The House of God

[JCain18]

I'm currently reading The House of God by Samuel Shem, and I'm wondering how accurate it is about the lives of interns. I understand the book is supposed to be a comedy, but what are the similarities and differences (for those who have read it)?


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[Waillin]

This is the premed forum so most people here will not have gone through residency. And the book was written in the 70's so things are different now (I hope). On a side note, I thought the book was good, but a little depressing at times (suicide, theme of doing nothing is better than doing something etc)

 

[Catalystik]

There are now work hours limitations for residents which didn't exist back then.

 

[kamakazi5]

I don't have any experience working with residents but the patient population sure hasn't changed.

 

[bc65]

I'm currently reading The House of God by Samuel Shem, and I'm wondering how accurate it is about the lives of interns. I understand the book is supposed to be a comedy, but what are the similarities and differences (for those who have read it)?

Just like the main character in the book, the author went into psychiatry after his internship, so he clearly didn't like internal medicine. Plus, it's a novel. There's some exaggeration , or at least there's a lot of concentrated action. In other words real ERs deal mostly with colds and sprains. That doesn't make for good TV, so on TV you see lots of trauma, unusual cases, and drama. The same is true in novels or memoirs. This one was no exception.

With work hour restrictions, there's less pressure on residents, so perhaps if it were written today, it wouldn't seem as bleak.

However, I think that the overall impression it makes is fairly accurate. The personality types are real, the overall gestalt is real. The sense of futility is real. I think that it's a pretty accurate impression of what being an intern feels like. In other words, the sense of futility that you get from the book matches the sense of futility I had as a resident. However, do keep in mind that it's not how you feel as an attending later on.

One area where the book didn't match my experience was all the sex. I don't think there was ever as much sex as described in the novel. Mostly you wanted to sleep when you have a chance.

Some younger doctors have found the book to be sexist. I didn't think so, but I could be wrong. I think it accurately describes the point of view of some males, sometimes. That aspect of the book may not be politically correct but it is accurate.

 

[MickyMyki]

The aspects of end-of-life care and 'gomers' may be true to some extent, but this is changing (read Being Mortal by Gawande). I agree...way too much sex and it was a bit focused toward internal medicine...so I don't think some things would apply to, say, surgery (you can't really 'turf' patients you have to operate on). I would take it with a grain a salt. The main thing to take away is to not let modern technology, bureaucracy, etc to drive away compassion or your heart (easier said than done)

 

[BeachBlondie]

I'm currently reading The House of God by Samuel Shem, and I'm wondering how accurate it is about the lives of interns. I understand the book is supposed to be a comedy, but what are the similarities and differences (for those who have read it)?


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Back in the 70's? Probably pretty accurate. But, I worked for MGH for 2.5 years (which is, very thinly veiled, the institution they're alluding to), and their residents are still put through grueling paces, even if to a slightly lesser degree than in the past.

 

[aymar]

The aspects of end-of-life care and 'gomers' may be true to some extent, but this is changing (read Being Mortal by Gawande). I agree...way too much sex and it was a bit focused toward internal medicine...so I don't think some things would apply to, say, surgery (you can't really 'turf' patients you have to operate on). I would take it with a grain a salt. The main thing to take away is to not let modern technology, bureaucracy, etc to drive away compassion or your heart (easier said than done)

Totally second the suggestion to read Being Mortal!

 

[Law2Doc]

It's actually still pretty reflective of what residency is like now. Main difference is many of the colorful terms used in that book have since been deemed politically incorrect so you can't call a patient a gomer or use any of those other phrases/rules out loud today (just perhaps think it).

 

[WheezyBaby]

surgery (you can't really 'turf' patients you have to operate on)

Somebody forgot to tell ortho

 

[Crayola227]

A doctor made it pre-requisite reeading before applying MD

 

[Crayola227]

Somebody forgot to tell ortho

 

[ahc336]

GOMERS GO TO FLOOR

 

[Catalystik]

you can't call a patient a gomer or use any of those other phrases/rules out loud today (just perhaps think it).

If only those in every medical venue were so politically correct.

Q Sign also seems rampant.

 

[JOHNBROCHILL]

He is referring to BID actually not MGH. MGH is man's best hospital in the book.

Every aspect of the book is a hyperbole for something that is otherwise true to an extent in medicine.

Just refer to the laws of the house of god.

 

[ahc336]

I wish I could TURF certain presidential candidates to Ortho. That'd be great

 

[tjo422]

If you want a non fictional account of intern life, try Intern Blues. Also written in the 80s before they restricted the hours an intern can work, but still a good read.


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[bc65]

GOMERS GO TO FLOOR

Wrong! It's "Gomers go to ground".

 

[nellbot2000]

Wrong! It's "Gomers go to ground".

Beat me to it!

 

[bc65]

It's actually still pretty reflective of what residency is like now. Main difference is many of the colorful terms used in that book have since been deemed politically incorrect so you can't call a patient a gomer or use any of those other phrases/rules out loud today (just perhaps think it).

I quote the laws quite often. I'm disappointed to find that most of today's doctors haven't read the book.

But really, there aren't really many patients that would qualify as "gomers". I think there are more nursing home beds now, and those patients get better care. As you get further along in training, and you get older yourself, you find that those patients don't seem as decrepit as they once did. I actually love talking to the older patients as I do minor surgical procedures on them. Most of them have great stories. I've heard war stories from D-day, from WW II fighter pilots, submarines, etc. Cool stuff. On more than one occasion the patients adult children have been with them and have been amazed to hear stories from their fathers that they had never heard before.

Totally second the suggestion to read Being Mortal!

Lots of people seem to like that book, but I didn't find anything new or interesting in there. In fact most doctors avoid futile care. Most will treat when there's a small chance of success, not when there's no chance of success. The families push for the futile care more than the doctors.

I don't think some things would apply to, say, surgery (you can't really 'turf' patients you have to operate on

Actually, ortho tries to get their patients turfed to medicine all the time, and surgery will also, once the acute post op period is over. However, the reality is that while residents want to avoid accepting transfers, attendings don't mind, since they get paid for caring for patients. Also, attendings realize that ortho actually should NOT be caring for the non-ortho problems, nor should surgeons be spending their time caring for post op diabetes and hypertension. That's a job for medicine. Now, in fact, hospitalists do all that care, so no one complains about turfing as much.

It's probably still a problem for residents.

 

[Law2Doc]

I quote the laws quite often. I'm disappointed to find that most of today's doctors haven't read the book.

But really, there aren't really many patients that would qualify as "gomers". I think there are more nursing home beds now, and those patients get better care. As you get further along in training, and you get older yourself, you find that those patients don't seem as decrepit as they once did...

Those patients are still there. We sometimes call them "rocks" now. And we aren't talking about the communicative types with cool stories.

 

[Crayola227]

I quote the laws quite often. I'm disappointed to find that most of today's doctors haven't read the book.

But really, there aren't really many patients that would qualify as "gomers". I think there are more nursing home beds now, and those patients get better care. As you get further along in training, and you get older yourself, you find that those patients don't seem as decrepit as they once did. I actually love talking to the older patients as I do minor surgical procedures on them. Most of them have great stories. I've heard war stories from D-day, from WW II fighter pilots, submarines, etc. Cool stuff. On more than one occasion the patients adult children have been with them and have been amazed to hear stories from their fathers that they had never heard before.



Lots of people seem to like that book, but I didn't find anything new or interesting in there. In fact most doctors avoid futile care. Most will treat when there's a small chance of success, not when there's no chance of success. The families push for the futile care more than the doctors.



Actually, ortho tries to get their patients turfed to medicine all the time, and surgery will also, once the acute post op period is over. However, the reality is that while residents want to avoid accepting transfers, attendings don't mind, since they get paid for caring for patients. Also, attendings realize that ortho actually should NOT be caring for the non-ortho problems, nor should surgeons be spending their time caring for post op diabetes and hypertension. That's a job for medicine. Now, in fact, hospitalists do all that care, so no one complains about turfing as much.

It's probably still a problem for residents.

the issue with turfing is being medicine and being primary for the post-op patient. It's harder to get surgery to get their asses to bedside when **** goes wrong. yes we should manage the dia-beet-us and HTN, but we're not expert in recognizing post-op complications. But you answered why I never see surgery as the primary with medicine consulting as often as I think it should be. **** it, what am I talking about. If they have medicine consulting they still dump them and won't come bedside.

 

[bc65]

Well, it looks like we answered OP's question: Little or nothing has changed!

the issue with turfing is being medicine and being primary for the post-op patient. It's harder to get surgery to get their asses to bedside when **** goes wrong. yes we should manage the dia-beet-us and HTN, but we're not expert in recognizing post-op complications.

I think that you'll find that it's much better once you're out of residency and out of a place with residents.

In residency, you fight to turf patients away from your service.
After residency, if you're fee-for-service, you fight to turf patients to your service.
It's just basic economics.

Medicine docs in private practice love to get stupid pointless "pre-op clearance" consults. It's easy money.
The same with rounding on post op patients. It's like manna from heaven.

 

[bc65]

Laws of the House of God

1. GOMERS DON'T DIE.
2. GOMERS GO TO GROUND
3. AT A CARDIAC ARREST, THE FIRST PROCEDURE IS TO TAKE YOUR OWN PULSE.
4. THE PATIENT IS THE ONE WITH THE DISEASE.
5. PLACEMENT COMES FIRST.
6. THERE IS NO BODY CAVITY THAT CANNOT BE REACHED WITH A #14G NEEDLE AND A GOOD STRONG ARM.
7. AGE + BUN = LASIX DOSE.
8. THEY CAN ALWAYS HURT YOU MORE.
9. THE ONLY GOOD ADMISSION IS A DEAD ADMISSION.
10. IF YOU DON'T TAKE A TEMPERATURE, YOU CAN'T FIND A FEVER.
11. SHOW ME A BMS (Best Medical Student, a student at the Best Medical School) WHO ONLY TRIPLES MY WORK AND I WILL KISS HIS FEET.
12. IF THE RADIOLOGY RESIDENT AND THE MEDICAL STUDENT BOTH SEE A LESION ON THE CHEST X-RAY, THERE CAN BE NO LESION THERE.
13. THE DELIVERY OF GOOD MEDICAL CARE IS TO DO AS MUCH NOTHING AS POSSIBLE.

 

[LizzyM]

my constant repeating of "Rule 1: Take a Breath" is based on "at a cardiac arrest the first rule is to take your own pulse." I have recommending this book since I first read it circa 1980 while working in ER

personally my favorite rule is "there is no body cavity that cant be reached with a #14 needle and a good strong right arm"

Ironically and sadly I write this while watching most lively aunt now on home hospice becomes a GOMER. She and my mom helped me come into this world and it my most sacred duty to help her pass from this one

now that I have BUFFED this post I am TURFING it out and hope it doesnt BOUNCE back.

Because your aunt is in home hospice, she will not be a GOMER because she will not land in the emergency room. Some things have changed... for the better. Keeping you and yours in my thoughts.

 

[Crayola227]

Well, it looks like we answered OP's question: Little or nothing has changed!



I think that you'll find that it's much better once you're out of residency and out of a place with residents.

In residency, you fight to turf patients away from your service.
After residency, if you're fee-for-service, you fight to turf patients to your service.
It's just basic economics.

Medicine docs in private practice love to get stupid pointless "pre-op clearance" consults. It's easy money.
The same with rounding on post op patients. It's like manna from heaven.

to be fair, even as a resident if their issues weren't too bad I don't mind the post-op or rocks. They are easy because you just copy the notes forward and follow note recs. obviously that's not the "maximize learning" attitude /strategy, but it's a nice break sometimes

or a ****show, just depends

 

[deleted245139]

The book is beyond fantastic. The author wrote a nice, brief follow up years later. Remove some of the free love portions and yeah... pretty damn spot on. That book put into words the angst that intern year can bring. I read it as an MS 4, the year my dad passed. To this day, try to re read it yearly. It allows you to vent some of the feelings medicine can bring on. I dunno... I may be unique in this, but I find reading it cathartic. Maybe it was my personal circumstances when I read it.... but it's a very important book for me.

For those EM minded... 'Something for the pain' is another fantastic read

 

[bc65]

The author wrote a nice, brief follow up years later.

I read House of God and two of the author's other, later books. He wrote at least 3 more. While I strongly recommend the House of God, I hated the others. YMMV.

 

[Crayola227]

It's incredibly accurate in capturing the spirit and in particular the lows and emotional difficulties of intern year especially for inpatient heavy specialties like surgery and medicine.

While the sex stuff is clearly over the top, it is also actually very accurate when you look at what underlies the sex scenes themselves - an emotional hunger and desperation for human connection, a feeling of depersonalization and objectification/sexualization of your coworkers. Those feelings and descriptions ring true to those who have gone through the emotional and physical exhaustion of intern year. That part of the book usually gets unfairly dismissed as a result of the fact that most of us haven't actually had a call room orgy.

The book should be required reading at each phase of medical education - once during premed, a second read during clinical rotations in medical school, and a third read at the end of intern year. You get something new out of it each time.

They say the same about Don Quixote in the 3 phases of life. I say the same for the viewing of Scrubs.

I don't remember there being call room orgies. Was there?

I only remember him cheating on his fiancee a lot. I found that off putting but you're spot on that there was a larger message in the antics.
I remember what you're talking about coming up in talks with classmates as early as the very start of first year with the cadavers. (Don't read that wrong.)
I would add to what you said, needing to feel "vital" "alive" "youthful" "feel good" to do something "life affirming" with your body in reaction to what the rest of the job is - which is often watching other people's bodies slowly rot away, and if "lucky" with no one home inside. Which could be part of a reaction to depersonalization but isn't solely. Maybe it was meant as some great literary foil of heightened contrast that was lost on a lot of people.

The book is right medicine can destroy your relationships.

 

[Crayola227]

theme of doing nothing is better than doing something etc

clinical pearl. don't forget it. you'll have it proved before your very eyes many times over. it is sad.

 

[Ismet]

They say the same about Don Quixote in the 3 phases of life. I say the same for the viewing of Scrubs.

I re-watched the pilot episode of Scrubs after my first day of internship. That show is accurate to a whole new level. Looking forward to re-reading House of God after intern year now, it's been quite a while since I read it so I don't remember a lot of it

 

[Catalystik]

They say the same about Don Quixote in the 3 phases of life. I say the same for the viewing of Scrubs.

I don't remember there being call room orgies. Was there?

I only remember him cheating on his fiancee a lot. I found that off putting but you're spot on that there was a larger message in the antics.
I remember what you're talking about coming up in talks with classmates as early as the very start of first year with the cadavers. (Don't read that wrong.)
I would add to what you said, needing to feel "vital" "alive" "youthful" "feel good" to do something "life affirming" with your body in reaction to what the rest of the job is - which is often watching other people's bodies slowly rot away, and if "lucky" with no one home inside. Which could be part of a reaction to depersonalization but isn't solely. Maybe it was meant as some great literary foil of heightened contrast that was lost on a lot of people.

The book is right medicine can destroy your relationships.

Oooh, capitals. I love it. Thank you.