This is less of a review and more of just a way for me to gauge what other people's reactions and thoughts are. Overall, I guess I "enjoyed" this book? It was super engaging and I liked the introspectiveness, by both the characters and the author (in the author's note) but I'm kind of in shock at the underlying cruelness of it all.
For context, this is a satirical fiction novel that follows the lives of a group of first year medical residents working at a hospital known as The House of God where they try and fail to overcome the trials and tribulations of a system that is not-so-subtly designed to break them. It was written in 1978 and it has sort of become a cult classic among doctors and med students.
I am pretty far removed from the medical field, so I had never heard of this book before until a med school friend recommended it to me. Since my medical knowledge is limited to what my friends tell me and what I've seen on shows like Grey's Anatomy, there were quite a few terms and procedures mentioned here that kinda went over my head so I can't really analyze this from a technical perspective. The general feeling I have now is that I'm worried for my friends and anyone else in this field.
I know the book is satire – the way the characters described patients and the Rules of the House were pretty funny but it got like depressingly real at the halfway point. It's also pretty raunchy (the sexual trysts of the characters are laid out in excruciating detail sometimes) which I guess makes sense in-story as a way to showcase their mental declines but also felt pretty unrealistic and I didn't really care too much about as a reader.
Has anyone else read this book and if so, what are your thoughts? If you're a physician, resident, or medical student, is this accurate to what you have seen or been through? I'm sure a lot of the details here are greatly exaggerated and I'd hope that working conditions have improved since the 70s, but somehow I'm not entirely convinced that's the case.
by psashankh
22 Comments
I personally couldn’t finish the book because of how annoying and self aggrandizing the sexual stuff was in the later third of the book. The book is a classic because it remains incredibly accurate despite being fifty years old. Working conditions are better in some ways as there are limits on hours (that are often abused and underreported today). Patients are significantly more complex today because advances in medical technology and knowledge means we can keep people alive longer with multiple, severe chronic conditions. This leads to more moral dilemma and burnout as you end up keeping people alive with little to no quality of life. A lot of the social dynamics of how the narrator and his coresidents view patients and their humanity are still accurate. At some point, everyone in training is burned out enough that they dehumanize patients to be able to make it home that day. The dynamics with money and medicine haven’t changed much beyond the specific details and scams. Specific rules and vocabulary from the book have become so ingrained in the culture of medicine that people will quote it without having read the book. But yeah, medicine is still bad.
20 years in air ambulance/pre-hospital emergency medicine, and my wife has 15 years acute care ICU…I just found out about, and read, this book 2 years ago.
Are some aspects exaggerated, yes, but the overall tone felt very familiar.
Can you work in medicine and not sleep with your colleagues, yes. Have I seen it in others that I work with first hand, yep.
Does working in medicine develop a sense of morbid, dark humor? I don’t know…either it fosters it in those who stay long enough, or those who have it are the ones who stay the longest.
But some of those with the darkest humor I have witnessed be the most compassionate and capable care givers. Some of those who clutch their pearls at the dark side of medicine are the first to freeze up when a patient codes in transport.
Strangely, fight club is quite applicable here…after flight club, it felt like everything else had the volume turned down…after enough exposure to emergency medicine, regular life feels rather inconsequential. Ironically, I’m in the middle of catch-22 for the first time, and that also feels quite adequate…you have to be crazy to do this, but the second you ask to be relieved of the duty, you exhibit rational thought and are ineligible for dismissal.
I have been put on standby to respond to a reported motor vehicle accident at 2:00am on a Saturday night, knowing full well it’s probably some drunk idiot who ran off the road, and I’ve literally uttered the words “I hope they’re dead” so that we get disregarded off the standby and I can go back to sleep…that is a horrible thing to say when you profess to be in the business of taking care of people…when I read the line in house of god where he fell to his knees and prayed that god would just let the patient die, I stopped, grabbed a pen, and underlined it….
All exaggeration has some basis in truth
I got recommended and read this book during my veterinary intern year. There are a lot of parallels with veterinary medicine (especially emergency). I thought the book was hilarious and it really hit hard during the intern year. I was working 80-100 hr weeks and very burned out. I loaned that book out 3 times and all 3 times I never got it back. The last time I bought a copy I decided to still recommend but not loan it again! I’m 20 years out of my internship now and probably due for a re-read. 🙂
I read it when it first came out and loved it. The satire, honesty, and slice of real life. I’ve read it again and still loved it.
Standard vocabulary for ERs – we specialized in “gomers” and had to “buff and terf” all the time.
Most of my family are in medical fields, and we all loved it.
It’s not really satire exactly. It’s more like a roman a clef. The author went to med school and interned at Beth Isreal in NYC. When first published it was so clearly a critique of the brutality of interning at Beth Isreal that it effected the hospital’s ability to attract interns. IIRC The author switched to psychiatry as the main character in the book did. It was also the direct inspiration for the TV series St. Elsewhere, which in turn influenced Scrubs. It’s been years since I read it, but it was good.
I listened to it on audiobook. Also in the medical field.. a lot of the things hit home for sure. You don’t realize how twisted your sense of “humor” is until non-medical people listen to the horrible stuff we talk about on a regular basis. I remember something about him going on about how the Gomers hurt him and that still sticks out to me. Like no matter what you do for some patients they are only capable of hurting you, whether that’s emotion or physical and it’s not their fault but just how it is. I think the book was a little self indulgent but overall I enjoyed it.
You can’t find a fever if you don’t take a temperature
This book sounds awesome.
It’s absolutely wonderful! Loved thebook so much for the dark humour and cynicism that just feels appropriately inappropriate for the medical field. And as uncaring as the characters may seem, they are inevitably always driven by the fact they care. It’s years since I’ve read it … I’ve really got to dive into it again.
*House of God* is referenced quite a bit on *Scrubs*, a sort of medical sitcom from a few years back. Even outside of that, it’s definitely awesome, bizarre and disturbing how well known the book is in the medical field. A friend told me it’s unofficial standard reading (she’s in geriatric medicine).
There’s a sequel called *Mount Misery* that’s also worth checking out. The same narrator heads into psychiatry. A lot of the same dark humour, but far less silliness and chaos. Shem also wrote another very similar-sounding book about five years ago – *Man’s 4th Best Hospital* – that was vaguely referred to as a follow-up or perhaps a reboot with more focus on health insurance, and another this year – *Our Hospital* – but I haven’t read those two.
I’m a doctor in the UK and so much of this rang true of my early years as a doctor. And mount misery too- the patient is not the only one with the disease in psych, the discussion of ward 4- the patients the worst, the nurses the worst, the consultants the worst etc etc. I also often think about the elevator scene and the scene with the 8×5 cards. However, as others have commented, I could have lived without the sex scenes.
US doctor. Some go the jargon has changed, but the general attitude, gallows humor, and cynicism are pretty accurate. The sex stuff is unrelatable. Maybe people were doing that in the 1970s, or maybe it was just the author. I know of at least two fuccboi docs who fucked coworkers in the call room.
If you want to get a feel for medical culture, Scrubs captures the feeling and tone of residency pretty well. It’s essentially a live-action cartoon, so it’s not exactly medically accurate, but the culture is well represented:
The episode where they did everything to try to get a radiologist to come in on a weekend.
The callousness of it all, like the episode a patient died of rabies and her organs went to three other people.
The stereotypes about every medical specialty.
The feeling of being both smart and dumb at the same time. Relying on competent nurses.
Eating hospital pudding cups because you have no money and no time.
Fucking up a medical procedure or a diagnosis and agonizing over it.
Challenges with dating while being a resident.
The Todd. I know so many dudebro docs. And yes, the surgeon picks the music.
JD’s self doubt. Turk’s crazy confidence, Elliott’s insecurity. Watching colleagues burn out. Watching relationships and marriages fail due to work.
Asshole attending physicians who still get hero worship because they seem brilliant when you’re an intern and you probably have a bit of Stockholm syndrome.
The conflicts of idealism and cynicism, watching patients due from their own life choices and being helpless to do anything. Realizing most of what you do doesn’t make a difference. People die.
Hospital administrators that care more about money than patients, VIP donors.
I love this book
I haven’t yet read the book, though it’s on my to-read list. I did see the movie adaptation about a year ago, which was a notoriously troubled production (and dumped to cable TV after five years on the shelf). For all of that, the movie is a lot better than its fate would suggest.
I’m a sucker for movies where things went dramatically wrong behind the scenes, so I’m certainly going to read the original book to compare soon.
I found the claims saying it’s sexist, agist, racist aren’t all that true. It had aspects of the claims but thoughout the book, Roy was actually learning from it, and he pulled through. It was a bit perverted but it’s a book of catharsis.
As a medical student…. even now, I would not call this book satire. it is almost painfully accurate to how medicine works and operates, and the mentalities of many people in it.
Adventures of an American Medical Student by James Champion is coming out on May 1st. Might be a good fit for fans of this.
This one and To Kill as Few Patients as possible are really good books
Late to the party OP but:
Yeah, the sex scenes and sexism is out of touch.
The rest of it though? Spot on. Medical trainees still get abused. I found the book very compelling (I’m a med student) for the simple reason of “Hey, I’m not the only person who feels like this!”
It’s a little dated and I hear there is a new one around the corner coming out this summer.
In 1978 I was starting a residency in psychiatry. The first of those 4 years was a “medical” internship—that is rotations through the ER, general medical wards and the cardiac and intensive care units. It was brutal as “call” nights were every 3rd night and generally we were up all night on those nights. So 36 hours straight on those days—the work week was about 100 hrs. Patients in the city/county/university hospitals and Veterans Administration hospitals that provide the patient fodder for us to learn on have no choice, but to trust in exhausted doctors. To my knowledge, I never hurt or killed anyone.
However, during a 4 month stint after medical school (I graduated 6 mos. behind the class I entered with because of numerous episodes of sexual harassment) when I acted as an anesthesia intern for a seriously understaffed anesthesia dept. in another university hospital, I watched in horror as another anesthesia intern turned on the nitrous oxide spigot instead of the oxygen spigot at the end of an operation, causing total brain damage if not death. She then said, “Oh, well, he won’t sue.”
Things have supposedly improved since then, but the de-humanization and contempt for patients, interns and residents continues.
“Samuel Shem” the nom de plume for Stephen Bergman, MD, now a very wealthy (from the book) addiction psychiatrist is still proud of his writing. He has fielded questions about the book’s blatant sexism and racism, but doesn’t ever seem to consider the damage his book has done. Naturally, since he made a ton of cash from it, he is ill-equipped to consider any downside.
I think the thing that perhaps bothered me the most was the blatant sexism—this from a book written by a Jew whose people have certainly suffered from discrimination. The one woman resident and the one woman attending physician are depicted as frigid and humorless because they don’t join in the antics.
Shem/Bergman is dead wrong about most interns, residents, and physicians who work very hard to care for patients in need. His takes on the rampant sex activity of trainees in empty rooms and broom closets is a total figment of his imagination. Like with all men who brag about their sexual prowess, he probably is utterly ineffectual in his sexual performance and therefore must make stories up.
Interns and residents are way too tired for that kind of subterfuge. I was not aware of even one time that such a thing happened. Many trainees are in committed relationships that they don’t want to lose.
The hospital that is depicted is Beth Israel Hospital, a teaching hospital in the Harvard system. I wonder why Harvard or Beth Israel hasn’t sued him?