Medical matters: The universal truths of a hospital – through the eyes of intern

The 1980s rules of my hero for medical students are still relevant today

They say you should never meet your heroes. Well, I'm about to meet one of mine. Dr Stephen Bergman, aka Samuel Shem, the author of the classic medical novel The House of God, will be in Dublin on Friday to speak at DotMED 2016.

The aim of the conference is to reinvigorate health professionals. (Full disclosure: I am a co-organiser of the conference.)

As a medical student and a junior doctor in the 1980s, and like many of my peers, I found the book echoed our experiences of 100-plus hour working weeks.

Yes, it is a satirical novel and identifying with it made you feel uncomfortable, but it reflected a certain brutal reality.


Shem has said the House of God was based on his experiences as an intern at the Beth Israel Hospital in Boston in 1973-1974. He explains how he and his colleagues were influenced by the Vietnam War and the civil rights movement, an influence that fostered a belief in their ability to change things for the better.

“When we entered our internship, we were told to treat our patients in ways that we didn’t think were humane.

“We ran smack into the conflict between the received wisdom of the medical system and the call of the human heart,” he wrote a quarter of a century after the book was first published.

Form of resistance

According to Shem, the book is best interpreted as a form of resistance to the selfish and doctor-centric world of academic medicine in 1970s Boston. The resistance was, in the author’s words, to “brutality and inhumanity, to isolation and disconnection”.

The book outlines 13 rules or universal truths of the hospital as seen through the eyes of intern Roy Basch and his senior resident, the Fat Man, who offers a counterweight of hope and humanity to the intern's disconnected world.

So, how close to reality are the rules of the House of God? As a patient one would hope never to be labelled a "Get out of my emergency room"(Gomer). And many healthcare professionals would be uncomfortable with the first two rules: Gomers don't die and Gomers go to ground.

But there is a persistent reality to the next two rules: at a cardiac arrest, the first procedure is to take your own pulse, and the patient is the one with the disease.

Would the House of God be as successful if it was written and published in 2016? Bergman thinks so.

He teaches a seminar on it to medical students at New York University and the students identify with the core of the book, "just as much as in 1978".

How does he explain such longevity in terms of the impact?

“The core is the same,” Bergman says. “The suffering of going through a ‘power-over’ medical training system that doesn’t allow – especially with the screening out of human connection – the things that we all go into medicine for; the human connection that lets us help patients heal.

"If you get isolated, as in The House of God, you can go crazy . . . [during internships] we not only got isolated from each other, we got isolated from our authentic experience of the system itself."

More rules

The author has since added four additional rules to the original 13. Number 14 says connection comes first, an essential buffer against isolation; 15 is to learn empathy; if you see a wrong in the medical system, speak up, is the gist of law 16; while rule 17 asks students to learn their trade in the real world inhabited by patients.

What prompted him to make these additions?

"I am a lot older," he reflects, "and have had a lucky and marvellous journey with my wife, Janet Surrey, and have learned something about the health of not putting the 'I' at the core of all things, but of shifting to the 'We' at that core." @muirishouston