Storyline
Dr. Roy Basch is an intelligent but naive former Rhodes Scholar and BMS ("Best Medical School")-educated intern ('tern') working in a hospital called the House of God after having completed his medical studies at BMS. Basch is poorly prepared for the grueling hours and the sudden responsibilities with limited guidance from senior attending physicians. He begins the year on a rotation supervised by an enigmatic and iconoclastic senior resident who goes by the name "The Fat Man". The Fat Man teaches him that the only way to keep patients in good health and to survive psychologically is to break the rules. The Fat Man provides his interns with wisdom such as his own "Laws of the House of God". One of his teachings is that in the House of God, most of the diagnostic procedures, treatments, and medications received by the patients known as "gomers" (see Glossary, below) actually harm these patients instead of helping them. Basch becomes convinced of the accuracy of the Fat Man's advice and begins to follow it. Because he follows the Fat Man's advice and does nothing to the "gomers", they remain in good health. Therefore, his team is recognized as one of the best in the hospital and he is recognized as an excellent intern by everyone even though he is breaking the rules.
Later, the Fat Man must leave for a rotation with another team. Roy is then supervised by a more conventional resident named Jo who—unlike the Fat Man—follows the rules, but unknowingly hurts the "gomers" by doing so. Basch survives the rotation with Jo by claiming to perform numerous tests and treatments on the "gomers" while doing nothing to treat them. These patients again do well, and Basch's reputation as an excellent intern is maintained.
During the course of the novel, working in the hospital takes a psychological toll on Basch. His personality and outlook change, and he has outbursts of temper. He has adulterous trysts with various nurses and social service workers (nicknamed the "Sociable Cervix"), and his relationship with his girlfriend Berry suffers. A colleague, Wayne Potts, commits suicide. Potts had been constantly badgered by the upper hierarchy and haunted by a patient—nicknamed "The Yellow Man" (due to the jaundice from his fulminant necrotic hepatitis)--who goes comatose and eventually (after months) dies possibly because Potts had not put him on steroids. Basch secretly euthanizes a patient called Saul the leukemic tailor, whose illness had gone into remission but was back in the hospital in incredible pain and begging for death. Basch becomes more and more emotionally unstable until his friends force him to attend a mime performance by Marcel Marceau, where he has an experience of catharsis and helps him recover his emotional stability.
By the end of the book, it turns out that the psychiatry resident, Cohen, has inspired most of the year's group of interns—as well as two well-spoken policemen, Gilheeney and Quick—to pursue a career in psychiatry. The terrible year convinces most of the interns to receive psychiatric help themselves. The book ends with Basch and Berry vacationing in France before he begins his psychiatry residency, which is how the book begins as well; the entire book is a flashback. But even while vacationing, bad memories of the House of God haunt Basch. Basch is convinced that he could not have gotten through the year without Berry, and he asks her to marry him.
Context and impact
The book takes place during the Watergate scandal, and follows such events as the resignation of Spiro T. Agnew and Richard Nixon.
A 2019 short essay by Shem [2] and an accompanying online documentary [3] document the origins of the book and the characters upon which it is based. The story is autobiographical, as the BMS is a thinly veiled Harvard Medical School (commonly called HMS), and The House of God represents the Beth Israel Hospital, now a part of Beth Israel Deaconess Medical Center, one of the HMS-affiliated hospitals in Boston, Massachusetts; "Man's Best Hospital" (MBH) represents Massachusetts General Hospital (MGH).
According to the author, many older physicians were offended by the work. [4] Many of the terms defined in the book (see glossary) have since become widely known and used in medical culture. [1]
The journal Academic Medicine argued The House of God was revolutionary in that it brought to light paradoxical issues of care in modern medicine. Patients (in the book under Putzel) who were not acutely ill could nevertheless be admitted to the hospital and undergo multiple invasive procedures, creating a revenue stream for the hospital but exposing the patient to risk and discomfort, and demoralizing the residents. [5] Reimbursement rules have been changed to prohibit this practice under value-based purchasing (see Pay for performance (healthcare)). JAMA (the Journal of the American Medical Association) has a distinct collection of hundreds of articles titled "Less Is More" that discuss multiple areas of medicine where standard interventions seem to hurt patients. [6] Furthermore, a 2011 essay proposes that the book was an impetus for limiting medical resident work hours. [7]
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Seymour I. Schwartz, was the Distinguished Alumni Professor for the Department of Surgery at the University of Rochester in Rochester, New York. He was one of the most prolific and honored surgeons in American history with further successes outside of the field of medicine as a renowned author and cartographic historian. His most notable accomplishments in surgery include being the founding editor-in-chief of Schwartz's Principles of Surgery, Chairman of the Department of Surgery at the University of Rochester (1987-1998), Editor-in-Chief of the Journal of the American College of Surgeons (1996-2004) and President of the American College of Surgeons (1997-1998). After spending nearly 65 years in the field of surgery, he has published hundreds of research articles, textbook chapters, and received numerous honors in the United States and abroad. Schwartz has lectured throughout the world as a visiting professor and donated to many philanthropic endeavors. His influence on surgical education and leadership has impacted nearly every practicing surgeon in the world. Throughout his career, Schwartz has treated and changed the lives of tens of thousands of patients and trained generations of residents and fellows to share in his legacy and do the same.
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The House of God is a 1984 American comedy-drama film written and directed by Donald Wrye and starring Tim Matheson, Charles Haid, Michael Sacks, Ossie Davis, and Howard Rollins. It is based on Samuel Shem's novel of the same name. According to Leonard Maltin, the film was never released theatrically.
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