ALiEM Bookclub: The House of God

Written as satire when published first, The House of God polarized the medical community. Doctors in training cheered the book as a voice for their generation to describe the grueling nature of medical training. Others were appalled by the crass language and apparent lack of humanity when describing patient care. Reading the book became a rite of passage for young trainees.

Brief Synopsis

The book follows the internship year of Dr. Roy Basch. According to wikipedia, the book “portrays the psychological harm done to medical interns during the course of medical internship in the early 1970’s.” Throughout the year, the reader follows Roy on a turbulent and treacherous roller coaster journey. The readers feel the pity of watching the residents essentially lose touch with their loved ones from the work stress, and feel the outrage when young patients die horrible deaths, as opposed to the ‘gomers’ who always manage to live. A particularly touching scene is the patient who is the same age as the young doctors who suffers a terrible death from brain hemorrhage. Even more jarring, a colleague of Roy’s commits suicide from the stress of training and guilt of mismanaging patients. Sexual trysts and alcohol flow through the pages in attempts to make the book entertaining, but also uncomfortable to read at times. Roy and his colleagues increasingly turn towards unprofessional behavior to cope with their stresses: groping the majority female nursing staff, mocking the higher ups who apparently have career ambitions at the expense of others, deriding the socially inept residents who seem unaware of a world outside of medicine, and even turning on each other at times through ridicule. The book concludes where it starts, in France, a safe place far away from The House of God, with Berry the one constant and (?sane) element of Roy’s life-altering year of internship.

Clinical Relevance

“The House of God continues to afford medical students the shock of recognition, and to offer them comfort and amusement in the midst of their Hippocratic travails.”

This quote is from the 1995 introduction by John Updike. The question now stands, is this book still relevant for this new generation of medical professionals? Has medical training changed so much as to make the book meaningless to the current generation of trainees?

Written as satire about internship year, this book still raises pertinent talking points. As such, we would argue that these topics are timeless and will keep this book present on bookshelves and reading lists. Particularly poignant areas of debate brought up by the book include principle of do no harm, ethics of end of life decisions, health care economics, among others. In order to focus the discussions, we have chosen three questions for debate and consideration.

Further Related Reading

• A Book Doctors Can’t Close. Howard Merkel MD, NYTimes 2009.
• 35 years later, author revisits ‘The House of God’. Suzanne Koven MD. The Boston Globe 2013.
• Beyond the ‘House of God’ – how medicine hasn’t really changed at all. Martin Young. Mmegi Online 2013.
• The House of God Revisited. Jamie S. Newman. ACP Hospitalist 2008.

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