In the fall of 2004, Fox didn’t have a trusty procedural like NBC’s Law & Order and CBS’s CSI: Crime Scene Investigation. So the network took a chance on House, a medical drama with episodic storylines driven by conditions, not crimes, and a British actor little known to stateside audiences playing a diagnostician with zero bedside manner. House became a commercial and critical hit, and it all started with the pilot episode, which aired on Fox on November 16, 2004.
In that first episode, Gregory House (Hugh Laurie) is shirking his duty at the Princeton-Plainsboro Teaching Hospital’s walk-in clinic, and he also brushes off the case of a kindergarten teacher named Rebecca Adler (Robin Tunney), who’s experiencing speech problems and seizures. When boss Lisa Cuddy (Lisa Edelstein) revokes House’s diagnostic authorizations, he relents and takes a shift at the clinic — and while treating an asthmatic boy, he flashes on the diagnosis of vasculitis for Rebecca. At first, it seems he’s right: Rebecca responds well to steroids… until she starts seizing again. It’s only after House discovers Rebecca appears to have consumed undercooked pork that he realizes she may have neurocysticercosis. Sure enough, an X-ray reveals a host of tapeworms in her body, and Rebecca begins her recovery after a course of albendazole.
Along the way, House’s first episode tells us all we need to know about the title character: He’s reclusive, impatient, grouchy, cynical, arrogant, and crass. He uses a cane and gobbles Vicodin after other doctors misdiagnosed an infarction and left him with agonizing leg pain. And yet he has the grudging respect of Cuddy, the devotion of his colleague and friend James Wilson (Robert Sean Leonard), and the admiration of his gaggle of diagnostician proteges, initially Eric Foreman (Omar Epps), Robert Chase (Jesse Spencer), and Allison Cameron (Jennifer Morrison).
In an interview with University of Toronto Magazine, House creator David Shore said that he based Gregory House on himself — or a “bigger a**hole” version of himself. “And House is smarter than I am, which allows him to get away with stuff,” Shore added. “If he was of average intelligence with that same attitude and if he was wrong 50 percent of the time, he would just never be tolerated. The only reason he’s tolerated is because he’s right, invariably. I don’t think I fall into that category. But his attitudes, his outlook toward the intellect versus emotions, his outlook toward almost everything comes from me.”
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Shore told Entertainment Weekly he imagined the lead character after going to a doctor’s appointment for a sore hip, even though the pain had dissipated by the time of his appointment. “The doctors were incredibly polite, and I couldn’t help thinking, ‘Why?! I am wasting your time!’” he recalled. “Writing House, I fell in love with the idea of a guy who would actually say that to a patient.”
Shore and fellow executive producers Katie Jacobs and Paul Attansio pitched House to Fox as a medical detective show — almost like a crime procedural, “with germs and diseases as suspects and culprits,” as Shore explained to EW. The writers gave their protagonist powers of deduction inspired by Sherlock Holmes — see: the drug habit, the antisocial personality, the sidekick with the initials J.W., the 221B street address — and medical cases inspired by diagnostic tales that Berton Roueché reported for The New Yorker and Lisa Sanders reported for The New York Times Sunday Magazine.
“Until House came about, diagnosis [in TV medical dramas] was the one-liner between symptoms and the terrible response to treatment. House takes that moment and looks at it, which is what my column did,” Sanders, who became a medical technical advisor for the show, explained to Yale Medicine Magazine.
And the House producers eventually found their star in Hugh Laurie, whom Shore knew “as a British twit” from his work in U.K. productions like Blackadder, as Shore told The New York Times. Laurie sent in an audition tape from a film shoot in Namibia, certain that the unsympathetic Gregory House must be a supporting character. But after seeing what then-Fox exec Craig Erwich called “one of the great auditions of all time,” the producers knew they had their leading man.
Fox execs had notes on the original script — they decided that House should walk with a cane instead of using a wheelchair, for example — but never shied away from House’s personality. “The phone call I expected to get from Day 1 I never got: ‘Everything is great, great, but you’ve got to make the character more likable,’” Shore told the Times. “You always get that call, and we never got that call.”
One of the final touches of House’s construction was deciding upon that title. Other titles considered were Chasing Zebras, Circling the Drain — in medical slang, a “zebra” is an unlikely diagnosis — and Jagged Little Pill. But House won out, and the network’s marketing department added an “M.D.” on the title card and a square around the letter “H” to emphasize the medical setting.
House debuted on November 16, 2004, with critics applauding the “funny, probing, and unsentimental” and its protagonist, “the most electrifying new main character to hit television in years.”
But the show hit it big with viewers that January when it served as a lead-out for the then-behemoth American Idol. Before long, House was a ratings behemoth in its own right, with tens of millions of weekly viewers. Not that Gregory House would like to meet any of them.
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