I've seen a few episodes of House M.D., and I wonder, are the episodes written according to a fixed structural pattern? If so, what are the details, and why does such a structure make the show popular?

The series is clearly compelling and has a large following. I would like to study the technical details of its structure, and see if I can take advantage of them in my own writing.

  • I'm curious as to whether this is on-topic or not. Opinions? Commented Feb 23, 2011 at 4:45
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    It could be, with a simple addendum along the lines of "This is obviously a compelling/popular/repulsive/[other] series format, and so I would like to understand it better, and perhaps adapt part of the formula for my own writing." I'd accept that addendum as implicit, but it'd be even better if OP added it to the question.
    – Standback
    Commented Feb 23, 2011 at 4:51
  • "Constant"? I use the show's structure to set my watch. :) (I love House. But yes, it's pretty consistent.) Commented Feb 23, 2011 at 13:26
  • Reminds me of this. Commented May 11, 2013 at 18:23

5 Answers 5


Yes, they do.

  • They open with a problem occurring -- an unknown disease that no one can figure out.
  • House has to be conned into taking the case.
  • They sit around a room and throw ideas at each other.
  • All of the ideas are wrong.
  • Patient nears death and no ideas are working.
  • House has a magical epiphany and solves the case.
  • The End.

(Also, don't forget the sexual jokes thrown in at various times.)

  • ...and they are called "procedural dramas" for a reason. Commented Feb 23, 2011 at 11:54
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    You know, now that I think about it, that's almost the exact same plot as Dragon Ball Z. Villains show up. Everyone gets their arse kicked. Goku finds new super power. Goku kicks arse. Commented Feb 23, 2011 at 22:07

Ralph certainly covered the structure of individual episodes: the patient's symptoms escalate; the team tries one treatment after another (with dramatic results, in some direction or another); House solves the case.

That's a fair description of the single-episode plotline, but there's a lot of other tools in the House arsenal - and ones which, I think, are more relevant to the show's fun and success then its bare-bones formula is.

Here's a few tools House uses which I think are worth taking note of.

Misanthropes are more interesting. House is a character crafted with the specific goal of causing conflict and tension wherever he goes, and whoever he interacts with. On the one hand, this is a lot of fun to watch - the malicious, snarky curmudgeon who does everything we'd never dare to do. On the other, more important hand - a character who causes conflict is a character who causes plot. A character like that is easy to bring into stories because he's willing to be outrageous, and because he actively encourages (or outright causes) the conflicts that create the plot. Notice how much of the plot consists of people telling House "no," and his attempts to get around them - his nature of head-butting others is what gives the story substance. Lesson to take home: create characters who can believably create conflicts or get involved in them - the bigger and more personal, the better. A trouble-maker is often a lot more interesting than a noble hero.

Get inside your characters' heads - by force, if necessary. It's often very difficult to do character exploration - it's tough to spotlight one character without ignoring the rest; often there's no good reason other characters should even know what's going on with the others; these are all particularly difficult in a series about medical professionals and a formula which doesn't really center around the characters at all. Luckily, House is a nosy bastard. And the writers spun that into "willing to do outrageous things to stay in the know"; "happy to blurt out embarrassing personal information to anybody and everybody"; and "tries to test his friends with convoluted behavior tests to understand their personality and motivations." That's not coincidence - again, this is a character deliberately crafted to serve and advance the plot (and the character arcs) in interesting, convincing ways. Lesson to take home: If character development is a goal of yours, be sure to have some element in the story that brings your characters' personality to the fore. If it's disconnected from the main plot, or purely reactive to it, it won't be interesting. Meddlesome characters are good tools for this.

Always have a goal. House is very good at having some big questions about the lead character juggling in the air at any given moment. It's also not shy about telling the viewers precisely what those questions are (the series, as its title character, is not known for its subtlety). "How far will House go in order to [get the girl/keep his team together/flip off a figure of authority/other]" is a common one. Other threads include "Why is House the way that he is?", "How is House affecting the doctors around him?", and others. These keep the viewers involved and curious - and rewarded when an arc does shed light on a certain point that's been built up. Lesson to take home: defining clear directions and mysteries to explore keeps viewers hooked - you're giving them something to look forward to, and presenting them with something mysterious and incomplete right now.

You've got to have a team. Well, not always. But House does - if he works in a vacuum, there's no show. So you've got to justify the team's existence, even though House is always the one who solves the case on his own. So, the series goes to great length to demonstrate that House instinctively needs a team, for feedback, brainstorming, and targeted mockery. That way, his need for a team - and his team in particular - becomes another facet of his complex personality, rather than an obvious plot device. Lesson to take home: When there's something you really need in order to tell a story, that might not quite fit or make sense - justify it; work its necessity into the very fabric of your writing; use this constraint and build upon it rather than accepting it as an unfortunate necessity.

That's what I'd take away from House. Hope this is helpful :)


Yes, and Ralph Gallagher's answer identifies the pattern pretty well.

Why does it make for a popular show? I think it's because it gives audiences something familiar, something they can expect to see every week, while still allowing a lot of room for variety within that structure. Most stories adhere to some kind of structure, whether it's as rigid as the one on "House" or something more general. You may have encountered the "roller coaster" model for basic story structure back in grade school: the setup, rising action, climax, falling action, and conclusion. It's a very simple model, but one a lot of stories use, whether consciously or not and often with some variations. Most hald hour TV shows work on a three act structure. Movies are generally between three and five acts, with some exceptions.

The structural nature of procedural dramas also plays in to the audience knowledge of how TV shows work. The viewers know that House and his team aren't going to solve the medical mystery in the first fifteen minutes, or that whoever the detectives on any version of "Law & Order" won't be the right suspect because there' still more than half the show to go. So it becomes a given that House's team won't guess right on the first try or the cops will initially collar the wrong suspect. There's still room to surprise the audience, though. House's initial diagnosis may turn out to be right, but other factors may lead him and his team to incorrectly conclude that it isn't. Or the detective may have the right suspect, but not the right evidence.

A lot of heavily structured TV shows will occasionally do a show that breaks the structure. Last night's episode of "House," for example, barely had anything to do with the medical case.

And every once in a very great while, it actually is lupus.

Addendum: Another reason that "House" is able to work while still being so formulaic is that the human drama is more important than the medical mystery. "House" has a lot of trappings of the mystery genre (in part because it's partly based on Sherlock Holmes), but it isn't the kind of mystery where the viewer gets all the necessary clues and tries to guess the solution. Unless you're incredibly knowledgeable about rare medical conditions, you'll never guess what's wrong with the patient of the week. Indeed, the event that cause's House's epiphany is usually completely unrelated to the actual case. It doesn't matter if the patient has endocarditis or heavy metal poisoning. What matters is that the patient believes that his faith is keeping him alive or feel guilty about the death of her son or that one of the team is having a crisis of confidence.

  • It's never lupus! ;) Commented Feb 23, 2011 at 16:57
  • I swear there was at least one episode where it was lupus. Commented Feb 23, 2011 at 18:22
  • I believe there was one where it actually was lupus. But I know House had kept vicodin stashed in a lupus textbook because "it's never lupus." (And, ironically, my grandmother died from lupus.) Commented Feb 23, 2011 at 19:10
  • Yep, there was one lupus case: the episode where Marc Blucas (Buffy's boring boyfriend) was the patient of the week. House had a dream where he was a soldier, and one of the other people in his dream then turned out to be that patient. (Turns out House had seen him years before at a fundraiser dancing with Cuddy.) [/geek] Commented Feb 23, 2011 at 21:24
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    The last time I tried to [/geek], it caused a fatal error. :) Commented Feb 23, 2011 at 23:21

Other answers above are good, but it's worth adding that in the best episodes of House (as well as Scrubs) the medical condition and the wider social situation are interconnected. Medical symptoms create a compelling initial problem, but the solution is never a mere chemical prescription or surgical procedure.

There are at least two resolutions to the medical problems: either the team (primarily House) solves the mystery by insight outside of strict medicine, or the team confronts defeat and has to learn how to deal with it somehow.

The extra-medical insight is usually that the team investigates the social situation of the patient, or the team has antics among itself, and those interpersonal struggles illuminate some key fact about the patient and her disease. Call this the "social-to-medical" structure.

And likewise on the other end, both solving the mystery and failing to solve the mystery often teaches the team (primarily House) about their own characters and situations. This can also teach the patient or the patient's family about themselves. Call this the "medical-to-social" structure.

There are also episodes where the specific medical resolution is irrelevant to the main story, but these are harder to generalize about. Usually the medical situation simply precipitates social events, or the medical setting is just a general backdrop to bring out the curious personailties of the team. These I suppose would be "social-to-social" story lines, which are constantly refreshed by the rotating team cast and their different combinations of interactions with different patients.

Hope that provides some food for thought.


I would have just commented, but I am too low for that at the moment.

I wanted to add that one reason for this format is the viewer can now focus on the relationships that are forming in the background. The humor of how House relates to his team, the drama of his drug abuse, the ups and downs of his romantic relationships -- all this develops because you are not looking for a change in the pattern, you are focusing on these elements.

Also, when the pattern does change, the twist feels more heavy because you were not expecting it. So, to use Ralph's answer (SPOILER ALERT):

  1. They open with a problem occurring -- an unknown disease that no one can figure out.
  2. House has to be conned into taking the case.
  3. They sit around a room and throw ideas at each other.
  4. All of the ideas are wrong.
  5. House thinks he is right. He diagnoses the patient.
  6. House realizes he is crazy from drug abuse. His team saves the patient.
  7. House goes to mental hospital.

Because you are used to House doing the solving, when he misses one, you are surprised.


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