Need to Know

Need to Know is a second season episode of House which first aired on February 7, 2006. A women with muscle spasms comes to the hospital. As the team looks into the patient‘s life, the only diagnosis that makes sense is one the patient insists on denying. Meanwhile, Wilson wants House and Stacy to confront their feelings for each other, Cameron refuses to get the results of her HIV test and House is no longer under the supervision of Foreman.
Like the previous episode, Failure to Communicate, this episode examines communication and knowledge, largely in the context of trying to avoid unpleasant truths.
In the first instance, we have the patient, Margo Dalton, who is afraid to let her husband know that she doesn't think she wants to have another child. She goes as far as to ruin her health to avoid not confrontation, but putting him in the position of responding to her needs. As a result, she must withhold information from everyone.
Next, we have Cameron, who needs a straightforward test to let her know if she has contracted AIDS from a patient. As a doctor, it must be clear to her that if she has contracted it, treatment will be possible. However, she instead opts to avoid the test.
Finally, we have the love triangle between Stacy, her husband Mark and House. We already know that communication between Stacy and Mark has been reduced to fighting over post office procedures, and that the forced communication between Stacy and House while they killed time in Baltimore has made both of them realize that breaking up may not have been the best idea. However, as much as Stacy wants to be with House, she is reluctant to tell Mark that he was right about her feelings for House all along. Meanwhile, Wilson and Cuddy attempt to both head off the coming storm and to prepare themselves in the event it arrives.
In the background, Eric Foreman, who is still ostensibly House's superior, realizes that his status as a lame duck puts him in no position to stand in House's way.
==Recap==
A busy mother and businesswoman starts flailing just after starting her car and drives it through the back of her garage.
Meanwhile, House has, out of all character, come in early with a pressed shirt. Wilson deduces that House came on to Stacy while they were away on business and wants to talk about it, but Cameron comes by and House ignores Wilson. He asks her about her HIV test but Cameron wants to tell him about the new patient.
The team is discussing the patient, who is flailing her arms and twitching. The team suspects the auto accident was the cause, but the flailing clearly started before the accident. The patient is on fertility treatment and the team suspects that might be a cause too. House orders a thorough pregnancy test along with the other tests. Foreman is still nominally in charge, but gives in to House's treatment plan.
They talk to the patient about the possible treatment and administer drugs to stop the flailing.
Wilson confronts Stacy about House, and warns her not to hurt him again. However, Stacy doesn't know whether House is toying with her.
The patient starts having spasms again after the treatment wears off and snaps at her daughter and her husband (her daughter's stepfather).
Foreman believes the sudden anger shows Huntington's disease. House agrees to start treatment before they confirm, but Chase thinks the progression is too fast. However, at that point, the patient has a psychotic break and starts smashing up her room. The team manages to subdue her and sedate her.
The test for Huntington's is negative despite the symptoms, and the psychotic break rules out fertility medication as the cause. There is no family history of mental illness. House starts talking about her busy lifestyle and wonders if she is taking cocaine to cope. Foreman and Cameron go to the patient's house to look for the drugs.
House goes to see Wilson, who is preparing marijuana for a patient. They start talking about Stacy. Wilson says Stacy sounds confused, but he doesn't think she really is. House doesn't think she will leave Mark while he is in rehab. Wilson points out that she left House when he was in rehab and just as House is about to leave, Wilson calls him back, prompting House to give the roll he stole back to the other man, House calling Wilson a "killjoy".
Foreman and Cameron start talking about her test for HIV. They find Ritalin in the patient's car. However, the pills are the daughter's. House thinks it is the Ritalin and wants to discharge her. Foreman, who is still in charge, overrules House and keeps her in until they can confirm the Ritalin is causing her symptoms. Instead, House goes to see the patient and her daughter. The patient says that she never gave Ritalin to the daughter, but the bottle is nearly empty. The patient finally admits that she took the pills. House discharges her.
House goes to see Stacy. Stacy says she's about to leave her position at the hospital and that Mark is going back to work. House accuses her of running away from him.
As the patient goes to leave the hospital, she collapses with a stroke. Cameron calls House, who is in bed naked with Stacy. He decides to wait a half-hour before he returns to the hospital.
The team is waiting around for House, and they suspect Stacy is the reason. House arrives in a very good mood and starts once again trying to determine the cause of the patient's symptoms. House announces that Cameron skipped her HIV test and collects a bet from Foreman. He tells them to take an ultrasound of the uterus. He then tricks Cameron into opening her mouth by telling her he loves her and gets a swab for the HIV test.
House goes to see Stacy again, and finds that she has been lying to Mark instead of telling him about their affair. She tells House she is willing to go ahead with an affair but she will not hurt Mark. House gives Stacy an ultimatum – him or Mark.
The ultrasound shows no abnormality of the uterus. At that moment, Foreman's authority over House runs out, and House orders a biopsy.
The daughter comes to see House while he is watching TV. House takes her back to the nurse who is watching her. They discuss her parent's relationship – they talk about having another baby a lot, but they never fight.
During the procedure, the patient starts bleeding and her blood pressure drops even before Chase starts the biopsy.
Stacy goes to see Cuddy. Cuddy says House didn't change after she left him. Stacy admits to having a relationship with House. They discuss the previous break-up.
The bleeding was coming from the liver, and indicated a tumor in the liver, which the team finds. A biopsy is impossible as the tumor is in one of the patient's blood vessels.
Mark comes to House worried that he's losing Stacy. He is actually looking for advice and admits he has shut her out. House doesn't want to help and tries to dodge Mark by going up the stairs. Mark gets out of his wheelchair to crawl up to House to confront him, but again House brushes him off.
House can't understand why the patient has a liver tumor – it doesn't explain her symptoms. They review the patient's personality. She is very non-confrontational and has trouble coping. House can't understand why a woman like that would want a second child. The Ritalin explains the psychosis. The stroke, blood clot, tumor and flailing can only be explained by one thing – birth control pills.
House confronts the patient – he accuses her of taking birth control pills to prevent herself from getting pregnant, and fertility medication to give her new husband a child. Luckily, the tumor is benign and will go away if she stops taking birth control pills. The patient goes ahead with the surgery and denies being on the pill.
House confronts Cuddy about the appropriate course of action. Cuddy points out that House has no real proof she is taking birth control pills, and if he's wrong the tumor will continue to grow and might kill her. Cuddy won't call in Stacy because she knows she won't agree with House.
They go ahead with the surgery and the tumor is removed. Luckily, it is benign as they anticipated and the patient recovers quickly. The patient asks Foreman to lie and say to her husband that the surgery means she can't be on the fertility treatments, but he refuses. He tells her that if she continues to be on birth control while on fertility treatments, it will eventually destroy her marriage and kill her. She plans on maintaining the deception until her husband gives up on the idea.
Cameron finally goes to get her HIV test result. It's negative.
House goes to see Stacy to break off their new relationship, even after Stacy offers to tell Mark she's willing to leave him. Stacy asks why he changed his mind. House realized that Mark was more willing to do things to keep Stacy, and that he can't make her happy. He is always doing things to alienate people, and knows he will simply drive Stacy away again. He simply can't bear the possibility of another break up.
Wilson finds House alone outside. Wilson agrees that Stacy is probably better off without House, but knows that House doesn't believe that, and believes that House merely wants to stay miserable. Wilson points out that although House doesn't like himself, but he does admire himself. He's afraid to change for that reason.
==Zebra Factor 3/10==
Benign hepatocellular adenomas aren't very rare.
==Quotes==
:Wilson: You don't like yourself. But you do admire yourself. It's all you've got so you cling to it. You're so afraid if you change, you'll lose what makes you special.
:Wilson: Being miserable doesn't make you better than anybody else, House. It just makes you miserable.
:House: Ultrasound her uterus this time. See if there's something growing in there that doesn't look adorable in a onesie.
:Chase: Millions of women are on fertility treatments, and they don't get cancer.
:House: Right. They get babies. She had a blood clot and a stroke. She'll get another one and probably die if we don't find that tumor. Do an endometrial biopsy.
:Foreman: Biopsy's painful and unnecessary. We just did an ultrasound. [House squints and looks at his watch] What?
:House: Shh.
:Cameron: If you have a personal issue that's interfering with...
:House: Shh, shh, shh, shh, shh.
:Foreman: What are we waiting for?
:House: Your four weeks just expired. Your reign of terror is over. Mine has just begun. Now go stick a needle up her hoo-hoo and find that cancer.
:Chase: Hoo-hoo?
:Foreman: He went to Hopkins.
:Stacy Warner: What was Greg like after I left?
:Dr. Lisa Cuddy: Uh, an egomaniacal narcissistic pain in the ass. Same as before you left.
:Stella: What's wrong with your foot?
:House: War wound.
:Stella: Does it hurt?
:House: Every day.
:Stella: Is that why you're so sad?
:House: Oh, aren't you adorable. I'm not sad, I'm complicated, chicks dig that. One day you'll understand.
:Wilson: This isn't just going to go away.
:House: No, but maybe you will.
:House: Wow. It's a big jump from "infidelity is morally wrong" to "do her".
:Foreman: They're prescribed to her daughter.
:House: Mommy does everything for her family nowadays. Even takes their pills.
:House: This better be important.
:Cameron: You've gotta come back in.
:House: No, I don't.
:Cameron: Margo's stable, but...
:House: Oh my God! I'll be right there!
:House: Peeing on a stick is only 99% accurate. Get a real pregnancy test. You know, the one with the blood and the hormones and the rabbit. Oh, I'm sorry. It's still your limo. What do you say, Miss Daisy?
:Foreman: Whatever you want.
:House: Lame duck's done quacking.
:Foreman: You quack, people shoot at you. Cuddy just put me here to make you miserable. Another two days, you can go back to making yourself miserable.
:House: Who finished the animal crackers? If you finish something, don't just put back the empty box, throw it out!
:House: Foreman, need your help here. You want to pull a bank job, would you go it alone? You're gonna rob a home, sure, it's a one or two man crew, but a bank - lookout, getaway driver...
:Foreman: I'm not saying anything until the metaphor plays itself out.
:House: [Handing Cameron an envelope] Knowing is always better than not knowing.
:Cameron: [opens the envelope and reads the letter] It's a referral request.
:House: Right. HIV thing came in earlier. You're fine.
:Cameron: You won't read your mail, but you'll open mine?
:House: It said "confidential". I wanted to know.
:Cameron: The most important letter of my life, and you're still an ass.
:House: Comforting, isn't it?
:House: We're done. Get rid of her!
:Foreman: We're not done! We have to confirm the diagnosis before we send her home to die of something else!
:House: Oh, yes. The power tastes so sweet! You just can't resist! You're like a diabetic at the ice cream counter, you want to say no, but you need that chocolate-y goodness!
:Foreman: Yeah, well, I'm still signing the charts. So until tomorrow, you're not allowed to kill anyone.
:House: Wuss!
:Foreman: Hypervigilance, sudden irritability...
:House: Symptomatic of... lunch with Cuddy?
:House: What does the flailing look like?
:Chase: Her arms spasm uncontrollably and there's a mild facial twitch.
:House: Demonstration?
:Foreman: You wanna know what it looks like, go see the patient.
:House: Ooh, snarky. Was he like this the whole time I was gone?
:House: [to the whiteboard] We give you so much, you give us so little.
:Foreman: It's the perfect marriage: there's nothing to fight over if you never talk about anything.
:House: You're gonna want to paralyze her. You run tests on a flailer, somebody's gonna lose an eye.
:House: [about Ritalin] Cocaine with a PG rating.
:Cuddy: He's actually on time.
:Wilson: He's six minutes early.
:Cuddy: Something's happened.
:Wilson: I'm on it.
:House: Morning, Jimmy. Anybody die while I was gone?
:Wilson: Did -- did you iron your shirt?
:House: Thought about shaving. Couldn't find a razor.
:Wilson: What the hell happened in Baltimore?
:House: Sorry, chief. Never kiss and tell.
:Wilson: I think you just did... there's no such thing as "just a kiss".
:House: Did you iron your shirt? Everybody's flash today.
:Wilson: Has she left Mark? Is she going to?
:House: I think I can hear cancer kids calling.
:Wilson: Are you planning on asking her to leave Mark?
:House: Not sure. Cameron keeps my calendar.
:Wilson: Hey. This is a big deal. This is an affair. Have you even talked to Stacy about what the hell this means?
:House: Didn't have a lot of time for talking. If you know what I mean.
:Wilson: Great. Breaking up a marriage. Fertile ground for high comedy. We need to talk about this.
:Wilson: What the hell did you do? Were you just cold and lonely?
:Stacy: Course he told you, he's an 8-year-old boy.
:Wilson: Hey, you're the one who kissed him.
:Stacy: Why are you so worked up over this?
:Wilson: Because you're married.
:Stacy: Not to you. This is none of your business.
:Wilson: The last time you left, I was the one stuck picking up the pieces.
:Stacy: Oh right. He cried himself to sleep every night. That so sounds like him.
:Wilson: He's been pining for five years!
:Stacy: You're being dramatic.
:Wilson: No. Actually, I'm underplaying. This is me being restrained.
:Stacy: It was one kiss.
:Wilson: Are you being intentionally thick? This was not just a one-night stand. You can't toy with him.
:Stacy: I'm not. He's probably toying with me.... I don't know what I'm doing.
:Wilson: Oh, boy.
:House: I know you're in there. I can hear you caring. [after getting no response, House goes around to a side door to enter from the balcony] The door was locked.
:Wilson: [rolling a joint] Means I didn't want to see anyone.
:House: High school reunion?
:Wilson: It's for a patient. She can't roll. Now lock that door, too.
:House: Paranoia. Must be the good stuff. Times like these I wish I had cancer. So what did she say?
:Wilson: That depends. What did you do, and who are we talking about?
:House: We both know that as soon as we talked you ran to Stacy so you could gossip and giggle. I need to know what she said.
:Wilson: I have a crazy idea: why don't you go talk to her?
:House: Because my bestest buddy says that could lead to trouble.
:Wilson: She sounds confused, but I dont' think she is. I think she's waiting for you to do something to show her you're serious.
:House: Wow. It's a big jump from "infidelity is morally wrong" to "do her".
:Wilson: I didn't say "do her", I said "do something".
:House: What exactly did she say?
:Wilson: She didn't say it was a mistake.
:House: She's not gonna leave Mark in the middle of his rehab. Too much guilt.
:Wilson: She left you.
:House: Harsh toke, dude.
:House: Why don't you take it up with Stacy? See which option minimizes your risk.
:Cuddy: Here's what I think she's gonna say. "Oh, I love Greg. But if you go against a patient's wishes, you're calling her a liar. And if something goes wrong, I end up in court having to defend the big mean doctor, albeit with dreamy eyes, would wouldn't believe the nice suburban mom. And even though his cane makes me melt, do the damn surgery."
:Foreman: Confidentiality rules stop me from telling your husband the truth. But my obligation to lie ends there.
:House: Cameron... I love you. [swabs her open mouth] Get your test results tomorrow.
:Dr. Wilson: This isn't just going to go away.
:House: No, but maybe you will.
==Major Events==
*Wilson discovers that House and Stacy kissed and suspects that they're having an affair.
*Later on, an enraged Wilson confronts Stacy and tells her that the last time that she left, he was the one caring for House.
*House says, "I love you," to Cameron to get her to open her mouth in shock to take a mouth swab to test her for HIV.
*House and Stacy sleep together once again.
*In the aftermath of their lovemaking session, House forces Stacy to choose: Mark or him.
*Following one month of supervision, House regains control of the Diagnostics Department once again.
*Mark confronts House and tells him that he's scared of losing Stacy.
*Cameron finally learns that her HIV test is negative.
*Stacy tells House that she wants to stay but he rejects her, saying that she'll be much better off with Mark instead.
*Distraught, Stacy quits her job and the hospital and leaves New Jersey with Mark for good.
==Title==
The title of the episode refers to a term used in espionage to describe sensitive information that should not be disclosed unless an operative actually needs to know it. It describes both Stacy's not wanting to tell Mark about her feelings for House and the patient's refusal to be honest with her husband about not wanting to have more children.
==Goofs==
*House hands Margo a piece of paper, implying its the result of a tox screen. She looks at it and says its a cafeteria menu. In fact, the piece of paper is completely blank.
*During the seizure scene, you can see the reflection of the cameraman when Ted opens the car door.
*House moves as if he's throwing away the box of animal crackers. However, it's visible in the next scene in its original position before House touched it.
*In Honeymoon, Mark says that the only jewelry Stacy wears is her ever present cross. However, in this episode, she's wearing a pair of earrings.
*If a patient has blood clots that lead to a stroke, the best place to look for them is the carotid artery in the neck. The doctors aparently didn't think of this.
*Side effects of fertility treatment would explain all of the patient's symptoms. In addition, the likely treatment that would explain the symptoms shouldn't be used for more than six months. Using it for thirteen months would be the obvious answer.
*It's really hard to get Ritalin as it's a FDA controlled substance. If someone obtained three refills in three weeks, someone would notice. 
*The "confirmation" that the tumor is benign is totally unrealistic. Since Chase was only observing, he probably hadn't scrubbed - a surgical sample should be kept in a sterile environment until it's examined and even the microscope has to be sterile. In addition, you don't just look at a tumor under a microscope. First, you need to stain it, then a machine slices off incredibly thin slices for microscopic examination.
==Trivia & Cultural references==
*The Hass avocado is the variety of avocado that's the most widely grown in the United States. It was first developed in California. 
*Animal crackers are actually sweet cookies that look like circus animals. 
*When House asks Foreman to allow the pregnancy test, he says, "What'll it be, Ms. Daisy?", which is likely a reference to the movie Driving Miss Daisy.
*When Cameron finds the Ritalin in Margo's car, she remarks, "Mama's little helper," which is likely a reference to the Rolling Stones song Mother's Little Helper, even though the song is about valium abuse.
*This is the last episode in which Mark Warner appears in the series, as well as Stacy's last recurring role in the series. She would later return in the series finale ("Everybody Dies").
*When House starts describing how the patient can do several things at once, he starts paraphrasing the lyrics of the 1962 hit I'm a woman.
*Cinco de Mayo (Spanish for "Fifth of May") is a Mexican-themed celebration of the Battle of Puebla. Although it's celebrated in many places in the United States, it is observed quite differently in Mexico. The date is marked primarily by military parades, battle re-enactments, and by a food and arts festival in Puebla.
*"Onesie" is a trademark for a particular brand of infant bodysuit, a T-shirt like garment that also has a snap or attachment at the crotch to allow the infant to be put into it or be removed from it in one step.
*The joke about House using the euphemism "Hoo-Hoo" instead of the proper term vagina is a dig at Johns Hopkins Medical School. Hopkins has a very conservative atmosphere and people often tease the students that the school is so conservative it would not teach them any "naughty" words even if they were the names of proper anatomical parts.
*Margo and Ted own a copy of Dunston Checks In, which can be seen during the environmental scan.
*Margo and Ted also own a copy of Winning London, which features Jesse Spencer.
==Reviews==
*IMDB users rated the episode an 8.4 with 24.7% of users giving it a 10. It was rated best by females under 18 (9) and worst by males over 30 (8.1).
*TV.com users rated the episode an 8.6. They chose Elle Fanning as their Most Valuable Performer.
*Polite Dissent gave the non-medical plot an A, but because of the weak diagnosis he only gave the overall medicine a B.
==Medical Ethics==
===Lies in the Doctor-Patient relationship===
House assumes that Everybody lies and in the vast majority of cases he has to work around those lies in order to come to a proper diagnosis. House also realizes that the vast majority of the lies he deals with are for understandable reasons and that patients usually don't lie unless they consider it to be important to do so. It's one of the reasons why House eschews direct contact with his patient - it tends to cloud his objectivity.
Here, House is faced with a difficult but hardly unique problem (it also appears in Control, among other places). The patient insists either that they are not going to engage in behavior that is relevant to their condition, or lies about engaging in behavior relevant to their condition. Here, House has reason to believe that the patient is lying about taking birth-control pills. His team finds evidence later on that would support this conclusion. House makes it clear to Margo that the tumor will reoccur if she continues to use birth control pills along with fertility treatments. It is also clear that, if he's right, she's consenting to dangerous surgery that is unnecessary.
Medicine is aware the lies are common on both sides of the doctor-patient relationship (see, for example ). There is also a realization that doctors aren't very good at spotting lies (like most people, they score no better than chance).
The phenomena is best explored in lifestyle diseases. For example, a patient with a heart condition fails to take their meds or to substantially change their diet. They downplay their non-compliance. What should be the doctor's response? In the past, the answer was easy - physicians treated patients like their children. However, it was eventually found that this approach led to patient outcomes that were worse. As such, it has largely been abandoned in the well developed countries, although it holds on in the less developed countries.
One new approach is to "put it in writing". Instead of just verbally having a patient agree to a course of action, the patient is required to negotiate an agreement about their treatment plan that they actually sign. The patient is told, in advance, of the consequences of failure to follow the plan, both to their own health and to their relationship with their physician.
It's also true that physicians get things wrong. Take a look at George. Despite his extreme obesity, he insisted that it had nothing to do with his present condition. Like many obese patients, he may avoid doctors because of "fat shaming". Although House was probably right, there was certainly a possibility that he was wrong. There have been cases like George's where House attached to a single behavior as the source of the illness, only to be proven wrong. This sort of mistake not only affects the immediate doctor-patient relationship, but the patient's belief in the medical system as a whole.
As such, modern medical practice holds that a patient must be a full participant in the treatment process. They must understand the diagnosis and course of treatment. The physician must not assume that they "know best" for the patient. Unfortunately, House often falls into the habit of dismissing or ignoring patient concerns.
In any event, it appears clear that in cases where the patient lies to the doctor, this is not sufficient reason for the physician to remove themselves from the case. This contrasts with other professions, like law, where lying can in many circumstances justify the lawyer's decision to end the lawyer-client relationship.
==Cast==
*Hugh Laurie as Gregory House
*Lisa Edelstein as Lisa Cuddy
*Omar Epps as Eric Foreman
*Robert Sean Leonard as James Wilson
*Jennifer Morrison as Allison Cameron
*Jesse Spencer as Robert Chase
*Sela Ward as Stacy Warner
*Currie Graham as Mark Warner
*Edward Kerr as Ted Dalton
*Elle Fanning as Stella Dalton
*Julie Warner as Margo Dalton
*Holly Daniels as Debbie
*Michael A. Casey as Heart Surgeon
==Music==
*Serenade, from Sigmund Romberg's The Student Prince - Sung by Hugh Laurie as he enters the room.
==Release Dates==
*United States - February 7, 2006 on Fox
*Canada - February 7, 2006 on Global
*Germany - January 30, 2007
*Netherlands - March 22, 2007 on SBS6
*Estonia - April 13, 2007
*France - May 17, 2007
*Hungary - May 30, 2007
*Japan - September 4, 2007
*Finland - November 22, 2007
==In Other Languages==
*Spanish - Necesidad de saber (direct translation)
*French - Désirs illusoires (Eng. Illusory desires)
==Links==
*Episode page at IMDB
*Episode transcript at Clinic Duty
*Episode summary at an Edward Kerr fan site
*Episode summary at House MD Guide
*Episode page at TV.com
*A review of the medicine at Polite Dissent (via archive.org)
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