Reviewed by Michael Norris, MD, President

I recently re-read The House of God, a satirical novel published in 1978. It details the intern experience of a young doctor at the House of God, patterned after Boston’s Beth Israel Hos­pital. The author is Samuel Shem, pen-name of psychiatrist Dr. Stephen Bergman. Like the novel’s protagonist, Roy Basch, the author spent his internship at the House of God. 

Roy is a graduate of the Best Medical School (BMS=Harvard) and has landed a prized slot at the prestigious institution of healing. There he meets his mentor, the Fat Man, a medical resident who preaches the Rules of the House of God. There are 13 rules, including number 6: “There is no body cavity that cannot be reached with a #14 needle and a strong right arm.”

As Roy proceeds though his year, he also learns Rule number 13: “The delivery of medical care is to do as much nothing as possible,” for he discovers that many of his elderly patients actually do better without numerous tests and interventions, while his younger patients will often die despite all his efforts.

The novel depicts the sleep deprivation, the housestaff camaraderie, the relationships with the nursing staff (often sexual). There are passages that are laugh-out-loud funny, yet others portraying housestaff isolation, depression, and even suicide.

I first read this book in the late 1970s, as a general surgical resident. All of my fellow resi­dents read it, and we would often quote the wisdom of the Fat Man. The broad satire seemed, at the time, to miss the truth by only a small amount. Bergman wrote this book in part to protest the inhumanity of the graduate medical education process of the time. As Chuck, another intern, wonders, “How can we care for patients, man, if’n nobody cares for us?”

The interns see the flaws in the system, in the delivery of medical care, and try to change it, ultimately by opting out. Protagonist Roy Basch, like Bergman, goes into psychiatry.

Many young doctors loved The House of God because it resonated with their own experienc­es during their internship training, but many senior physicians found it offensive. A movie was made of the novel in 1984, starring Tim Matheson as Roy Basch, but it was considered too dark and never released in theaters, though it was shown on HBO a few times, mostly as filler in non-peak hours.

Re-reading the book after 36 years made me a little nostalgic for the young me, those days and nights spent in the hospital. Yet I can now see, as an “older” doc, how it can also be ac­cused of casting the medical profession in a negative light. 

This book review is found at http://www.smcma.org/sites/default/files/NovDec2015PresidentsMessage.pdf#overlay-context=san-mateo-county-physician-current-issue.

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