By: Samuel Shem
With his latest novel, Our Hospital, out this month, author Samuel Shem reflects on the impact that House of God has had on doctors and medical students for over 40 years and reminds students of the essential truths of practicing medicine.
I never wanted to write a novel; it was sort of an accident. After finishing my year-long internship in the real-life setting behind The House of God, I was in psychiatric training and writing plays on the side. To relax I invited my intern buddies to come over and drink and smoke cigars and vent about the hospital and it was just so gut-wrenchingly funny that I started typing it up. I never wanted to publish it. But then someone saw it and sent it to a publisher. Six revisions later it was ready.
In 1978 House of God arrived, and my guys loved it. The older doctors hated it and me—I’d exposed the actual experience, riding on humor and humanity. For two years, I didn’t speak about it in public, but one day I got a letter forwarded by my publisher: “I’m a doc on call alone in a Veterans Hospital in Tulsa all night and if I didn’t have your book I’d kill myself.”
I was shocked. I believed him, and from that day on “Shem” almost never declined an invite. For more than four decades I’ve spoken out about the importance of staying human in Medicine, the danger of isolation, and the healing power of good connection. What’s good connection? Mutual connection. If it isn’t mutual, it isn’t that good. This is the essential truth of practicing medicine.
Med students have gobbled up this truth. Once when I was speaking in a German medical school, a student said, “How could you dare write this?” I said, “If it rings true and if you stick together, you’ll have power. Just don’t go it alone.”
In fact it has become harder and harder in America to be a good, satisfied doctor. When American medical students get into the hospital and see the “real” medicine that is America, it’s a shock.
Why?
Two things: medical insurance, and computers. Students get on the wards and find that they can spend barely any time with patients! In any large hospital, up to 80 per cent of their time is spent in front of a computer. What are they doing? They’re engaged in a war across the screen: on one side, the resident is forced to bill insurance the highest possible cost for the service, and on the other side of the screen the insurance person is trying to pay the least money. This isn’t why they went into medicine! Doctors of all ages now are having a bad time. We see increasing rates of suicide, drug addiction, dropping out of medicine. And for patients it gets harder and harder to see a doctor.
Recently I was speaking to third year medical students in Boston who were horrified at how little time doctors spend with patients compared with computers. I asked, “Does anyone know of a better system?” A few said, “Yes—the VA hospitals.” I pressed them to pinpoint why? They considered this, and then someone said, “There’s no arguing about payment—the government pays a set fee at every VA hospital all across the country.”
The for-profit insurance industry is killing American medicine.
