1 - Uncertainty in Medicine: The Art of Not Knowing
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Why does the TV show *House MD* illustrate medicine’s fear of uncertainty?
Twelve fifty two PM, Doctor House checks in. Please write that down. Do you have cable TV here somewhere? General Hospital starts in eight minutes.
No TV, but we've
got patients.
For those who don't recognize the voice, that is Dr. Gregory House of the hugely popular television series from the early two thousands, House MD.
Hoff just won't go away. Runny nose looks a funny color. Orange. The colour? Well the fruit. How orange?
House is a legendary diagnostician that heads up a team of doctors that solve the medical mysteries no other doctors can. He's cantankerous, he's remarkably rude, and of course, brilliant.
You you're talking about brain surgery. I'm talking about really cool brain surgery.
His name is actually a clever nod to Sherlock Holmes. And like Holmes, Dr. House is fictional. We know this because House solves everything. All medical cases he touches are gradually stripped of uncertainty by the sheer force of House's medical deduction.
Clue number one, if I were Jesus, curing this kid would be as easy as turning water into wine. Demonic possession? Close, but no wafer. Clue number two, rheumatology roan, is almost right. It causes autoimmune symptoms. Leprosy? Yeah, that's real big in the Jersey suburbs. It's leprosy.
So we try to find an episode of House where he isn't able to solve the case, where uncertainty rules the day. Just one episode. We actually put the question to the House MD subreddit, which boasts 119,000 members, and we got a lot of responses. They found multiple episodes where House's colleagues cracked the case, and a few where the patient died, which sounded promising at first in a weird way, but House eventually solves those cases during the autopsy. The one episode where fans agreed that House came closest to not solving a case was the season two finale, an episode titled No Reason, where the patient is a man with an engorged tongue.
It's hilarious to watch him try and talk. I asked him anything I could think of. Favorites. Dessert topping. Uh
Which *House* episode actually leaves a case unsolved and why does that matter?
Room.
It's a wild episode. The patient bleeds into his ocular orbit and more grisly things actually happen that I won't get into. It was the season finale, after all. But the fans are right, the case goes unsolved. And there's a reason it goes unsolved.
Are you hallucinating? Yeah, I'm hallucinating. No, I mean right now. But you're hallucinating.
House hallucinates the whole thing. It's something having to do with the experimental ketamine treatment that House was given after being shot at the beginning of the episode, which is a long story. But the point is that uncertainty, even here, had to be explained away. Uncertainty, almost as a concept, was never allowed to remain in House MD throughout the entirety of its 177-episode run. The writers must have thought that for the audience, lingering uncertainty would be unbearable, that audiences wouldn't accept it, that it just wasn't satisfying.
Much of what we do in our cases and our simulations tend to be cases that have a a linear path. There's a presentation, there's a diagnostic step, and we know it.
This is Gupreet Daliwal, a professor of medicine at UCSF. He's actually kind of a real life house, although he'd probably dispute that. A New York Times article about Guprit's diagnostic abilities wrote that to observe him at work is like watching Steven Spielberg tackle a script or Rory McElroy a golf course. Here he's talking about case conferences, where medical trainees walk through a specific patient's case to understand their course of diagnosis and treatment, where typically the diagnoses are very clean and simple.
Imagine instead if the cases were uh messy, they ended without resolution. I can tell you right now when we have a case and the um diagnosis is uncertain at the end, people sort of energy falls out of the room. Everyone wanted the clear answer and I get the I I mean I'm as guilty as everyone else. I wanted a simple ending, right? A clean ending. But imagine if many case conferences were sort of like, No, this story is just about the resident um wrestling with the messiness of
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Chapters
8 chapters
1
Why does the TV show *House MD* illustrate medicine’s fear of uncertainty?
0:01–2:16
2
Which *House* episode actually leaves a case unsolved and why does that matter?
2:16–5:18
3
How do real‑world case conferences differ from TV drama in handling diagnostic uncertainty?
5:18–9:03
4
What does Dr. Gupreet Daliwal say about teaching residents to sit with ambiguous cases?
9:03–12:17
5
How did Alexa Miller’s personal family experience shape her view of medical uncertainty?
12:17–16:41
6
What definition of uncertainty do the hosts settle on and how does it feel for clinicians?
16:41–20:17
7
Why is striving for certainty sometimes harmful, and how can clinicians work with uncertainty instead?
20:17–23:44
8
What can listeners expect from the rest of the *Uncertainty in Medicine* series?
23:44–28:01