Changes: The Socratic Method

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This is an article about the episode. For a description of the teaching method, see Socratic Method.

Discussing the 2nd century physician's treatment for schizophrenia:

House: "You think I'm interested because of the schizophrenia."

Wilson: "Yeah. I'm pretty sure."

House: "Galen was pretty sure about the fumigation thing. "

— The Socratic Method

The Socratic Method is a 1st season episode of House which first aired on December 21, 2004. While dodging Cuddy in the emergency room, House runs into the son of a schizophrenic woman who has been diagnosed with alcoholism. Intrigued by her schizophrenia and the fact she has a condition she's too young to get, he takes her case and finds multiple problems. However, when the patient does something unexpected, House starts to wonder if she's really mentally ill at all.

Recap

A schizophrenic woman is with her son talking to a social worker when she starts suffering the effects of a deep vein thrombosis. To quiet her down, her son gives her vodka while the social worker is away getting water. She starts complaining about the voices she hears. All of a sudden, she grabs her chest and collapses.

The woman is rushed to Princeton-Plainsboro, and House hears a page from Cuddy. He is hiding from her in the ER waiting room and meets up randomly with the patient's son, who asks if it’s a good hospital. An ER doctor tells the son about the thrombosis which broke off and went to her lungs, causing a pulmonary embolism. The son Luke argues that it can't be from the alcohol he's given her, but House stands up and shouts at the ER doctor for not checking whether or not the patient has other signs of alcoholism.

House takes the case and asks the team how the patient got a deep vein thrombosis. He points out that she's too young at 38 to have one without a prior history. He's taken the son's voluminous notes. He also rules out the schizophrenia as the cause of the thrombosis.

Wilson wants to know why House took the case. He says it's because she's too young to have a thrombosis. He also talks about the treatment of schizophrenics. He also tells Wilson he's going to speak to the patient. Wilson is shocked, but figures it's because of the schizophrenia.

House goes to see the patient, and sends the son out of the room. House asks the patient how much she drinks. Foreman is also perplexed about why House is talking to the patient - Chase says House likes people who aren't boring. House keeps questioning the patient. The patient says that nobody believes her, but House says he does.

Foreman talks to Wilson. Wilson says House likes puzzles - House hates people, but is fascinated by them.

House reports the patient has had tremors, which has caused her to stop shaving her legs two months ago. However, Chase realizes she had tremors since she was diagnosed and she must have cut herself before. House figures that she‘s probably bleeding more from the cuts. He orders blood tests. He also orders them to take her off the medicine for her schizophrenia. Cameron wishes House a happy birthday. House doesn't react except to ask how Cameron knew (she saw a form while answering his mail with his birth date).

The team has trouble taking blood from the patient, and they have to restrain and sedate her.

The son confronts House about sedating his mother - she doesn't like getting Haldol as it "makes her soul numb". He starts reading to his mother. All of a sudden, she starts vomitting blood.

Foreman is arguing the Haldol couldn't have caused the vomiting blood. House notes that Foreman shouldn't have given her the sedative just because she spit at him. The clotting studies come back from the lab, but they are normal except for a prolonged PT time. Foreman realizes that this usually means the blood wasn‘t drawn correctly, but House agrees that Foreman probably did the draw correctly. House thinks the patient is bleeding from a Vitamin K deficiency. However, Cameron thinks it is a reaction to an antibiotic she was prescribed, but House says that the son‘s notes say she didn‘t take it. Chase thinks it is alcohol. House orders an environmental scan and an ultrasound of the patient's liver.

Chase and Foreman go to the patient's apartment. Foreman has stolen the son's key. The apartment is very well organized, with date labels on the drawers. Foreman finds some drug, but also an intact bottle of the antibiotic, disproving Cameron's theory. However, the Vitamin K deficiency seems to be confirmed when they find the refrigerator is full of frozen hamburgers.

Luke says frozen hamburgers are all Lucy will eat and he checked out the nutritional values on the label. House is explaining to the son how Vitamin K would be missing from the patient's diet. He tells the son he will continue having trouble taking care of his mom.

Chase still isn't convinced the problem is Vitamin K.

House is looking at what appears to be the son's X-ray. He says he realizes the son is only 15, not 18. House realizes why the son wants to stay with his mom. The son threatens to sue House if he squeals, but House says he was just bluffing - the X-ray wasn't even the son's.

Chase does the ultrasound and finds a mass on the liver, probably a tumor. Wilson confirms the tumor caused the bleeding. They break the news to the patient and the son.

The patient needs a liver transplant, but can't afford it. Even if she could, she probably wouldn‘t qualify because of her other medical issues. House wants to try to cut out the tumor, but Wilson points out it's too big under the surgical guidelines. House suggests they can make it shrink. They use ethanol to dehydrate the tumor to make it smaller to fool the surgeon.

Cuddy finds House in the clinic and says she knows something is up. House pretends it is about his birthday. All she wanted to do was to remind him he still owes clinic hours. However, after disposing of the present she was going to give House, she goes to get all of House's charts. She follows House into the men's room to tell him she knows about the shrinking tumor. House says he did it for the patient - he claims the guideline about tumor size is just to protect doctors from malpractice suits and to keep their statistics from going down.

Cameron wants to know why House isn't celebrating his birthday, but he dodges the question and sends her to assist with the surgery.

They proceed with the surgery, and Dr. Bergin realizes the tumor was shot up with ethanol. He does the surgery anyway, but tells Cameron he won't stand for that sort of thing again.

Chase tells the son that the tumor was likely due to alcohol, but the son still won't buy it. Chase is going over the care procedures when a social worker shows up to take him to children's services.

House is wondering why Cuddy didn't try to stop the surgery. The son confronts House about telling about his real age to social services as he leaves. All of a sudden, House says to Wilson that he doesn't think Lucy has a mental illness.

House starts reading to the patient. He accuses the patient of calling social services. She denies it, but House found a phone call from her room. House thinks this act of rationality and self-sacrifice rules out schizophrenia. In addition she was 36 when she presented - which is late. In addition, the drugs for it weren't working on her.

House goes to play "Happy Birthday" on the piano while he thinks about the patient. All of a sudden he grabs the son's notebook. He calls the patient's other doctors, even though it's late at night. They generally just hang up on him.

House goes to his team and asks what it could be if it isn't schizophrenia. He points out that specialists focus on diseases within their speciality. Cameron thinks it might be Wilson's disease, a buildup of copper in the body. House realizes that some of her other symptoms, like cirrhosis and problems seeing match as well. They scan her eyes and find the copper colored circles in her iris that show the disease. They start treating her. A few weeks later, she is her old self and is reading herself and is ready to be discharged. Her son comes in and they embrace, and then she tells him to get a haircut.

They run into House in the elevator, and she thanks him for treating her. He says you're welcome, but Luke doesn't want to talk to him. To cover for Lucy, House tells the son he had Cuddy call social services to get him out of his life. Lucy and Luke leave the hospital. House tells Wilson he was right: it was the schizophrenia that made her interesting, not the blood clot. Wilson nods, then, changing the subject, says, " isn't your birthday around now?" and House grimaces.

Major Events

Cameron discovers that it is House's birthday.
We begin to suspect that Chase might have had an alcoholic family member due to his concern about Luke's behavior.

Clinic Patients

House is challenging a mother by telling her that her daughter doesn't have strep throat. What the mother really wants is for her daughter to avoid ice cream to lose weight, but House just starts insulting the mother more for wanting her daughter to be thinner. He tells her to get her the cake for her birthday.

The next patient has hiccups. He's been hitting himself. House makes him do it repeatedly.

Zebra Factor 7/10

Wilson's disease is very rare, occurring in no more than 4 out of 100,000 people in the United States.

Title

The Socratic Method is a form of dialectical inquiry (i.e. a conversation between two people to examine a philosophical proposition) where one person (generally the teacher) takes the role of the questioner and the other (usually the student) answers the questions to the best of their ability. Generally, this pattern continues until a question is posed to which the student cannot answer, generally because it would contradict an answer they gave earlier. In Western philosophy, the technique was attributed to the Athenian philosopher Socrates by his student Plato, who gave examples of the dialogues in his Epistles, a collection of works that appear to be properly attributable to Plato.

In this episode, it refers to House's suspicions that Socrates, like Lucy, suffered from schizophrenia. However, House uses the technique frequently. It is the basic form behind a differential diagnosis - a fellow proposes a diagnosis, and House asks questions that require the fellow to defend the diagnosis. Either House comes up with a question that the fellow cannot answer, or House runs out of questions, which would tend to confirm the diagnosis as provisional. House also frequently uses the method when debating.

Trivia and cultural references

Vodka is an alcoholic spirit, first distilled in Russia, and generally distilled from grain.
Pablo Picasso was a prolific and influential 20th century artist.
LeRoy Neiman was a 20th century artist, best known for his expressionistic paintings of sporting events.
"You're on your way to Stockholm" is a reference to the Nobel Prize, which is awarded there annually.

Galen was a physician in 2nd century Rome who first gained fame as a surgeon to gladiators and is considered to be the father of modern experimental physiology. He was the first person to correctly determine the function of the kidneys and spinal column.
Marcus Welby was a long running medical drama where the title character, a old-fashioned family practitioner, would often clash with his younger partner..
Pink Floyd are referred to due to having a schizophrenic guitarist, a reference to Syd Barrett.

Socrates was a philosopher in 5th century B.C. Greece who is considered to be the father of Western philosophy. He developed the Socratic Method as a form of dialectical inquiry. He was eventually sentenced to death for corrupting the youth of Athens and took hemlock voluntarily to carry out the sentence. His teachings were put into writing by his student Plato, and those teachings were systematized into the forerunner of the first modern post-secondary humanities academy by Plato’s student Aristotle.
Sir Isaac Newton was a 17th century mathematician and scientist who is generally regarded as the father of the modern study of physics.
Socrates, Barrett and Newton were all suspected to have suffered from schizophrenia.

A Reuben sandwich (House’s favorite) is a hot sandwich (although House prefers his cold, no pickles) made of corned beef, sauerkraut, Swiss cheese and Russian dressing on rye bread. His request for "dry" means he wants the sauerkraut to be drained before it is put on the bread so it doesn't get soggy.

The New York Mets are a professional baseball team in the National League of Major League Baseball who play their home games at Citi Field in Flushing, New York.

Mickey Mantle was a Hall of Fame major league professional baseball player who spent his career with the New York Yankees. However, he was known to be a heavy drinker and had problem with alcohol for the rest of his life. He eventually succumbed to liver cancer complicated by cirrhosis and hepatitis C. He was given a liver transplant just before he died, which caused much controversy.

For the first and only time in the series, Hugh Laurie “fakes” a British accent to cover the fact that he’s calling someone in the United States late at night, pretending that he forgot the time difference.

House calling Earth "The Little Planet that Could" is a reference to the children's story "The Little Engine that Could".
"Her Praise", a poem by William Butler Yeats is read three times during this episode. First it is read to Lucille by her son, indicating that her condition has stripped her of her ability to read. House later reads it to her before confronting her about her decision to call child services. Finally, Lucille is shown reading it aloud to herself, affirming the successful treatment of the disease. It appears in the volume "The Wild Swans at Coole".
In later seasons, 221B Baker Street is consistently shown on the immediate left on the ground level after coming in the main entrance. In this episode, House's apartment is on the fourth floor of the building.
The Madness of King George was a 1994 film about the mental illness suffered by King George III during the late 18th century.

Goofs

New Jersey doesn't have a department called "Social Services". It's correct name the Department of Youth and Family Services and is commonly referred to as "Dyfus" after its acronym even by it's own case workers.
When House and Luke talk about hamburgers, the top of the ketchup bottle keeps opening and closing depending on whether the camera is facing House or Luke.
Cuddy's pearl necklace disappears in the few minutes between the time she sees him in the hall to talk to him about his birthday and the time she follows him into the men's washroom.
The hose containing the vomit/blood mix is visible when the camera angle changes during the scene where Lucy vomits blood.
At the end of the episode, it appears there is an elbow belonging to a sixth person. However, when the door opens, there are only five people on the elevator.
After House and Foreman's argument, the camera crew is visible as a reflection in the glass as the camera zooms in on House.
Kayser-Fleischer rings are grey-green in color, not copper colored, even though they are caused by copper in the blood.
When Wilson sees a mass on the sonogram, he diagnoses cancer even though such a mass only indicates a tumor and may be benign. It would take a biopsy to confirm cancer.
When Hugh Laurie walks past Aaron Himelstein after giving Lucy haldol, the edge of Laurie's shoulder accidentally catches the end of Himelstein's nose.
A patient with deep-vein thrombosis would never be discharged from the emergency room. At a minimum, the patient would be admitted for overnight observation to ensure that the clot isn't getting bigger.
When House gets up to confront Dr. Wells about his diagnosis, he's holding the paper in front of him. However, a split second later, the paper is resting in his lap.
Lucy already had a chest tube which Foreman could have used to draw blood. There was no need for him to restrain her or use a needle.

Reviews

TV.com users rated this episode an 8.8. They chose Hugh Laurie as their most valuable performer.
IMDB users rated the episode an 8.6. It did best with females under the age of 18 (9.0) and worst with men over the age of 30 (8.3).

Medical Ethics

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
Stacy Edwards as Lucy Palmeiro
Aaron Himelstein as Luke Palmeiro
Al Espinosa as Dr. Wells
John Prosky as Dr. Bergin
Sonya Eddy as Sally
Pat Musick as Trina Wyatt
David Vegh as Clark
Lilas Lane as Terri
Veronica Leigh as Wendy
C. Xavier Drayton as Male Truant Officer
Farrah Skyler Greye as Nurse
Kenya D. Williamson as Nurse

Quotes

House: How old is she?
Lucas: You're a doctor?
House: I own my own stethoscope.

Lucy: Don't lie to me, limpy. Lively Lucy never lies to Lucas.

Cameron: Happy birthday.
House: Thanks... Whose?

House: Happy birthday! And give the kid a damned ice cream cake.

House: So when I said, "No psych meds," which word did you not understand?

House: I can tell you're upset about something. You're going to open up to me, aren't you?
Lucas: It's all my fault
House: ...here we go.

Chase: Feeding alcohol to an alcoholic is not the answer.

Lucas: My life is working.
House: That's not the word I'd use.

Wilson: I have some bad news about your ultrasound. You have cancer.

House: Your outfit makes you look professional and still says that you're a woman. Actually, it shouts more of the second.
Cuddy: Your cane isn't exactly subtle, either.

Lucas: So you're saying that you'd handle this differently?
Chase: No, I'd probably handle it just like you.

Lucas: You said you wouldn't call. You're a real bastard, you know that?
House: Yeah, I get that a lot... [watches child services walk out with Lucas] I don't think mom's crazy.

House: You're his mother, you couldn't do this to him anymore. Good for you.

House: Lucy! I don't think you're crazy.
Lucy: Neither do I. But I'm crazy.

Foreman: Wow! I guess we should start treating her for Wilson's.
House: It's what I do.

Dr. Allison Cameron: [Watching House and Foreman yelling at each other in the next room] I think they're choosing a movie.

Lucy Palermo: I will talk no more of books or the long war / But walk by the dry thorn until I have found/ Some beggar sheltering from the wind, and there/ Manage the talk until her name come round./ If there be rags enough he will know her name/ And be well pleased remembering it, for in the old days/ Though she had young men's praise and old men's blame/ Among the poor both the old and young gave her praise.

Dr. Eric Foreman: He's really talking to a patient?
Dr. Robert Chase: I don't know who I am anymore.

Dr. Gregory House: Self-sacrifice is not a symptom of schizophrenia. It excludes the diagnosis.

House: On the other hand, we dont really know anything about schizophrenia, so maybe it is connected.
Wilson: Well, the schizophrenia explains one mystery: why youre so fascinated by a woman with a bump in her leg. Like Picasso deciding to whitewash a fence.
House: Thanks. Im more of a Leroy Neiman man. And it is only about the DVT. Shes 38 years old, she should be---
Wilson: Right. Solve this one and youre on your way to Stockholm.
House: We dont even know how to treat it! Come on! Fumigation of the vagina?
Wilson: A little louder — I dont think everyone heard you.
House: Two thousand years ago, thats how Galen treated schizophrenics — the Marcus Welby of ancient Greece.
Wilson: Oh! Clearly youre not interested.
House Im interested. Im interested in how voices in the head could be caused by malposition of the uterus.
Wilson: Theres a better place for it?
House: And now what have we got? Weve got lobotomies, rubber rooms, electric shock — my — Galen was so primitive.
Wilson: Where are you going?
House: Going to see the patient. That all-important human connection. Thought Id give it a whirl.
Wilson: You wont talk to patients because they lie, but give you patient with no concept of reality---
House: If it wasnt for Socrates, that raving untreated schizophrenic, we wouldnt have the Socratic method — the best way of teaching everything, apart from juggling chainsaws. Without Isaac Newton, wed be floating on the ceiling.
Wilson: Dodging chainsaws, no doubt.
House: And that guitar player in that English band — he was great. You think Im interested because of the schizophrenia.
Wilson: Yeah. Im pretty sure.
House: Galen was pretty sure about the fumigation thing. Pink Floyd.

Luke: It's not the alcohol. It's gotta be something else.
House: Of course it's the alcohol! Hello! This guy's a professional doctor! Plays golf and everything, I bet. He's not gonna tell you your mom's an alcoholic without proof. I'm sure he scoped for varices, checked her esophagus, ran all kinds of blood tests. Doctors like this, they don't make assumptions. They do the work!

Chase: He likes crazy people. He likes the way they think.
Foreman: They think badly. That's the definition of crazy. Why would he like...?
Chase: They're not boring. He likes that.

House: Ooh, girl in the boys' bathroom. Very dramatic. Must be very important what you have to say to me.
Dr. Cuddy: Yesterday your patient's tumor was 5.8 centimeters. Today it's 4.6. How does that happen?
House: At a guess, I'd say "Dr. House must be really really good, why am I wasting him on hiccups?" I wash before and after.
Dr. Cuddy: You also requisitioned 20cc of ethanol. What patient was that for? Or are you planning a party?

Dr. Foreman: Mickey Mantle had a whole bar named after him - he got a transplant.
House: Yeah, well, Lucy can't switch hit.

Dr. Cameron: You really didn't know?
House: No, I didn't, and frankly I'm angry. Which I'm guessing is the correct response. Of course I'll know better once I know what you're talking about.
Dr. Cameron: Your birthday.
House: Oh. Anger was a bad guess. Normally I'd put on a festive hat and celebrate the fact that the Earth has circled the sun one more time. I really didn't think it was going to make it this year, but darn it if it wasn't the little planet that could all over again.

House: You think I'm crazy.
Dr. Wilson: Well, yeah, but that's not the problem.

Dr. Wilson: You won't talk to patients because they lie, but give you a patient with no concept of reality...

House: Gee, I wish my idea was as cool and vivid as yours. By the way, do you have one?

House: It turns out your best judgment is not good enough. Here's an idea - next time, use mine.

House: The boys in the lab – sure, they're hard drinkers. But they're pros.

House: We needed blood for tests. I assume that was the only way to get it.
Luke: He knocked her out!
House: Look, I've got a cane and I know how to use it.

Luke: Is this a good hospital?
House: Depends on what you mean by "good." I like these chairs.

Music

Happy Birthday to You by Patty S. Hill and Mildred J. Hill, performed by Hugh Laurie.

Release Dates

United States - December 21, 2004 on Fox
Canada - December 21, 2004 on Global
Estonia - January 20, 2006
Germany - June 13, 2006
Finland - October 26, 2006
Mexico - February 14, 2007
France - March 7, 2007

In Other Languages

Spanish - El método socrático (literal translation)
French - Une mère à charge (A Dependent Mother)

Links

Previous episode:
Damned If You Do

The Socratic Method

Next episode:
Fidelity

@@ Line 82: / Line 82: @@
 == Title ==
+The [[Socratic Method]] is a form of dialectical inquiry (i.e. a conversation between two people to examine a philosophical proposition) where one person (generally the teacher) takes the role of the questioner and the other (usually the student) answers the questions to the best of their ability. Generally, this pattern continues until a question is posed to which the student cannot answer, generally because it would contradict an answer they gave earlier. In Western philosophy, the technique was attributed to the Athenian philosopher Socrates by his student Plato, who gave examples of the dialogues in his ''Epistles, ''a collection of works that appear to be properly attributable to Plato.
+In this episode, it refers to House's suspicions that Socrates, like Lucy, suffered from [[schizophrenia]]. However, House uses the technique frequently. It is the basic form behind a [[differential diagnosis]] - a fellow proposes a diagnosis, and House asks questions that require the fellow to defend the diagnosis. Either House comes up with a question that the fellow cannot answer, or House runs out of questions, which would tend to confirm the diagnosis as provisional. House also frequently uses the method when debating.
 ==Trivia and cultural references==