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Doctor of Medicine (MD, from the Latin Medicinæ Doctor meaning "Teacher of Medicine") is a doctoral degree for physicians granted by medical schools. It is a professional doctorate / first professional degree (qualifying degree) in some countries, including the United States and Canada, although training is entered after obtaining from 90 to 120 credit hours of university level work (see second entry degree) and in most cases after having obtained a Bachelors Degree. In other countries, such as India, the United Kingdom, Germany, and Sri Lanka, the MD is an advanced academic research degree more similar to a PhD. In India, Britain, Ireland, and many Commonwealth nations, the medical degree is instead the MBBS i.e., Bachelor of Medicine, Bachelor of Surgery (MBChB, BM BCh, MB BCh, MBBS, BMBS, BMed, BM) and is equivalent to the MD and DO degrees in the U.S. system.

History of the medical degree[link]

According to Sir John Bagot Glubb, Syed Faride and S. M. Imamuddin, the first medical schools to issue academic degrees and diplomas were the teaching Bimaristan (Hospitals) of the medieval Islamic world. The first of these institutions was opened in Baghdad during the time of Harun al-Rashid. They then appeared in Egypt from 872 and then in Islamic Spain, Persia and the Maghreb thereafter. Physicians and surgeons at these hospital-universities gave lectures on Medicine to medical students and then a medical diploma or degree was issued to students who were qualified to be practicing physicians.^[1][2][3]

According to Douglas Guthrie,^[4] who bases his account on L Thorndike,^[5] medical men were first called "Doctor" at the Medical School of Salerno. He states that the Emperor Frederick II decreed in 1221 that no one should practice medicine until he had been publicly examined and approved by the masters of Salerno. The course lasted 5 years, and to start one had to be 21 years old and show proof of legitimacy and of three years study of logic. The course was followed by a year of supervised practice. After the laureation ceremony the practitioners could call themselves "magister" or "doctor."

Academic degrees for physicians by country[link]

United States and Canada[link]

The first medical schools that granted the MD degree were Columbia, Penn, Harvard, Maryland, and McGill.^[6] These first few North American medical schools that were established were (for the most part) founded by physicians and surgeons who had been trained in England and Scotland. University medical education in England culminated with the MB qualification, and in Scotland the MD, until in the mid-19th century the public bodies who regulated medical practice at the time required practitioners in Scotland as well as England to hold the dual Bachelor of Medicine and Bachelor of Surgery degrees (MB BS/MBChB/MB BChir/BM BCh etc.). North American Medical schools switched to the tradition of the Ancient universities of Scotland and began granting the M.D. title rather than the MB beginning in the late 18th century. The Columbia University College of Physicians and Surgeons in New York (which at the time was referred to as King's College of Medicine) was the first American University to grant the MD degree instead of the MB.^[7]

In the United States, MDs are awarded by medical schools accredited by the Liaison Committee on Medical Education (LCME), an independent body sponsored by the Association of American Medical Colleges and the American Medical Association (AMA).^[8][9]

Admission to medical schools in the United States is highly competitive, with about 17,800 out of approximately 47,000 applicants receiving at least one acceptance to any medical school in recent application years. Before entering medical school, students must complete a four year undergraduate degree and take the Medical College Admission Test (MCAT). Before graduating from a medical school and achieving the degree of Medical Doctor, most schools require their students to take the United States Medical Licensing Examination (USMLE) Step 1 and both the Clinical Knowledge and Clinical Skills parts of Step 2. The M.D. degree is typically earned in four years. Following the awarding of the MD, physicians who wish to practice in the United States are required to complete at least one internship year (PGY-1) and pass the USMLE Step 3. In order to receive Board Eligible or Board Accredited status in a specialty of medicine such as general surgery or internal medicine, then undergo additional specialized training in the form of a residency. Those who wish to further specialize in areas such as cardiology or interventional radiology then complete a fellowship. Depending upon the physician's chosen field, residencies and fellowships involve an additional three to eight years of training after obtaining the M.D. This can be lengthened with additional research years, which can last one, two, or more years. The Doctor of Osteopathic Medicine or D.O. degree is the only other legal and professional equivalent to the M.D. degree in the United States and some parts of Canada. The differences between the M.D. and the D.O. degrees lie in the distinctive osteopathic philosophy and osteopathic manipulative treatment (OMT). In Canada, the M.D. is the basic medical degree required to practice medicine. McGill University Faculty of Medicine is the only medical school in Canada to award M.D., C.M. degrees (abbreviated MDCM). MDCM is from the Latin "Doctorem Medicinae et Chirurgiae Magistrum" meaning "Doctor of Medicine and Master of Surgery".

Research physicians[link]

Even though the M.D. and D.O. are first professional degrees and not doctorates of research (i.e., a Ph.D.), many holders of the M.D. or D.O. degree conduct clinical and basic scientific research and publish in peer-reviewed journals during training and after graduation. Combined medical and research training is offered through programs granting MD/PhD or DO/PhD degrees. The National Institutes of Health through its Medical Scientist Training Program funds MD/PhD training programs at many universities. Some MDs and DOs choose a research career and receive funding from the NIH as well as other sources such as the Howard Hughes Medical Institute. A few even go on to become Nobel Laureates.^[10] The United States Department of Education and the National Science Foundation do not include the M.D. or other professional doctorates among the degrees that are equivalent to research doctorates.^[11][12]

UK, Ireland and some Commonwealth countries[link]

In the UK, Ireland and many Commonwealth countries, the MD is a postgraduate research degree in medicine. At some universities, this takes the form of a first doctorate, analogous to the PhD, awarded upon submission of a thesis and a successful viva. The thesis may consist of new research undertaken on a full- or part-time basis, with much less supervision (in the UK) than for a PhD, or a portfolio of previously published work.^[13]

In order to be eligible to apply for an MD degree from a UK or Commonwealth University one must hold either an MBBS, MBChB, or an equivalent US-MD degree and must usually have at least 5-years of postgraduate experience. Therefore graduates from the MBBS or MBChB degrees do not hold doctorates, however physicians holding these degrees are referred to as 'Doctor' as they are fully licensed as primary care physicians upon the completion of mandatory clinical internship minimum of one full year after graduating from the medical college. In some commonwealth nations these interns are designated as as House surgeons. Total duration to obtain MBBS degree is about 6 years that includes 5 years of course work and minimum one year of Compulsory rotating clinical internship.

At some other universities (especially older institutions such as Oxford, Cambridge and St Andrews) the MD is a higher doctorate (similar to a DSc) awarded upon submission of a portfolio of published work representing a substantial contribution to medical research.^[14]

In the case where the MD is awarded (either as a first or higher doctorate) for previously published research, the candidate is usually required to be either a graduate or a full-time member of staff, of several years' standing of the university in question.^[15]

The entry-level first professional degree in these countries for the practice of medicine is that of Bachelor of Medicine and Bachelor of Surgery (MBBS, MB, MB BCh BAO, BMBS, MBBChir, or MBChB). This degree typically requires between four and six years of study and clinical training, and is equivalent to the North American MD degree.

The University of Melbourne^[16] in Australia introduced the North American MD degree in 2011 for graduates of the Bachelor of Biomedicine and Bachelor of Science New Generation degrees. The university is the first in Australia to leave the Bachelor of Medicine and Bachelor of Surgery (MBBS) and offer the Doctor of Medicine (MD) as a first professional degree in medicine rather than as a research degree. The first cohort of MD students from the university will graduate in 2014, one year after the last graduating cohort of MBBS students. The University of Melbourne renamed its previous research MD degree to Doctor of Medical Science (DMedSc), which will distinguish the new MD graduates from the doctors who obtain the research degree.

The University of Western Australia from 2014 will begin a similar 4 year post graduate course with graduates qualifying with an MD rather than the MBBS as it stood up until 2011.

The University of Queensland is planning on also introducing the MD to replace the current Bachelor of Medicine and Bachelor of Surgery.^[17]

Argentina[link]

In Argentina the First Degree of Physician or Medic Title (Título de Médico)^[18] is equivalent to the North American M. D. Degree with 6 year of intensive studies followed by usually three or four years of the residency as a major specialty in a particular empiric field, compounded of internships, social services and sporadic research. Only by holding a Medical Title the postgraduate student might apply for the Doctor degree through a Doctorate in Medicine program approved by the National Commission for University Evaluation and Accreditation.^[19]

India[link]

The MBBS degree represents the first (graduation) level of training required to be licensed as a physicians, and the MS OR MD degree is a higher postgraduate degree, representative of specialty training. The equivalent training in the US or Canada would be completion of a medical (post-graduate) degree. Eligibility for the MS or MD course is restricted to medical graduates holding the MBBS degree. The MBBS course is for five and a half years, and training is obtained in medical disciplines (e.g.: Internal Medicine, Radiology, Pathology, etc.). After three years of study and the successful completion of an examination, which includes both theoretical and practical elements, in a pre-clinical or clinical subject of a non-surgical nature the candidate receives MD degree, were as in a pre-clinical or clinical subject of a surgical nature i.e,anatomy ,general surgery, orthopaedics and gynaecology the candidate receives the equivalent degree Master of Surgery (MS).

The research element is not prominent in India, as this is primarily a clinical qualification resembling the professional doctorates of the USA. In general surgery, orthopaedics and gynaecology and in a pre-clinical subject like anatomy the equivalent degree is Master of Surgery (MS).

A third qualification, termed DNB [Diplomate of National Board], is considered equivalent to the MD and MS degrees. This can be obtained by passing the exam conducted by the National Board of Examinations after completing 3 years of post-MBBS residency training in teaching hospitals recognised by the board.

After obtaining the first postgraduate degree, that is MD/MS/DNB, one can go for further specialisation in medical or surgical fields. This requires three years of additional training and study and then passing an examination, both theory and practical, and the degree awarded is DM (Doctor of Medicine), like DM in Cardiology, Neurology, Nephrology, Gastroenterology, etc. For surgical subspecialities the degree awarded is MCh (Magister Chirurgiae), like MCh in Cardiac thoracicSurgery, Neurosurgery, etc. A third qualification in subspecialities is DNB (superspecialties), offered by National Board of Examinations, like DNB in Cardiology, Neurology, Cardiac Surgery, Neurosurgery, etc.

The MCh degrees are for super-specialties in medicine and are very high ranked/prestigious.

In Ayurveda, B.A.M.S in Unani, Bachelor of Unani Medicine and Surgery BUMS in Sidha BSMS in homoeo B.H.M.S are the basic qualification for practicing Ayurveda,Unani,Homoeo&Sidha. The B.A.M.S, B.U.M.S, B.S.M.S and B.H.M.S are 6 year degree (including internship called house surgeoncy) course after 12 years of formal education at a C.C.I.M approved colleges. M.D has to be done after B.A.M.S, B.U.M.S, B.S.M.S or B.H.M.S in a speciality, and it takes 3 years (including submission of a thesis) to complete the course. In Acupuncture Diploma in Acupuncture D Acu is the basement course for Bachelor of Acupuncture B Acu (three years). MD Acu is the post graduate(Master)degree in Acupuncture(two years after B Acu).

Pakistan[link]

In Pakistan equivalent degree is MBBS (bachelors of medicine and bachelors of surgery). MBBS is awarded as the basic medical qualification after completing five years of study. This comprises two years of basic science subjects including anatomy, physiology, and biochemistry, with a particular emphasis on human anatomy. Subsequently, there are three years of clinical internship and courses on medicine surgery and pharmacology. Finally, the student is required to work for one year under a professor, before one is awarded Degree of MBBS with license to practice. For specialization, one has to pass Fellow of College of Physicians & Surgeons Pakistan (FCPS) exam-1 in field in of specialization and obtain an internship in the field for 3–6 years. Next, one can take the FCPS exam part 2, which includes intensive practical exams. Upon successful completion a fellow of the relevant specialty is awarded. Tough entry tests are passed successfully before entering in to a medical college. Medical colleges and foreign medical qualifications are supervised by the Pakistan Medical and Dental Council (PMDC). Specialized degrees are awarded by the Pakistan College of Physicians and Surgeons. In basic medical sciences such as Anatomy, Physiology, Biochemistry, Pathology etc. the research postgraduate degree awarded by many universities is M.Phil., which has a pre-requirement of at least two years of Demonstratorship in relevant subject in a recognized Medical College. The Mphil course is 2–4 years and is a research postgraduate degree, containing submission and defence of research thesis in basic sciences similar to MD degree program in India. Many universities in conjunction with tertiary hospitals offer coursework MD and MS degrees as well.

Romania[link]

Romanian medical school lasts for 6 years including clinical practice and concludes with a final licensing examination (licenta). The degree awarded is Doctor-medic (Medical Doctor) abbreviated as MD.^[20]

Sri Lanka[link]

In Sri Lanka, MBBS degree is the degree to be held for one to be licensed as a physicians by the Sri Lanka Medical Council. MD degree is a higher postgraduate degree and in Sri Lanka awarded by the Postgraduate Institute of Medicine after completion of a postgraduate course and examinations. The MD degree in Sri Lanka is representative of specialty training in clinical, para clinical and preventive medicine (e.g., General Medicine, Cardiology, Nephrology, Oncology, para clincal such as microbiology, haematology and preventive such as Community Medicne .). Entry for the MD course open only for medical graduates holding the MBBS degree (with a duration of five and a half years), and training is obtained in medical disciplines that are non-surgical in nature (e.g., Internal Medicine, Radiology, Pathology, etc.). After three or four years of study and the successful completion of an examination with written as well as cases and viva examinations, the MD degree in the respective field of Study is awarded. In Community medicine and Medical Administration, part I examination consists of a theoretical exam while the degree is cofered after completion of a thesis as n PhD. This thesis has to be completed within a period of five years. After successfully defending the academic thesis, MD degree is conferred to the candidate,The MD degree holder is certified as a Board certified specialist by the respective board of study of the Postgraduate Institute of Medicine after he/she undergoes 2–4 years of local and foreign training depending on the specialty/subspecialty selected .

Equivalent degrees in other countries[link]

• In the Dominican Republic it is known as "DOCTOR EN MEDICINA" (DOCTOR IN MEDICINE). In 1511 the Spanish Catholic church founded the first university of the Americas in Santo Domingo present capital of modern day Dominican Republic and name it UNIVERSIDAD SANTO TOMAS DE AQUINO (today UNIVERSIDAD AUTONOMA DE SANTO DOMINGO). In 1630 this university graduated the first medical doctors of the Americas and amongst the graduates some Native Americans included.

• The Bachelor of Medicine and Bachelor of Surgery degrees (MB BS or MB ChB, and several variants).
• In Italy, the title of "Dottore in Medicina e Chirurgia" (literally "Doctor in Medicine and Surgery") is awarded by a preventive selection ("test a numero chiuso"): only 10% of the students that pass this test have to complete 6 years of medical school and have to pass a final state examination (called "abilitazione") to acquire the right to work as a physician; finally they can use the title "Dott." or "Dr." before the name. All Doctors then must sign theirself to a schools of specialization (literally "scuole di specializzazione") that, after the winning of the competition in the field that each doctors choose, last 4 years at least.
• In Germany students having completed 6 years of medical school and two rigorous state examinations acquire the right to work as a physician but no definite title. To obtain the degree "Dr. med., doctor medicinæ; Dr. med. dent., doctor medicinæ dentariæ; Dr. med. vet., doctor medicinæ veterinariæ" writing a dissertation/thesis is required. It is estimated that 70% of all graduates will eventually complete a dissertation, which is perceived to be important for career promotion and to attract patients.
• The Czech and Slovak title MUDr. (Medicinae Universae doctor or doktor medicíny) is a professional doctorate granted upon completion of six years pregraduate Master's study at medical schools. The postgraduate academic research degree in medicine is a PhD degree.
• In Poland the title of lekarz (physician, medic) or "lek." (previously lekarz medycyny or "lek. med.") is granted after completing a 6-year Master's medical program (although students apply to it directly after graduating high school).^[21][21] In contrast, a higher doctoral academic research degree in medicine resembling a PhD is named "dr n. med." or doktor nauk medycznych (Doctor of Medical Sciences). Specialization is valued similarly to a specialization in the English system and is a pre-requisite for a "dr. n. med." which is usually defined within the same field.
• The Danish and Norwegian Candidatus medicinae or Candidata medicinae degrees (cand.med.) is awarded after completing a 6-year medical programme, to which students apply directely upon finishing secondary school. The programme usually includes a small thesis. However, the cand.med. degree must not be confused with the previous Danish and Norwegian dr.med. degree, which is equivalent to the current post-graduate PhD.
• In Mexico, schools of medicine award the "Titulo de Medico Cirujano" degree after completing either 6 or 7 years of study. This curriculum includes a rotating internship year and a year of social service providing care to an underserved community.
• In Nepal, a MBBS degree is awarded.
• In Greece, after a six-year study, a medical student acquires his medical degree and the right to use "Δρ.", (Dr.) before his name. This is considered equivalent to the M.D. title.
• In Iran the professional degree in Medicine or MD is awarded upon completion of seven years continuous study started with 5.5 years university education include 2.5 years basic sciences,1 year pathophysiology and 2 years clinical courses followed by one & half year of internship in accredited hospitals plus thesis.
• In mainland China, some medical schools award MBBS to foreign students while all medical schools award Bachelor of Medicine to nationals. MD is a higher academic research degree.
• In Colombia, the medicine faculties of the universities awards the title of "Medico Cirujano" after taking 10 semesters of studies on "all clinic and surgery disciplines an 2 semester on internship. After receiving the degree there is a mandatory year "obliged social work" were the doctors practice as GP in the countryside. Residency programs last between 3-4 years depends on the specialty.
• In Sudan the awarded degree in most of the medical schools is, Bachelor of Medicine and Basic Surgery (MBBS).In schools that are based on the English system of medical teaching, the degree is granted after 6 years of studying. As for the schools that are adopting the American system, they grant their students the degree of MBBS in only 5 years.
• In Turkey, the title of "Tıp Doktoru" (literally "Doctor of Medicine") is awarded upon completion of six years continuous study started with 5 years university education include 3 years basic sciences, 2 years clinical courses followed by one year of internship in university hospitals.
• In the Netherlands, the title 'Arts' (Dutch, meaning 'physician') is awarded after six years of study, and most patients address the physician as 'Dokter'. Most Dutch universities have divided the medical study in four years theory and two years practical experience. Exception are the universities of Maastricht and Utrecht. At Utrecht the program consists of two and a half year of theory, two and a half year specialty-dedicated theory blocks, a clinical rotation in that specialty, and one year continuous practical experience.
• In Indonesia, the title of "dokter" (dr.) is awarded after a Medical student received their Bachelor in Medicine (Sarjana Kedokteran; S.Ked) after 3-3,5 years of study (at least) and 1,5 – 2 years of clinical course in university hospitals. After a medical student finished those 5 years of study and take Hippocrates Oath, The title of Dokter (Dr.) is entitled before their name. Then they need to take Ujian Kompetensi Dokter Indonesia (UKDI, test to get license to practice medicine as general practitioner) then take a year long internship course in primary health care clinics (also known as Puskesmas) or primary hospitals all over the country to practice as general practitioner under supervision of senior doctors. Those who wished to further their study into specialties can take graduate course of medicine of their preference and will be entitled with "Specialist of ..." after their name (e.g.: Sp.A for Spesialis Anak = Pediatrician). graduate course of medicine is equal with residency program which is required the candidates to study for 4 years and hospital internship. (Note: dr. (dokter) is used for medical graduates, while Dr. (Doktor) is used for PhD holders.)

Other postgraduate clinical degrees[link]

There is also a similar advanced professional degree to the postgraduate MD: the Master of Surgery (usually ChM or MS, but MCh in Scotland, Ireland, Wales and at Oxford and MChir at Cambridge). The equivalence of these degrees, but their differing names, prevents the need for surgeons (addressed as Mr. in the UK) having to revert to the title Dr., which they once held as new MBBS graduates.

In Ireland, where the basic medical qualification includes a degree in obstetrics, there is a similar higher degree of Master of the Art of Obstetrics (MAO). A Master of Midwifery was formerly examined by the Worshipful Society of Apothecaries of London (hence MMSA) but fell into abeyance in the 1960s; in this case the term Master referred not to a university degree but rather a professional rank that is common among craft guilds.

In East Africa, the medical schools in Kenya, Tanzania and Uganda award the degree of Master of Medicine (MMed) degree in both surgical and medical specialty disciplines following a three year period of instruction.

In West Africa, the West African College of Physicians and the West African College of Surgeons award the Fellowship of the West African College of Physicians (FWACP) and the Fellowship of the West African College of Surgeons (FWACS) in medical and surgical disciplines respectively after a minimum of four year residency training period.

References[link]

http://www.ucl.ac.uk/medicalschool/undergraduate/mbbs-programme/prospectus/medicalschoolprospectus2012.pdf

Further reading[link]

• Biabangardi, Zinab; Baradaran (2006). JCEHP 26 (3). 

Gregory House, M.D., (often simply referred to as House)^[1] is the title character and an antihero of the American television series House, played by Hugh Laurie. House is the Chief of Diagnostic Medicine at the fictional Princeton-Plainsboro Teaching Hospital in New Jersey, where he leads a team of diagnosticians. House's character has been described as a misanthrope, cynic, narcissist and curmudgeon. He is the only character to appear in all 177 episodes. The season 6 premiere is the only episode in which House is the only regular character to appear, besides Wilson (briefly).

In the series, the character's unorthodox diagnostic approaches, radical therapeutic motives, and stalwart rationality have resulted in much conflict between him and his colleagues.^[2] House is also often portrayed as lacking sympathy for his patients and having a practice allowing him the time to solve pathological enigmas. The character is partly inspired by Sherlock Holmes.^[3][4] A portion of the show's plot centers on House's habitual use of Vicodin to manage pain stemming from a leg infarction involving his quadriceps muscle some years earlier, an injury that forces him to walk with a cane. This addiction is also one of the many parallels to Holmes, who was a habitual user of cocaine and opium.^[5]

Throughout the series' run, the character has received positive reviews.^[6][7] Tom Shales of The Washington Post called House "the most electrifying character to hit television in years".^[8] In 2008, House was voted second sexiest TV doctor ever, behind Dr. Doug Ross (George Clooney) from ER.^[9] For his portrayal, Laurie has won various awards, including two Golden Globe Awards for Best Actor in a Television Drama Series and a Screen Actors Guild Award for Best Actor from Drama Series.^[10] Laurie also earned Primetime Emmy Award nominations in 2005, 2007, 2008, 2009, 2010 and 2011.^[11][12][13] TV Overmind has named House the best TV character of the last decade.^[14]

Character history[link]

Gregory House was born to John and Blythe House (R. Lee Ermey and Diane Baker) on 15 May 1959^[15] or 11 June 1959.^[16] House is a "military brat"; his father served as a Marine Corps pilot and transferred often to other bases during House's childhood.^[17] One place in which his father was stationed was Egypt, where House developed a fascination with archaeology and treasure-hunting, an interest which led him to keep his treasure-hunting tools well into his adulthood.^[18] Another station was Japan, where, at age 14, House discovered his vocation after a rock climbing incident with his friend. He witnessed the respect given to a buraku doctor who solved the case that no other doctor could.^[19] He also spent some time in the Philippines, where he received dental surgery. House loves his mother but hates his father, who he claims has an "insane moral compass", and deliberately attempts to avoid both parents.^[17] At one point, House tells a story of his parents leaving him with his grandmother, whose punishments constituted abuse.^[20] However, he later confesses that it was his father who abused him.^[20] Due to his father abusing him, House never believed that John House was his biological father; at the age of 12, he inferred that a friend of his family with the same birthmark was his real father.^[15] In the season 5 episode "Birthmarks", House discovers that this was true, after he ordered a DNA test that compared his DNA against John's.^[15] After performing a second DNA test in the season 8 episode "Love Is Blind", House discovers that the man who he thought was his biological father, Thomas Bell, wasn't his biological father either.^[21] The identity of his real father is unknown.

The final season's opening episode partly explores what path an imprisoned House would take aside from practicing medicine, revealing physics as his other forté.^[22] The episode "Body & Soul" makes a nod to this with a reference to a particle physics text amongst his books, as mentioned by his then-wife Dominika Petrova (Karolina Wydra).^[23] House fakes his own death in the series finale, thus giving up his ability to practice medicine again, in order to spend time with Dr. James Wilson (Robert Sean Leonard), who has five months left to live. He does this in order to avoid being sent back to prison for destroying an MRI machine in a prank gone wrong. The series ends with House and Wilson riding off into the countryside on motorbikes, as Dr. Robert Chase (Jesse Spencer) takes over House's department.^[24]

Medical school[link]

House first attended Johns Hopkins University as an undergraduate. Before fully committing to medicine as his discipline, he considered getting a Ph.D. in physics, researching dark matter.^[22] He was accepted to the Johns Hopkins Medical School, and excelled during his time there. He was a front runner for a prestigious and competitive internship at the Mayo Clinic;^[25] however, during this time in medical school, he was caught cheating by another student, Philip Weber.^[25] During the time he was appealing his expulsion he studied in the medical school at the University of Michigan, where, while working at a bookstore, he met his future employer and love interest Lisa Cuddy (Lisa Edelstein),^[26] with whom he shared (in his words) a night where "he gave her everything she asked for.^[27] After the appeal process, he was denied re-entry into the Johns Hopkins Medical School. During a medical convention in New Orleans he attended shortly after graduating medical school, House first saw his eventual best friend Dr. James Wilson (Robert Sean Leonard). Wilson, who was going through his first divorce at the time,^[15] broke a mirror in frustration and started a bar fight after a man repeatedly played "Leave a Tender Moment Alone" on a jukebox.^[15] House paid for the damage, bailed him out, and hired an attorney to clear his name (who in fact failed to do so), starting their professional and personal relationship.^[15] House eventually became a Board certified diagnostician with a double specialty in infectious disease and nephrology.^[28]

Leg injury[link]

Approximately ten years before the beginning of the series, House entered into a relationship with Stacy Warner (Sela Ward), a constitutional lawyer, after she shot him during a "Lawyers vs. Doctors" paintball match.^[19] Five years later, during a game of golf, he suffered an infarction in his right leg which went misdiagnosed for three days due to doctors' concerns that he was exhibiting drug-seeking behavior. House would eventually diagnose the infarction himself.^[29] An aneurysm in his thigh had clotted leading to an infarction and causing his quadriceps muscle to become necrotic.^[29] House had the dead muscle bypassed in order to restore circulation to the remainder of his leg, risking organ failure and cardiac arrest.^[29] He was willing to endure excruciating post-operative pain to retain the use of his leg.^[29] However, after he was put into a chemically induced coma to sleep through the worst of the pain, Warner, House's medical proxy, acted against his wishes and authorized a safer surgical middle-ground procedure between amputation and a bypass by removing just the dead muscle.^[29] This resulted in the partial loss of use in his leg and left House with a lesser, but still serious, level of pain for the rest of his life.^[29] House could not forgive Stacy for making the decision and this was eventually the reason Stacy left him.^[29] House now suffers chronic pain in his thigh and uses a cane to aid his walking. He also frequently takes Vicodin to relieve his pain.^[30] House does however break his addiction with psychiatric help, after he suffers a psychotic break. When Warner makes her first appearance in season 1, she is married to a high school guidance counselor named Mark Warner.^[31] Although she and House have a brief, intimate encounter during the second season, House eventually tells Stacy to go back to her husband, devastating her.

At the beginning of season three, House temporarily regains his ability to walk and run after receiving ketamine treatment.^[32] However, the chronic pain in his leg comes back and House takes painkillers and uses his cane once again.^[33] The other doctors speculate that his cane and opiate re-usage are due to his psychological tendencies.^[33] On a routine clinic visit, a police detective, Michael Tritter, is seen by House. Tritter observes House taking Vicodin for his pain and attributes that as his reason for being rude and a bully. Tritter, believing that doctors should be more responsible while practicing medicine, decides to take it upon himself to take legal action to curb House of his addiction by launching an investigation into House's addiction and suspected drug abuse. The investigation slowly involves Cuddy, Wilson and House's diagnostics team using extreme measures to get information. House, being forcibly weaned off of Vicodin to take a deal where he would keep his medical license, goes to extreme lengths to manage his pain by stealing Oxycodone from a cancer patient of Wilson's who had just died giving Tritter what he needed to bring House to trial. At the pretrial hearing, the Judge decides that House is not a danger to society and that his pain management for his leg is not as serious as Tritter made it seem. This conclusion is reached when Cuddy manufactures evidence and perjures herself to keep House out of jail.

During season five, House once again regains his ability to walk without pain after taking methadone, but soon stops after nearly killing a patient due to an uncharacteristic medical error. At the end of season five, House's use of Vicodin reaches a level in which House starts hallucinations about a former fellowship candidate and a relationship with Cuddy. When House comes to the conclusion that the Vicodin is making him hallucinate and taking over his life, he checks himself into Mayfield Psychiatric Hospital. At the start of season six, after spending time in the Mayfield, House stops taking pain medications and with the help of Dr. Darryl Nolan, finds other ways to deal with his pain and other aspects of his life. Thirteen and Wilson discover that House is a great cook, attributing this to House thinking of ingredients in terms of chemistry. House eventually finds the one thing that seems to help the pain go away: practicing medicine. After he diagnoses a patient online for his team (without their knowledge) and he shows Doctor Nolan how this reduces his pain, Nolan suggests that House resume his medical career.^[34] In season seven when Cuddy, who is House's girlfriend at this point, has a brush with death. House, who tries to deal with the fear of losing her, goes back on Vicodin. Nearing the end of season seven, House finds out that the experimental drug he has been using caused fatal cancerous tumors in all of the lab rats in the experiment. He gets a CT scan of his leg and finds three tumors that are close to the surface of his skin in his leg. He goes home, cleans his bathroom, and attempts to perform surgery on himself to extract the tumors in his bathtub.^[35] In season eight, House finds himself in jail after running his car into Cuddy's house. There he finds that his need for Vicodin is a weakness when an inmate makes House steal 20 pills of Vicodin or be killed. Throughout season eight House's use of Vicodin is pretty typical just like before season five.

Personality[link]

House's character frequently shows his cunning and biting wit, enjoys picking people apart, and often mocks their weaknesses.^[36] House accurately deciphers people's motives and histories from aspects of their personality and appearance.^[37] His friend and colleague Wilson says although some doctors have the "Messiah complex"—they need to "save the world", House has the "Rubik's complex"—he needs to "solve the puzzle".^[38] House typically waits as long as possible before meeting his patients.^[36] When he does, he shows an unorthodox bedside manner and uses unconventional treatments.^[39] However, he impresses them with rapid and accurate diagnoses after seemingly not paying attention.^[33] This skill is demonstrated in a scene where House diagnoses an entire waiting room full of patients in little over one minute on his way out of the hospital clinic.^[40] Critics have described the character as "moody," "bitter," "antagonistic,"^[41] "misanthropic,"^[38] "cynical"^[42] "grumpy," "maverick"^[43], "anarchist," "sociopath," and a "curmudgeon."^[44] The Global Language Monitor chose the word "curmudgeon" as the best way to describe the character.^[45]

Laurie describes House as a character who refuses to "obey the usual pieties of modern life" and expects to find a rare diagnosis when he is treating his patient.^[46][47] As a protagonist, many aspects of his personality are the antithesis of what might be expected from a doctor.^[36] Executive producer Katie Jacobs views House as a static character who is accustomed to living in misery.^[48] Jacobs has said that Dr. Wilson, his only friend in the show, and House both avoid mature relationships, which brings the two closer together.^[49] Leonard has said that Dr. Wilson is one of the few who voluntarily maintains a relationship with House, because he is free to criticize him.^[49]

Although House's crankiness is commonly misattributed to the chronic pain in his leg, both Stacy and Cuddy have said that he was the same before the infarction.^[31][50] To handle the chronic pain in his leg, House takes Vicodin every day, and as a result has developed an addiction to the drug.^[51] He refuses to admit that he has an addiction ("I do not have a pain management problem, I have a pain problem").^[28] However, after winning a bet from Cuddy by not taking the drug for a week, he concedes that he has an addiction, but says that it is not a problem because it does not interfere with his work or life.^[52] In the 2009 season House goes through detox and his addiction goes into remission, so to say.^[53] However, it does seem that House may have gotten over his addiction in the season 6 premiere.^[54] House creator David Shore told the Seattle Times in 2006 that Vicodin is "becoming less and less useful a tool for dealing with his pain, and it's something [the writers] are going to continue to deal with, continue to explore".^[55]

House openly talks about, and makes references to, pornography.^[56] In "Lines in the Sand", he returns the flirtations of a female underage patient.^[57] He regularly engages the services of prostitutes,^[25][58] of which his former female diagnostic team member Dr. Allison Cameron (Jennifer Morrison), who has a crush on him, is aware.^[59] He also likes to gamble, frequently making wagers.

A polyglot, House speaks English, Spanish,^[26] Russian,^[60] Portuguese,^[61] Hindi,^[25] and Mandarin.^[62] He listens to jazz, plays the piano (as does Hugh Laurie) and has an interest in vintage electric guitars. He plays video games and watches a soap opera. House is (as is Hugh Laurie) a motorcyclist. He rides a Honda CBR1000RR Repsol, license plate Y91 as seen in "Swan Song","Help Me" and "Post Mortem" meanwhile he tends to drive anonymous American sedans. He attends monster truck rallies with Wilson.

House is an atheist. He openly and relentlessly mocks colleagues and patients who express any belief in religion, deeming such beliefs as illogical. He does not believe in an afterlife because he finds it is better to believe that life "isn't just a test".^[29] However, in the season four episode "97 Seconds", he expresses sufficient interest in the possibility of an afterlife to electrocute himself in an effort to find out; however, he is dissatisfied with the results and denounces the possibility of an afterlife.^[63] This is also an example of House's tendency to self-experiment and submit to risky medical procedures in the name of truth. Over the course of the series, he disproves the effectiveness of a migraine cure by self-inducing a migraine and controlling the effects through drugs,^[25] undergoes a blood transfusion to assist with a diagnosis, and overdoses on physostigmine to improve his memory after sustaining head injuries, subsequently causing his heart to stop beating, then undergoes deep brain stimulation soon after.^[64][65][66]

House frequently says "Everybody lies", but jokingly remarked that he was lying when he said that in the first season finale. Even though that could be mistaken as an example of the Liar paradox, House was not creating a paradox when he said he was lying.^[46] House criticizes social etiquette for lack of rational purpose and usefulness.^[57] Dr. Cameron states in the first episode of the first season "House doesn't believe in pretense ... so he just says what he thinks".^[68] In the season three episode "Lines in the Sand", he explains how he envies an autistic patient because society allows the patient to forgo the niceties that he must suffer through.^[57] In the same episode, Dr. Wilson suggests that House might have Asperger syndrome, which is characterized by a number of traits found in House, such as difficulty accepting the purpose of social rules, lack of concern for his physical appearance, and resistance to change; though he later reveals to House that he does not truly believe this, and that claiming this was a part of a ploy to soften Cuddy's opinion of House.^[57] House is a strong nonconformist and has little regard for how others perceive him.^[47] Throughout the series, he displays sardonic contempt for authority figures.^[69] House shows an almost constant disregard for his own appearance, possessing a permanent stubble and dressing informally in jeans, T-shirts, and sneakers.^[70] He avoids wearing the standard white lab coat to avoid patients recognizing him as a doctor.^[30][69]

Social behavior[link]

House does not have much of a social life, and his only real friend is Dr. James Wilson.^[38][47] Wilson knew House before the infarction and looked after him when House's relationship with Stacy ended.^[50] Dr. Wilson's moving into House's apartment after his failed marriage in "Sex Kills" symbolizes his taking emotional refuge in his friend.^[71] Although they frequently analyze and criticize each other's motives, Wilson has risked his career to protect House, including having his job terminated in the first season as an effort of Edward Vogler to dismiss House, and having his practice damaged by Detective Michael Tritter in an investigation of House's narcotics consumption.^[56][72] House has quietly admitted, at several instances, that he is grateful for Wilson's presence, including referring to Wilson as his best friend. When Wilson resigns and moves away from both New Jersey and House's friendship in the season 5 premiere, House is desperate to have his friend back, and hires a private investigator (Michael Weston) to spy on him.^[73] The two ultimately reconcile at House's father's funeral in a scene similar to their first meeting where Wilson again breaks something valuable with a glass in a moment of anger, this time directed at House.^[15]

Edelstein has said that despite his sardonic personality, House is a character who is reliant on people surrounding him.^[46] Edelstein says this characteristic is portrayed on several occasions in the third season, during which House's medical career is in jeopardy due to investigations by Det. Michael Tritter (David Morse), who arrests him for possessing narcotics.^[74] House's legal trouble ends when Edelstein's character, Lisa Cuddy, commits perjury during his hearing.^[53] In Season 5, a relationship with Cuddy begins to blossom, as they are unable to deny feelings between each other.^[75] They share a kiss in episode six "Joy" which sparked an ongoing romantic tension between them.^[75] When Cuddy's office is destroyed by a gunman and is being renovated, she moves into House's office in what Wilson believes to be an attempt to get closer to House. The two try to drive each other away, doing things to each other's office to make them worse, but in an uncharacteristically nice move, House has Cuddy's mother send her medical school desk for her new office as a surprise. Cuddy is touched by what he did, but is devastated when she spots him with a prostitute he hired, not knowing he had done so only to mess with Kutner and Taub. In the season finale "Both Sides Now" it is confirmed that House wishes to pursue a romantic relationship with Cuddy. In this same episode he believes he has slept with Cuddy and informs Dr. James Wilson the following morning. This however is revealed to be a psychosis, which is a side effect of his Vicodin abuse. The House-Cuddy story culminates in the season 6 finale, "Help Me", when Cuddy cancels her engagement to Lucas to face the inevitable realization of her loving House all along;^[76] they share a passionate kiss, thus hinting on mutual willingness to try to develop a real relationship.^[77] However, in season 7, this relationship is ended when House starts taking Vicodin again when he is faced with Cuddy possibly having a terminal illness.

House can also been seen acting as mooch at times, frequently stealing food from Wilson. In "You Don't Want to Know," while House is searching for the cause of Thirteen's twitching, he claims to have stolen money from her wallet.^[78] In the same episode, Wilson later observes that House's blood type is AB, the universal recipient, reflecting his desire to take whatever he can. In another episode, he reveals to Wilson that he's been borrowing larger and larger sums of money from him without paying him back, just to see at what point Wilson would turn him down.

Development[link]

Conception[link]

While the show was originally set to be a medical procedural, the idea changed when the writers started to explore the possibilities of a curmudgeonly title character.^[67] Shore traced the concept for the title character to his background as a patient at a teaching hospital.^[80] Shore recalled that "I knew, as soon as I left the room, they would be mocking me relentlessly [for my cluelessness...] and I thought that it would be interesting to see a character who actually did that before they left the room".^[81] Shore also based the character partly on himself: in a 2006 interview with Macleans he explained that, while he does not have "cynical and cold attitude lurking within" him, he almost agrees with House's point of view.^[79] A central part of the show's premise was that the main character would be disabled in some way.^[82] The initial idea was for House to use a wheelchair, inspired by the 1960s police drama Ironside, but Fox turned down this interpretation (for which the crew was later grateful).^[67][82] The wheelchair became a scar on House's leg, which later turned into a bad leg necessitating the use of a cane.^[82] House usually holds his cane on the same side as his injured leg; Shore explained: "Some people feel more comfortable with the cane in the dominant arm, and that is acceptable".^[83] The cane tricks that are seen throughout the series are created by Laurie himself.^[49]

Cathy Crandall, costume designer for the show, created a look for the character that made it seem like he did not care about his clothing.^[84] She designed House with a wrinkled t-shirt, a blazer that is one size too short, faded and worn-in jeans and heather-gray rag socks.^[84] It was Laurie's idea to have the character wear sneakers, because he thought "a man with a cane needs functional shoes"; the Fox studios' wardrobe department keeps 37 pairs of Nike Shox on hand.^[84] House has worn t-shirts designed by famous designers such as Barking Irons and Lincoln Mayne,^[84] but also by less known designers such as Andrew Buckler^[85] and Taavo.^[86] The shirts are usually kept tied in a ball overnight to get them to wrinkle.^[84]

Casting[link]

When casting for the part started, Shore was afraid that in "the wrong hands", House would "just be hateful".^[79] The casting directors were looking for someone who could, as Shore described, "do these horrible things and be somehow likable without just, you know, petting a kitten".^[87] When Laurie was asked to audition for the role of House, he was filming Flight of the Phoenix in Namibia.^[88] Laurie had no big expectations for the show, thinking that it would only "run for a few weeks".^[70][89] He planned to audition for the roles of both James Wilson and Gregory House.^[87] However, when he read that Wilson was a character with a "handsome open face", he decided to audition solely for the role of House.^[87] Laurie chose not to change his clothing, but to remain in the costume he wore for the film; he also decided not to shave his beard.^[70] He put together an audition tape of his own in a Namibian hotel bathroom, the only place with enough light,^[90] while his Flight of the Phoenix co-stars Jacob Vargas and Scott Michael Campbell held the camera.^[70] He improvised by using an umbrella for a cane.^[91] Laurie initially believed that James Wilson would be the protagonist of the show after reading the brief description of the character and did not find out that House was the main character until he read the full script of the pilot episode.^[92][93]

After he had watched casting tapes for the pilot episode, Bryan Singer grew frustrated and refused to consider any more British actors because of their flawed American accents.^[47] Although Singer compared Laurie's audition tape to an "Osama bin Laden video",^[94] he was impressed with Laurie's acting and, not knowing who he was, Singer was fooled by his American accent.^[90] He commented on how well the "American actor" was able to grasp the character, not knowing about Laurie's British nationality.^[81] Although Laurie's appearance was very different from the way Shore pictured House, when he watched the audition tape, he was equally impressed as Singer.^[79] More famous actors such as Denis Leary, Rob Morrow and Patrick Dempsey were also considered, but Singer, Shore, and executive producers Paul Attanasio and Katie Jacobs all thought Laurie was the best option and decided to cast him for the part.^[95] Laurie was the final actor to join the cast of House.^[96] After he was chosen for the part, Laurie, whose father Ran Laurie was a doctor himself, said he felt guilty for "being paid more to become a fake version of my own father".^[90] Adopting an American accent for his role has been difficult for Laurie, who said words such as "coronary artery" are particularly tricky to pronounce.^[58]

Parallels to Sherlock Holmes[link]

House and Wilson's relationship mirrors Holmes and Watson's (pictured) relationship.

Similarities between House and the famous fictional detective Sherlock Holmes appear throughout the series;^[97] Shore explained that he was always a Sherlock Holmes fan, and found the character's traits of indifference to his clients unique.^[81] The resemblance is evident in various elements of the series' plot, such as House's reliance on psychology to solve a case, his reluctance to accept cases he does not find interesting and House's home address (221B Baker Street, same as Holmes).^[46][98] Other similarities between the two characters are drug use (House battled a Vicodin addiction for years and Holmes was a recreational user of cocaine), successful detoxification (which proves to be only temporary in House's case), playing an instrument (Holmes plays the violin and House plays the guitar, piano, organ and harmonica) and a talent for accurately deducing people's motives and histories from aspects of their personality and appearance.^[99]

Shore has also explained that the name "House" is a play on the name "Holmes" via its phonetic similarity to the word "homes." The pun does not extend to the meaning of the names, as the surname "Holmes" actually denotes that its initial bearers lived near or worked with holly or holm-oak trees, such that "Holl[e]y" or "Oak[e]s" would be a more literal equivalent.^[100] Both Holmes and House each have one true friend, Dr. John Watson and Dr. James Wilson, respectively.^[4] Leonard has said that House and his character were originally intended to play the roles of Holmes and Watson in the series although he believes that House's team has assumed the Watson role.^[101] Shore has also said that Dr. House draws inspiration from Dr. Marc Chamberlain, a professor of neurology at the University of Washington, Seattle, and Dr. Joseph Bell (who was a teacher of Arthur Conan Doyle's and thus a chief source of inspiration for the creation of Holmes), who could "walk into a waiting room and diagnose people without speaking to them".^[4] In the season two finale "No Reason", House is shot by a man named Jack Moriarty, a name that coincides with Sherlock Holmes' adversary, Professor James Moriarty;^[99][102] likewise, in the fifth season, Wilson uses Irene Adler as the name for an imaginary love interest of House,^[103] the same name as the only female adversary Holmes ever encountered.^[99]

Bibliography[link]

• Holtz, Andrew (2006). The Medical Science of House, M.D.. New York: Berkley Books. ISBN 978-0-425-21230-1. 
• Holtz, Andrew (2011). House M.D. vs. Reality: Fact and Fiction in the Hit Television Series. New York: Berkley Books. ISBN 978-0-425-23893-6. 
• Hockley, L., and Gardner, L. (2010). House The Wounded Healer on Television: Jungian and Post-Jungian Reflections. Routledge. ISBN 978-0-415-47913-4. 

References[link]

External links[link]

	United States portal
	Fictional characters portal

Wikiquote has a collection of quotations related to: Gregory House

• Gregory House at the TV IV
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• Dr. House Doctor Ratings

Michael A. Klaper, M.D., is an American physician, author, and vegan.

Biography[link]

Early years and education[link]

Dr. Michael Klaper spent much of his childhood vacations on his uncle's dairy farm in Wisconsin.^[1]

Dr. Klaper graduated from the University of Illinois College of Medicine in 1972 and served his medical internship at Vancouver General Hospital with the University of British Columbia. He also studied obstetrics at the University of California in San Francisco.^[2]

Career[link]

After graduation, Klaper moved between a number of locations, practiced acute care medicine, and eventually became certified in urgent care medicine. Following a desire to lead a less violent life, Klaper became a vegan in the early 1980s.^[3]

He served as director of a vegan health spa in Pompano Beach, Florida from the early 1990s, where he observed the healing powers of plant-based nutrition, and was featured on the PBS documentary Diet For A New America by John Robbins.^[4] However financial realities required him to return to urgent care medicine, which led him to practice in Maui, Hawaii, between 1995 and 2006, and Whangarei, New Zealand, between 2006 and 2009.^[5] In 2010, he returned to nutritional medicine and currently serves on the medical staff at the TrueNorth Health Center in Santa Rosa, California.^[6]

His books include Vegan Nutrition: Pure and Simple and Pregnancy, Children, and the Vegan Diet.

See also[link]

• Neal D. Barnard
• Caldwell Esselstyn
• Joel Fuhrman
• Michael Greger
• John A. McDougall
• Vegan nutrition

References[link]

External links[link]

• Official website
• A Diet For All Reasons - Video - one hour presentation by Dr. Michael Klaper, 1993

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