Is Dr Greg House a Dreysfus Expert?

My 2018 Box Set is all eight seasons of House. I watched my way through S1 during the Great Flu, and have despatched the first disc of S2 already. Dr Greg House is supposed to be the best diagnostician in the USA, and the question that will occur to you and me is, well, is he a Dreyfussian ‘expert’.

Hubert Dreyfus is a phenomenologist whose most well-known work came from trying to understand the failure of so-called ‘expert systems’ that, in the 1960’s and 1970’s, were going to replace everyone by now. And yet haven’t. The reason that rule-based, as opposed to computationally-heavy algorithms, failed, Dreyfus suggested, was that experts don’t use rules. More than that, the process of becoming an expert involved abandoning detached rule-based decisions and replacing it with a huge stock of special cases and a sophisticated pattern-matching process that the human brain seems to be good at creating but can’t be reduced to rules.

In Dreyfus’ model there are five stages to acquiring and practicing a skill. The novice is given simple techniques and processes to use and explicit rules about when these can be used; the advanced beginner has a larger stock of techniques and processes, and has added an amount of judgement in how these are used to deal with the tasks they are given; competency begins when the practitioner has too many rules and conditions and must make a decision about how to solve the problem in front of them (and it becomes problem-solving because it’s not immediately obvious which rules apply and which techniques will work). This stage must involve emotional engagement to be effective: the practitioner must experience hope and upset during its progress, and satisfaction or disappointment at the result. The emotional involvement is what seems to set the more complex learning processes going.

At the proficient stage, the act of recognising what kind of problem it is becomes more and more automatic, but the practitioner still needs to think about what to do, and may apply rules to determine the action. (“Ah yes, it’s Watkins’ Irritation: do we use hapagobulin or leave it to pass on its own?”) The Expert passes straight from seeing the situation to prescribing the action: to the Novice, the Expert “just seems to know what to do”.

So back to Dr Greg House. Each episode of House has a period of Shakespearean comic relief, called the Clinic. House has to see regular patients and treat them. These he dispatches within the minute: a glance at the person, listen to the symptoms, and he has the answer. “Your husband in cheating on you, you’re losing sleep and taking too many pills” or something similar. We’ve seen this before: it’s Sherlock Holmes. Holmes combined acute observation with a huge amount of background knowledge and experience to tell people things about themselves they thought were hidden. Conan Doyle called it ‘deduction’, but it wasn’t. It was Dreyfusian expertise, reconstructed as deduction for the benefit of the audience. Faced with regular life, House is smart as a whip.

Each episode of House also has the Puzzling Patient. This is the patient whose symptoms don’t make sense. House and his team spend the episode trying and rejecting one hypothesis after another, often with dramatic effects on the patient. The Puzzling Patient defeats the experts because their symptoms don’t fit one paradigm or another: there’s always a symptom missing or a symptom left over. Sometimes the patient has been treated before for something that matched some of their symptoms. In other words, the Puzzling Patient disables the Expert’s expertise.

So now there’s nothing for it but experiment. When the experiment goes wrong, the team react immediately and correctly. Faced with an episode that their Expert can recognise, they respond as Experts. And if the experiments don’t work, it’s time for the oddest feature of the show, the break-in to the patient’s living quarters. House’s catchphrase is ‘Everybody Lies’. It’s a way for him to remember that the patient may not be telling him everything they need to. In one episode, a Mexican handyman never mentions that he works at an illegal cock-fighting event Saturday nights. If he had, House would have immediately suspected a reasonably well-known problem. So the break-ins and other devices are there to find something the patient isn’t saying, or may not even know is relevant.

And when the final piece of information is found, the diagnosis is immediate and dealt with Expertly. Each episode of House is about the search for the missing fact that will make the Puzzling Patient no longer Puzzling, but an instance of one of the thousands of special cases in House’s Expert list.

And it all, so far, ends happily ever after.

DISCLAIMER: Yes I know the hospital in House bears the same resemblance to reality as the CSI lab in CSI: Vegas does to real CSI Labs; and that any doctor who behaved like House would be out on his ear in a month. This is TV, not a reality show.