose, but not too rare. Stir in some other conditions that could credibly cloud the broth. Add a pinch of ethical dilemma, a generous dollop of interpersonal conflict or sexual tension, some spiffy high-tech visuals and bring to a boil.
Above all, make sure the ensuing brew can be savoured in no more than 44 prime-time minutes.
This is the task faced by the writers of House, M.D.
The hit series about the crack if curmudgeonly diagnostician Gregory House — played by British actor Hugh Laurie — and his overachieving team of assistants debuts its third season Tuesday.
Creator David Shore, a native of London, Ont., admits the pressure of replicating that recipe, week in and week out, was daunting in the early days of the show. Having written the pilot, he wasn't sure where he'd find the material to write show number 2.
“I'm surprised at how well we've done at finding new and different ways to stump House and have House surprise us,” Shore confesses in an interview from Hollywood.
Shore is not the only one. His smart show, which can see House and his team run through a half-dozen potential diagnoses per case, also has the admiration of some experts whose job it is to help TV shows and movies get their medical facts straight.
“House is excellent,” says Dr. John Brooks, a medical epidemiologist who specializes in HIV/AIDS at the U.S. Centers for Disease Control in Atlanta.
Brooks is one of a number of specialists who has consulted with the show's writers through a program called Hollywood, Health and Society operated out of the University of Southern California's Annenberg School of Communication.
Funded by the CDC, the National Institutes of Health and several other U.S. health agencies, the program's goal is to help the entertainment industry accurately portray medical issues by putting screenwriters in touch with experts.
Physicians are a tough audience for medical shows, quick to mock when an actor is reading an upside-down X-ray or mispronouncing the name of a medical procedure, Brooks says. Those types of jarring moments haven't been a problem on House, he adds.
“There've been a few times when I look at something and I'm like: ‘Hmm, I might have done it another way.'
“But I would say it is for the most part accurate. And that's something that I want to say is really critical in these shows.”
Shore, who was a Toronto lawyer in his pre-Hollywood incarnation, says the show gets critical letters when viewers spot what they think is a misstep. Checks with the experts show the complainants are wrong about as often as the show's writers, he says.
“We strive to do our best but I'm sure we mess up here and there,” Shore admits.
The show has a medical practitioner on set whenever medical scenes are being filmed. One of the writers is a doctor who gave up a practice in Boston to join the show. As well, every script is reviewed for accuracy by outside physicians.
Vicki Beck, director of the Hollywood, Health and Society program, says House is a regular user of the service.
“There are many opportunities for us to consult on that show, because they go through so many diagnostic, clinical topics by the time they reach the final diagnosis,” Beck says.
“We put experts on the phone with them and help them go through some scenarios. What it could be, what the symptoms might be. That step-by-step process that they use on the show, which is really, I think, very appealing to audiences — and from what I hear, even to physicians.”
One of the real challenges of writing a show like House is coming up with a continual supply of conditions that are hard to diagnose. There's no drama in the fourth case of Munchausen's syndrome, no mystery when the symptoms are a dead giveaway of a disease.
“We need stuff that is life-threatening and can be confused with several other conditions,” Shore agrees, noting some conditions with vague or common symptoms — or which can manifest themselves in unusual presentations in rare circumstances — will be becoming familiar to regular viewers.
“There are certain conditions you're going to hear on our show on more than one occasion. Vasculitis, (an inflammation of blood vessels) you're going to hear as a possible diagnosis. Lupus, you're going to hear as a possible diagnosis.”
What you won't hear are ultra-obscure conditions with distinct symptoms — even though occasionally a member of Shore's writing staff will get fired up after stumbling across a medical rarity. Why not? Shore simulates the exchange in which he has to burst the writer's bubble to explain.
(Writer:) “It's only happened once in the last 100 years. It causes your nose to fall off.”
“And I go: ‘Well, how many conditions cause your nose to fall off?'”
“And they go ‘This is the only one.'”
“And I go: ‘Well, then, he's going to figure it out pretty quickly.'”
