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]
University of Mississippi Medical Center (UMMC) is the health sciences campus of the University of Mississippi and is located in Jackson, Mississippi, United States. UMMC, also referred to as the Medical Center, is the state's only academic medical center.
A medical school is a tertiary educational institution, professional school, or forms a part of such an institution, that teaches medicine, and awards a professional degree for physicians. Such medical degrees include the Bachelor of Medicine, Bachelor of Surgery, Master of Medicine, Doctor of Medicine (MD), or Doctor of Osteopathic Medicine (DO). Many medical schools offer additional degrees, such as a Doctor of Philosophy (PhD), master's degree (MSc) or other post-secondary education.
Samuel Shem is the pen name of the American psychiatrist Stephen Joseph Bergman. His main works are The House of God and Mount Misery, both fictional but close-to-real first-hand descriptions of the training of doctors in the United States.
Coma is Robin Cook's first commercially successful novel, published by Signet Book in 1977. Coma was preceded in 1973 by Cook's lesser-known novel Year of the Intern.
Residency or postgraduate training is a stage of graduate medical education. It refers to a qualified physician, veterinarian, dentist, podiatrist (DPM) or pharmacist (PharmD) who practices medicine or surgery, veterinary medicine, dentistry, podiatry, or clinical pharmacy, respectively, usually in a hospital or clinic, under the direct or indirect supervision of a senior medical clinician registered in that specialty such as an attending physician or consultant.
The Columbia University College of Physicians and Surgeons is the medical school of Columbia University, located at the Columbia University Irving Medical Center in the Washington Heights neighborhood of Manhattan.
William Stewart Halsted, M.D. was an American surgeon who emphasized strict aseptic technique during surgical procedures, was an early champion of newly discovered anesthetics, and introduced several new operations, including the radical mastectomy for breast cancer. Along with William Osler, Howard Atwood Kelly and William H. Welch, Halsted was one of the "Big Four" founding professors at the Johns Hopkins Hospital. His operating room at Johns Hopkins Hospital is in Ward G, and was described as a small room where medical discoveries and miracles took place. According to an intern who once worked in Halsted's operating room, Halsted had unique techniques, operated on the patients with great confidence and often had perfect results which astonished the interns.
Medical resident work hours refers to the shifts worked by medical interns and residents during their medical residency.
New York State Department of Health Code, Section 405, also known as the Libby Zion Law, is a regulation that limits the amount of resident physicians' work in New York State hospitals to roughly 80 hours per week. The law was named after Libby Zion, the daughter of author Sidney Zion, who died in 1984 at the age of 18. Sidney blamed Libby's death on overworked resident physicians and intern physicians. In July 2003, the Accreditation Council for Graduate Medical Education adopted similar regulations for all accredited medical training institutions in the United States.
Clinical clerkships encompass a period of medical education in which students – medical, dental, veterinary, nursing or otherwise – practice medicine under the supervision of a health practitioner.
The Interns is a 1962 American drama film directed by David Swift and starring Michael Callan, Cliff Robertson, James MacArthur, Nick Adams, Haya Harareet and Suzy Parker. The film was followed by a 1964 sequel, The New Interns, and a 1970–1971 television medical drama series, The Interns, that was based on the films. The Interns was directed by David Swift.
Radio Rounds is a medical radio talk show produced and hosted entirely by medical students.
Martin A. Samuels, MD, DSc (hon), FAAN, MACP, FRCP, FANA, was an American physician, neurologist and medical educator whose unique teaching style and contributions, accessible to a wide audience, were widely known and celebrated. He wrote and spoke on the relationships between neurology and the rest of medicine, and linked the nervous system with cardiac function, highlighting the mechanisms and prevention of neurogenic cardiac disease.
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.
Willis John Potts was an American pediatric surgeon and one of the earliest physicians to focus on the surgical treatment of heart problems in children. Potts set up one of the country's first pediatric surgery programs at Children's Memorial Hospital in Chicago.
Samuel M. Seidlin was Russian-born American endocrinologist who pioneered the field of nuclear medicine by using radioiodine for diagnosis and therapy of thyroid cancer during the early 1940s.
Brigid Gray Leventhal was a British-American pediatric oncologist. She was the first director of the Pediatric Oncology Division at Johns Hopkins University, a position she held from 1976 to 1984. She was inducted into the Maryland Women's Hall of Fame in 1996.
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.
A teaching hospital is a hospital or medical center that provides medical education and training to future and current health professionals. Teaching hospitals are almost always affiliated with one or more universities and are often co-located with medical schools.
