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In 2004, David Shore and Paul Attanasio, along with Attanasio’s business partner Katie Jacobs, pitched the show (untitled at the time) to Fox as a CSI-style medical detective program, a hospital whodunit in which the doctors investigated symptoms and their causes. Attanasio was inspired to develop a medical procedural drama by The New York Times Magazine column “Diagnosis”, written by physician Lisa Sanders. Fox bought the series, though the network’s then-president, Gail Berman, told the creative team, “I want a medical show, but I don’t want to see white coats going down the hallway”. Jacobs has said that this stipulation was one of the many influences that led to the show’s ultimate form.

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Shore traced the concept for the title character to his experience as a patient at a teaching hospital. Shore recalled that, “I knew, as soon as I left the room, they would be mocking me relentlessly [for my cluelessness] and I thought that it would be interesting to see a character who actually did that before they left the room”. A central part of the show’s premise was that the main character would be disabled in some way. The original idea was for House to use a wheelchair, but Fox rejected this. Jacobs later expressed her gratitude for the network’s insistence that the character be reimagined-putting him on his feet added a crucial physical dimension. The writers ultimately chose to give House a damaged leg arising from an incorrect diagnosis, which requires him to use a cane and causes him pain that leads to a narcotic dependency.

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After Fox picked up the show, it acquired the working title Chasing Zebras, Circling the Drain (“zebra” is medical slang for an unusual or obscure diagnosis, while “circling the drain” refers to terminal cases, patients in an irreversible decline). The original premise of the show was of a team of doctors working together trying to “diagnose the undiagnosable”. Shore felt it was important to have an interesting central character, one who could examine patients’ personal characteristics and diagnose their ailments by figuring out their secrets and lies. As Shore and the rest of the creative team explored the character’s possibilities, the program concept became less of a procedural and more focused upon the lead role. The character was named “House”, which was adopted as the show’s title as well. Shore developed the characters further and wrote the script for the pilot episode. Bryan Singer, who directed the pilot episode and had a major role in casting the primary roles, has said that the “title of the pilot was ‘Everybody Lies’, and that’s the premise of the show”. Shore has said that the central storylines of several early episodes were based on the work of Berton Rouech?, a staff writer for The New Yorker between 1944 and 1994, who specialized in features about unusual medical cases.

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