The House of God is a 1978 satirical novel by Samuel Shem (a pseudonym used by psychiatrist Stephen Bergman). The novel follows a group of medical interns at a fictionalized version of Beth Israel Hospital over the course of a year in the early 1970s, focusing on the psychological harm and dehumanization caused by their residency training. The book, described by the New York Times as "raunchy, troubling and hilarious", was viewed as scandalous at the time of its publication, but has since acquired a cult following and is frequently included in the discussion of humanism, ethics, and training in medicine. and an accompanying online documentary document the origins of the book and the characters upon which it is based. The story is semiautobiographical, 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.
Many of the terms defined in the book (see glossary) have since become widely known and used in medical culture.
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. 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. Furthermore, a 2011 essay proposes that the book was an impetus for limiting medical resident work hours.
Glossary
Nouns
- Gomer: An acronym meaning "get out of my emergency room". The acronym is used to refer to a patient who is frequently admitted to the hospital with complicated but uninspiring and incurable conditions.
- LOL in NAD: "Little old lady in no apparent distress". An elderly patient who, following a minor fall or illness, would be better served by staying at home with good social support rather than being admitted into a hospital. (Compare "NAD" = "no abnormality detected" or "no apparent distress" (used to record the absence of abnormal signs on examination.)
- Zebra: A very unlikely diagnosis in which a more common disease is a more likely cause of a patient's symptoms. The term is derived from the common admonition that "if you hear hoof beats, think horses, not zebras".
Verbs
- Buff the charts: To make a patient look well-treated in the charts or medical records without actually providing any treatment.
- Turf: To find any excuse to refer a patient to a different department or team.
- Bounce: To return a "turfed" patient to the department that referred him or her.
Cultural references
References to life
In-jokes abound in the work. One of the principal characters is "Eat My Dust" Eddie, a doctor so-called because of the saying embroidered on his jacket. His name often is abbreviated as EMD, which is also the acronym of the feared, often terminal, cardiac event "electromechanical dissociation" (EMD), otherwise known as pulseless electrical activity (PEA).
References by other works
In 1984, The House of God was made into a film. The film was never released in theaters or on VHS/DVD, but was shown on HBO multiple times. It starred Charles Haid as The Fat Man, Tim Matheson as Roy, and featured Bess Armstrong, Ossie Davis, Sandra Bernhard, and Michael Richards in supporting roles.
The TV medical sitcom-drama Scrubs features numerous references to The House of God, which was reading material for some of the show's writers. "Turfing", "Bouncing" and "Gomers" occasionally feature in the show's dialogue. In the episode "My Balancing Act", Dr. Cox uses the term "zebra". In the episode "My Student", J.D. quotes the medical student rule: "A famous doctor once said, 'Show me a med student that only triples my work, and I'll kiss his feet.'" One episode focuses on Dr. Dorian saving a patient by "doing nothing," which is a major theme of the novel.
Sequel
Shem has published three sequels to The House of God: Mount Misery, Man's 4th Best Hospital, and Our Hospital.