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Screen Shot 2013-08-11 at 7.11.29 AMWritten 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.

BOOK CLUB QUESTION CORNER

  1. House of God was written over 35 years ago and was widely read by medical students preparing to enter residency training. Are there any current books, writings, or publishing that you would recommend a medical student to read, in order to prepare for today’s medical training?
  2. Some say that the House of God illustrated the dehumanization that occurs in medical doctors while on call and working 100+ hours a week on patient care. Since the publishing there has been significant changes and restrictions to work hours, in particular for interns, and now there are some who state that the work hour restrictions, particularly for interns, has swung too far the other direction. What are your thoughts on this?
  3. Do you think TV shows such as Scrubs and Grey’s Anatomy connect with an audience of medical professionals as much as they connect with the general public audience?

Post your responses to our questions or comments below or tweet us using the Twitter hashtag #ALiEMbook.

Further Related Reading

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Nikita Joshi, MD

Nikita Joshi, MD

ALiEM Associate Editor
Editorial Board Member
ALiEM-CORD Fellowship Director
ALiEM-EMRA Fellowship Director
Clinical Instructor
Stanford University, Division of Emergency Medicine