Occam's Razor

Occam's Razor is a 1st season episode of House which first aired on November 30, 2004. After a spirited sexual intercourse with his fiancee, Brandon collapses, suffering from abdominal pain, nausea, fever, and low blood pressure. House and his team cannot pinpoint Brandon's problem since there is no illness with this many symptoms. But then, Brandon complains of pain in his fingers and House suddenly zeroes in on the cause.
This episode explores an interesting concept which may be unique to the series - what if House had a patient who would have gotten better on his own? In every other episode, it's clear that absent House's intervention, the patient would have died anyway. Sometimes, the patient does die due to House's mistake, or because even an earlier diagnosis would not have allowed them to treat the disease.
As such, we're allowed to see at least the possibility what would happen to a patient if House treated them too aggressively. Here, House takes credit when the patient gets better, but it was despite House's clumsy attempts to diagnose him, not because of it.
That being said, we see that sometimes House's arrogance is what makes him such a good doctor. When the patient gets worse again, House is positive he knows the reason why and doesn't let up even when the trail leads elsewhere.
==Recap==
A young man is on the phone asking his boss for a day off on account of a lack of sleep, scratchy throat, and fever. It appears that he is skipping work to spend time with his girlfriend. However, he admits to his girlfriend that he really does have a cough, and she notices he has a rash, too. They start making love, but all of a sudden he starts having trouble breathing and collapses on top of her, and she can't revive him.
The patient is taken to Princeton-Plainsboro. He has abdominal pain. Wilson tries to get House to take the case, and House agrees - because the patient's blood pressure isn't responding to fluids.
House goes to his team and starts a differential. Cameron notes no condition accounts for all the symptoms. House says the priority is to control his blood pressure. He orders antibiotics for sepsis and an echocardiogram. The girlfriend is upset that they are testing him rather than treating him.
House goes to the clinic. Cuddy notes he's late to clinic. House tells the waiting room that he's bored, doesn't really want to treat them, and suggests to the patients that he may be a Vicodin addict. He asks who wants him to treat them, and no one volunteers. They agree to wait for one of the other two doctors on duty. However, Cuddy assigns a patient to House anyway.
The girlfriend apologizes to Chase and admits they were having sex. She's afraid she's responsible because she was rough. Chase shares the information with the team. Foreman tells them to stop the antibiotics because the patient's test results are getting worse because his kidneys are shutting down from the treatment.
House notes the patient now has seven symptoms. Foreman thinks the treatment caused the seventh - kidney failure. He thinks it's a cardiac infection, but it only explains five symptoms.
However, House writes down several other conditions and realizes that nothing covers all seven. They start to think it might be two conditions, but Foreman disagrees. However, both conditions that explain the symptoms are rare. House wants to treat for sinus infection and hypothyroidism.
They start treating the patient when his parents arrive. The patient introduces his parents to his girlfriend and tells them they're engaged.
Foreman wonders why the other two are always agreeing with House. They say House is always right. Foreman isn't convinced and goes to test for viral infections. However, Cameron and Chase agree to help him. Chase and Foreman start talking about how attractive Cameron is. House comes in - he knows they were in the lab trying to prove him wrong. House tells them to test the patient's urine.
The tests show the antibiotics didn't cause the kidney failure. House informs them the patient is getting better.
House tells Wilson he criticizes his fellows to make them feel terrible because it will make them better doctors.
Someone asks House what he is doing, and he says that he's on "Level 4" (although there is no such thing). It's shown that he's playing Metroid Zero Mission on a Game Boy Advance. Later, he's playing again, near a Chozo Statue in game. He comments, "Don't let the Space Monkeys get you."
The patient is improving, but he still has a cough. Foreman orders some more tests. They show that the patient doesn't have hypothyroidism. Foreman goes to House and says it can't be two diseases and he still thinks he's right about the virus. House bets $50 and sends Foreman to do a white cell count.
Chase is pouring coffee, but spills some because he was staring at Cameron. They talk about her remark about sex killing the patient, and Cameron starts to get very graphic talking about the effects of sex on the human body. She stops when Foreman comes in. The tests show the white cell count is down - the patient's immune system has completely shut down. They move him into a clean room. Foreman tells the parents that a cold will now kill the patient.
They do a bone marrow biopsy on the patient. The patient is worried he will have to stay in a clean room for the rest of his life.
House goes to Cuddy to get excused from clinic duty. Cuddy is making him do it so he will have to deal with people. She threatens to make him more miserable if he tries to keep calling her in for consults.
While Wilson signs out a Vicodin Prescription from the pharmacy, He asks if House has a thing for Cuddy, but he denies it. Wilson wonders why House isn't kissing up to Cuddy. The pharmacists puts two bottles of medicine on the counter, and Wilson points out that, despite it being the one he was given, House picked up the wrong bottle. All of a sudden, House asks Wilson what the patient's first symptom was. Wilson says it was a cough. House goes to think in his office.
House meets with his team. He thinks the patient was given gout medicine - Colchicine- instead of cough medicine - a pharmacy screw up. It explains all the symptoms. However, Cameron points out that he isn't getting better - he got better then got worse. House thinks there may have been another screw up - someone gave him the medicine at the hospital.
House meets with the family. He accuses them of giving the patient the "cough medicine" after he arrived at the hospital. The mother admits to it and finds the medicine bottle. Chase goes to the pharmacy. The mother and girlfriend have a disagreement about whether they should be optimistic. However, it turns out they gave the patient the cough medicine after all.
House has to admit he was wrong although his theory was perfect. However, he now thinks the cough medicine may have caused the problem. Wilson suggests exploratory surgery, but the patient will likely die if he undergoes surgery. However, House agrees to it as they have no other choice.
They start to prepare the patient for surgery. However, the patient goes into cardiac arrest while they insert a heart catheter. They get his heart started again. However, they have to cancel the surgery. The patient now also has pain in his fingers. Cameron tells House, and he starts thinking of something.
House goes into the clean room without preparation. He still thinks the patient was poisoned by Colchicine because of the new symptom - hair loss. He thinks the kid has been using illegal drugs contaminated with Colchicine and orders treatment. The patient starts improving.
However, House is not satisfied - he still can't figure out the source of the poisoning. The patient and his family start making wedding plans. However, the patient starts coughing again. They give him cough pills, and he realizes they aren't the same as the previous pills he was taking; the new pills have the letter "L" on them while his previous pills did not. Chase attempts to build his relationship with Cameron by asking her out to get some food, but she cuts him off right away and declines the offer.
The episode ends with a scene showing House in the pharmacy after hours, sitting on the floor searching through bottles. He has two similar-looking pills; both have the same shape, only one has writing on it and one does not. House gives a smile of satisfaction, his first instinct being correct.
==Clinic Patient==
The patient brings a mucus sample to House for examination. He insults the patient and guesses that she's getting fired because her glasses and teeth have recently been worked on. He agrees to give her a full body scan while her insurance is still good.
The next patient has a sore throat. House makes him wait. Cuddy comes in an examines the patient. House acts like he's surprised the patient has a sore throat. Cuddy sends the patient home to drink hot tea.
House tells the next patient he kissed Cuddy's ass to get out of an hour of clinic duty. He realizes the patient has something in his anus because he hasn't sat down. The patient says it's an MP3 player. House leaves the patient to Cuddy.
==Major Events==
*In addition to being a diagnostician, House also has a double specialty in infectious diseases and nephrology.
*House has been a doctor for twenty years.
*In an attempt to make his clinic hours more interesting, House starts calling Cuddy for consults.
*First time mentioning about Chase's interest in Cameron. Foreman and Chase talk about how attractive she is. Foreman tells Cameron that Chase cannot look at her without thinking about sex.
==Title==
The title of the episode comes from the principle of Occam's razor which states that one should not make unnecessary assumptions when drawing conclusions. It does not, like Foreman states, mean that the simplest answer is usually correct. This principle is played with throughout the episode.
==Zebra Factor 3/10==
As House himself said, pharmacy errors cause thousands of deaths a year, and many more illnesses. However, colchicine poisoning is rather rare.
==Trivia & Cultural References==
*There is a label on the conference room coffee machine - "Good Coffee - cheaper than Prozac".
*House is playing Metroid: Zero Mission on a Game Boy Advance SP. However, the details of the game are not consistent. It's playing the wrong soundtrack. When the character rolls up into a ball in the hands of a larger character, both House and a patient react as if that's a bad thing, but in fact that's a game goal that results in a reward. When House says he is on Level 4, he is in fact in the starting area of the game and the game itself doesn't have levels, just different areas to explore.
*The small yellow pills with an "L" on one side are actually low-dose aspirin, the type taken on a daily basis as a blood thinner.
*The scene between Brandon and Mindy at the beginning was considered too explicit. Originally, the producers put a warning at the beginning of the program. However, many stations refused to show the episode in syndication. Current syndicated episodes have cut most of the scene out.
*The Great Wall of China was a series of connected fortifications separating China from Mongolia. The most important and best known parts of the wall were built from the 14th century to the 17th century, but there is evidence of fortifications dating back to the 7th century B.C.E..
*The Recording Industry Association of America is a trade organization representing record labels and music distributors. Its primary activity is launching copyright lawsuits against illegal downloading.
*Stockholm syndrome describes a psychological phenomenon when individuals in a captive situation start to sympathize and empathize with their captors. It was first names after a hostage taking situation in Stockholm, Sweden where the hostages refused to testify in court against their captors.
*After Foreman mentions Occam's Razor during the DDX, House says, "One is lower, it's lonelier," which is referencing the song that's played at the end of the episode.
==Goofs==
*As the patient's symptoms fill the whiteboard, the lines circling the symptoms keep changing.
*Although the doctors describe the patient's heartbeat as "ectopic" (i.e. a premature beat followed by a pause) the heart monitor actually shows a perfectly normal rhythm.
*During the patient's cardiac arrest he had no electrical activity (asystole) on the monitor - meaning this is a non-shockable rhythm - yet he is given a shock to save him.
*The writing on the whiteboard keeps changing back and forth during some scenes.
*Tests for proteins, RNA, and DNA take hours to run.
*Even if House had figured out the problem, he still should have stayed out of isolation if the patient's white blood cell count was low. As long as it's low, the patient will die if he's exposed to any sort of infection.
*Thyroid hormones are rarely given intravenously, usually being given orally instead. In addition, the hormone pills have to be introduced gradually until the patient finds an equilibrium, otherwise hyperthyroidism may result.
==Reviews==
*IMDB users rated the episode an 8.3 with "8" being the most common rating and 23.3% of respondents giving it a "10". It did best with females 18-39 (8.5) and worst with people under the age of 18 (8).
*TV.com users rated the episode an 8.8. They chose Alexis Thorpe as their Most Valuable Performer.
*Polite Dissent thought this was the first episode where the medical mystery was plausible.
==Medical Ethics==
===Pharmacy Errors===
As House pointed out, "pharmacy errors" (which is not identical to "pharmacy negligence", but negligence is included in errors) kill about 7,000 people in the United States a year. That's much smaller than the number of deaths from "medical mistakes" (again, which includes but is not equal to "medical negligence" or "malpractice) which is closer to 100,000.
The most common pharmacy errors are:
*Misread/illegible prescriptions (which really is a physician problem)
*Similar looking medicines or medical packaging (which was the problem in this episode)
*Dispensing a drug with a similar name
*Dispensing the wrong dose
Errors of this kind are the number one cause of complaints to pharmacist discipline bodies. However, the threat of litigation and discipline also discourage pharmacists from reporting such errors. Part of the problem is the speed of the process - a busy pharmacist might have to fill 25 prescriptions an hour. In addition, the mandatory reporting of such errors has only recently become a requirement.
Most pharmacists who are studying the problem believe that the root cause is a "blame and shame" culture that discourages pharmacists from looking at the root causes of such errors. Most errors are caught before the drug ever reaches the patient, but the blaming culture makes no effort to examine why a particular error took place, or to find systemic problems that lead to errors.
Among the root causes identified were:
*Continued reliance on handwritten prescriptions
*Similar drug names
*Similar packaging
*Confusing or misleading dosing information
*Lack of effective controls on prescription medication
*Interruptions
Many pharmacists doing drug safety courses now do root cause analysis assignments as part of their coursework.
Given current practices, House's team could have reported the possibility of a pharmacy error up the chain of command and call in their own pharmacy team for a consult. However, one surprising thing is that no one who took a medical history of the patient noted that he was already on medication. Medical histories of this nature have to be very thorough as patients often believe that when a doctor asks about medication, they mean prescription medication and not over-the-counter medication.
===Diagnostic Trials===
Once again, House starts treating a patient without confirming a diagnosis. As Cuddy quite correctly points out, this is exceedingly dangerous even in urgent cases. The wrong treatment can be more damaging than allowing the real disease to take its course.
And this is a perfect example. The patient's condition abated on its own once he stopped taking his "cough medication". Had House merely waited, the patient would have gotten better. The tests would have come back negative. The matter would have remained a mystery and that might have driven House nuts, but the patient would be fine and that's supposed to be the goal.
But in four episodes, this is the fourth time he's tried to reach a diagnosis by trying to treat the patient, rather than reaching a diagnosis then treating the patient. In all three of the previous times, he's been wrong, but the patient suffered no adverse effects. House got lucky this time. Thyroid hormones can wreak havoc with a person with normal hormone function and the most common result would be hyperthyroidism, which is dangerous on its own.
On the other hand, House's lack of caution might be justified. After all, his patients are all the patients who doctors tried to diagnose and treat "by the book" and they were unsuccessful. The patient's symptoms were real and urgent. as House points out, most other doctors would prefer to let a patient die, then satisfy themselves by the fact they did "nothing wrong". House prefers to put his medical career on the line in an attempt to get a better result.
==Quotes==
Wilson: That smugness of yours really is an attractive quality.
House: Thank you. It was either that or get my hair highlighted. Smugness is easier to maintain.
Cuddy: It's not gonna work. You know why? Because this is fun. You think of something to make me miserable, I think of something to make you miserable... it's a game! And I'm gonna win. Because I got a head start. You are already miserable.
House: It was so perfect. It was beautiful.
Wilson: Beauty often seduces us on the road to truth.
House: And triteness kicks us in the nuts.
Wilson: So true.
House: This doesn't bother you?
Wilson: That you were wrong? I try to work through the pain...
House: I was not wrong. Everything I said was true. It fit. It was elegant.
Wilson: So... reality was wrong?
House: Reality is almost always wrong.
House: I'm doing good too. I get to knock off an hour early today? Know why? Because I kissed my boss's ass? You ever do that? I think she just said "Yes" because she wants to reinforce that behavior--wants me to kiss a lot of other people's ass. Like she wants me to kiss yours. What would you want? A doctor who holds your hand while you die, or a doctor who ignores you while you get better? I guess it would particularly suck to have a doctor who ignores you while you die.
House: Make a note: I should never doubt myself.
Wilson: I think you'll remember. You know, it wouldn't hurt you to be wrong every now and then.
House: What, you don't care about these people?
Wilson: You know what? I'm not interested.
House: You're not curious?
Wilson: No. Because I'm well-adjusted.
Foreman: Occam's Razor. The simplest explanation is always the best.
House: And you think one is simpler than two.
Cameron: Pretty sure it is, yeah.
House: Baby shows up. Chase tells you that two people exchanged fluids to create this being. I tell you that one stork dropped the little tyke off in a diaper. You going to go with the two or the one?
Foreman: I think your argument is specious.
House: I think your tie is ugly. Why is one simpler than two? It's lower, lonelier... is it simpler?
Chase: He thinks outside the box, is that so evil?
Foreman: He has no idea where the box is!
Foreman: Why didn't you page us?
House: Cause I knew you'd be here.
Chase: Who told him?
House: No one. I assume you're trying to prove my crazy two-illness theory wrong, so, obviously, you're going to be in the lab.
Wilson: I get that you're not a big believer in the "catching flies with honey" approach, but do you honestly think you'll collect a jarful by cleverly taunting them?
House: Flies, no. Doctors, sure. If I'd said to Foreman, "Nice try, it was a great guess, but not this time," what do you think he'd be doing right now?
Wilson: I think he'd be going home not feeling like a piece of crap.
House: Exactly
Wilson: You want him to feel like a piece of crap?
House: No, I don't want him going home.
Patient: How can you treat someone without meeting them?
House: It's easy if you don't give a crap about them. That's a good thing. If emotions made you act rationally, then they wouldn't be called emotions, would they? That's why we have this nice division of labor: you hold his hand, I get him better. If I start tucking him in at night, well, that's not fair to you guys, and if you start prescribing medicine, that's not fair to me.
House: Hello, sick people and their loved ones! In the interests of saving time and avoiding a lot of boring chit-chat later, I'm Dr. Gregory House. You can call me Greg. I'm one of three doctors staffing this clinic this morning.
Dr. Cuddy: Short, sweet, grab a file.
House: This ray of sunshine is Dr. Lisa Cuddy. Dr. Cuddy runs this whole hospital so, unfortunately, she's much too busy to deal with you. I am a board certified diagnostician with a double specialty of infectious disease and nephrology. I'm also the only doctor currently employed at this clinic who is here against his will. That is true, isn't it? But not to worry, because for most of you this job could be done by a monkey with a bottle of Motrin. Speaking of which, if you're particularly annoying, you may see me reach for this. This is Vicodin. It's mine. You can't have any. And no, I do not have a pain management problem, I have a pain problem. But who knows? Maybe I'm wrong. Maybe I'm too stoned to tell. So, who wants me? And who would rather wait for one of the other two doctors? Okay, well, I'll be in Exam Room 1 if you change your mind.
Dr. Cameron: I'm uncomfortable about sex.
Dr. Chase: But we don't have to talk about this.
Cameron: Sex... could kill you. Do you know what the human body goes through when you have sex? Pupils dilate, arteries constrict, core temperature rises, heart races, blood pressure skyrockets, respiration becomes rapid and shallow, the brain fires bursts of electrical impulses from nowhere to nowhere and secretions spit out of every gland, and the muscles tense and spasm like you're lifting three times your body weight. It's violent, it's ugly, and it's messy, and if God hadn't made it unbelievably fun... the human race would have died out eons ago... Men are lucky they can only have one orgasm. You know that women can have an hour-long orgasm? Hey, Foreman. What's up?
House: I know you're gonna get fired. That's why you've got the new glasses, that's why your teeth are sparkly white. You're getting the most out of your health insurance while you still can.
Jodi: I might be quitting.
House: If you were quitting, you have known that last week, when your snot was still pale goldenrod, you're getting fired.
Jodi: I just don't like being told what to do.
House: ...I'll get you in for a full body scan later this week.
Dr. Cameron: So, a woman can't express her interest in sex without it being some professional power play?
House: No. If you look the way you do and you say what you said, you have to be aware of the effect that it's going to have on men.
Dr. Cameron: Men should grow up.
House: Yeah, and dogs should stop licking themselves. It's not going to happen.
House: Occam's Razor--the simplest explanation is almost always that somebody screwed up.
Dr. Foreman: What's wrong with her?
House: Her leg hurts after running six miles. Who knows, it could be anything.
Dr. Wilson: You will lie, cheat and steal to get what you want, but you're incapable of kissing a little ass?
House: Well, we all have our limitations.
Dr. Cuddy: Working with people actually makes you a better doctor.
House: When did I sign up for that course?
Dr. Cuddy: When did I give you the impression that I care?
House: Working in this clinic obviously instills a deep sense of compassion.''
Dr. Foreman: You want to bet on the patient's health?
House: You think that's bad luck? You think that God will smite him because of our insensitivity? Look, if God does, you make a quick fifty.
Dr. Foreman: You visited a patient?
House: I was sitting by his bed all morning. Just so he'd know someone was there for him.
Dr. Wilson: I looked in on him.
House: You once asked me why I think I'm always right. And I realized you're right. At least I think you're right...I don't really know now, do I?
Dr. Cameron: Brandon's not ready for surgery.
House: Okay, let's leave it a couple of weeks - he should be feeling better by then. Oh wait - which way does time go?
Dr. Wilson: Beauty often seduces us on the road to truth.
House: And triteness kicks us in the nuts.
Dr. Wilson: So true...
Jodi Matthews: You're not a very nice doctor, are you?
House: And you are very bad at whatever it is you do.
Dr. Chase: She's [Cameron] weird, isn't she?
Dr. Foreman: Bad idea.
Dr. Chase: What?
Dr. Foreman: Bad idea. You work with her.
Dr. Chase: What'd I say? Is "weird" some new ghetto euphemism for "sexy?" Like "bad" is "good" and "phat" is "good?" Then what the hell does "good" mean?
Dr. Foreman: "Ghetto euphemism?" You don't think she's hot?
Dr. Chase: No.
Dr. Foreman: Then you're brilliant. And I am using "brilliant" as a euphemism.
Chase: Obviously, the girl is hot. I, you, you're not talking about her aesthetics. You're talking about if I want to jump her. I don't.
Foreman: Brilliant. Your Epstein-Barr is ready.
House: What's wrong with her?
Dr. Cameron: Him.
House: Him, her. Does it matter? Does anyone think it's a testicular problem?
House: No. There is not a thin line between love and hate. There is in fact a Great Wall of China with armed sentries posted every twenty feet between love and hate.
House: Why do you want me to treat this guy?
Dr. Wilson: Blood pressure's not responding to IV fluid...
House: No, no. I didn't ask how you planned to con me into treating him. I asked you why you want me to treat him.
Dr. Wilson: He's sick, I care, I'm pathetic.
House: There are a billion sick people on the planet. Why this one?
Dr. Wilson: Because this one's in our emergency room.
House: Ah, so it's a proximity issue. If someone was sick in the third floor stairwell that's him we'd be talking about.
Dr. Wilson: Yes, I checked the stairwell, it's clear.
House: C'mon, nobody's going to be mad. I just want to know who tried to kill the kid.
Cameron: Negative on parvovirus B19.
Foreman: I'm impressed.
Cameron: Thank you, I was born to run gels.
Foreman: I meant about Chase
Cameron: What about Chase?
Foreman: Well, the man has no physical interest in you. He has a completely professional relationship with you. Respects you as a colleague and a doctor. And yet, he can't look at you without thinking sex.
Cameron: Because I asked what kind of sex could kill you?
Foreman: You now have total control over your relationship with him.
==Music==
*"One" by Three Dog Night, while House checks the pharmacy stock of colchicine.
==Release Dates==
*United States - November 30, 2004 on Fox
*Canada - November 30, 2004 on Global
*Estonia - December 30, 2005
*Hungary - April 5, 2006
*Germany - May 23, 2006
*Finland - October 5, 2006
*Mexico - January 24, 2007
*France - February 28, 2007
==In Other Languages==
Yet another title that doesn't translate well into other languages. "Occam's razor" is an idiom and not a statement of possession.
*Spanish - La Navaja de Occam - (literally, "The Knife of Occam". Razor translates as "shaving clippers")
*French - Cherchez l'erreur (Find the mistake)
*German - Das Ende danach? (The end afterwards?)
==Links==
*Episode page at IMDB
*Episode article at Wikipedia
*Episode article at TV IV
*Episode page at House MD Guide
*Unofficial episode transcript
*Goofs at Movie Mistakes
*Pictures at Dr. Greg House.com﻿
*Episode page at TV.com﻿
*A review of the medicine at Polite Dissent (from archive.org)﻿
==Cast==
*Hugh Laurie as Dr. Gregory House
*Lisa Edelstein as Dr. Lisa Cuddy
*Omar Epps as Dr. Eric Foreman
*Robert Sean Leonard as Dr. James Wilson
*Jennifer Morrison as Dr. Allison Cameron
*Jesse Spencer as Dr. Robert Chase
*Kevin Zegers as Brandon Merrell
*Alexis Thorpe as Mindy
*Faith Prince as Becky Merrell
*Lauren Cohn as Jodi Matthews
*Marco Pelaez as Marco the Pharmacist
*Jason Stuart as Adam Brown
*Ben Campbell as Jerry Morris
*John Kelly as Robert Merrell
*Joshua Wolf Coleman as Suburban Pharmacist
*Beth Hall as Shelly Lever
*Alexander Hall as Doctor
*Kimberely Simonetti as Intern
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