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House of God #2
Man's 4th Best Hospital
The sequel to the bestselling and highly acclaimed The House of God
Years after the events of The House of God, the Fat Man has been given leadership over a new Future of Medicine Clinic at what is now only Man's 4th Best Hospital, and has persuaded Dr. Roy Basch and some of his intern cohorts to join him to teach a new generation of interns and residents. In a medical landscape dominated by computer screens and corrupted by money, they have one goal: to make medicine humane again.
What follows is a mesmerizing, heartbreaking, and hilarious exploration of how the health-care industry, and especially doctors, have evolved over the past thirty years.
Years after the events of The House of God, the Fat Man has been given leadership over a new Future of Medicine Clinic at what is now only Man's 4th Best Hospital, and has persuaded Dr. Roy Basch and some of his intern cohorts to join him to teach a new generation of interns and residents. In a medical landscape dominated by computer screens and corrupted by money, they have one goal: to make medicine humane again.
What follows is a mesmerizing, heartbreaking, and hilarious exploration of how the health-care industry, and especially doctors, have evolved over the past thirty years.
384 pages, Hardcover
First published November 12, 2019
402 people are currently reading
2912 people want to read
About the author
Samuel Shem
19 books243 followersSamuel Shem (b. 1944) is the pen name of the American psychiatrist Stephen Joseph Bergman. His main works are The House of God and Mount Misery, both fictional but close-to-real first-hand descriptions of the training of doctors in the United States.
Of Jewish descent, Bergman was a Rhodes Scholar at Balliol College, Oxford in 1966, and was tutored by Denis Noble FRS, cardiac physiologist and later head of the Oxford Cardiac Electrophysiology Group. In an address to Noble's retirement party at Balliol, he related that Noble's response to Bergman's attempt to become a writer was to ply him with copious sherry. He graduated from Harvard College and Harvard Medical School.
He was an intern at Beth Israel Hospital (subsequently renamed Beth Israel Deaconess Medical Center) ,which inspired the book The House of God.
As of 2017, Bergman is a member of the faculty of the New York University School of Medicine at NYU Langone Medical Center.
Shem's play Bill W. and Dr. Bob had an Off Broadway run at New World Stage in New York City. It ran for 132 performances and closed on June 10, 2007. The New York Times called it "an insightful new play."
Of Jewish descent, Bergman was a Rhodes Scholar at Balliol College, Oxford in 1966, and was tutored by Denis Noble FRS, cardiac physiologist and later head of the Oxford Cardiac Electrophysiology Group. In an address to Noble's retirement party at Balliol, he related that Noble's response to Bergman's attempt to become a writer was to ply him with copious sherry. He graduated from Harvard College and Harvard Medical School.
He was an intern at Beth Israel Hospital (subsequently renamed Beth Israel Deaconess Medical Center) ,which inspired the book The House of God.
As of 2017, Bergman is a member of the faculty of the New York University School of Medicine at NYU Langone Medical Center.
Shem's play Bill W. and Dr. Bob had an Off Broadway run at New World Stage in New York City. It ran for 132 performances and closed on June 10, 2007. The New York Times called it "an insightful new play."
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Displaying 1 - 30 of 110 reviews
May 7, 2020
1/5 stars
For a little bit of context: I loved The House of God. I'm a medical intern and in many ways I think that book was one of the funniest (albeit a bit hyperbolic) satirical representations of my experiences as such. Then came Mount Misery, which I couldn't even finish... Still, I wasn't expecting to detest Man's 4th Best Hospital. But I did.
I reserve my 1-star reviews for books I actively hate, and this is one that qualifies for sure.
Full review to come soon, as I have a lot more to say. For now: just a lot of disappointment.
For a little bit of context: I loved The House of God. I'm a medical intern and in many ways I think that book was one of the funniest (albeit a bit hyperbolic) satirical representations of my experiences as such. Then came Mount Misery, which I couldn't even finish... Still, I wasn't expecting to detest Man's 4th Best Hospital. But I did.
I reserve my 1-star reviews for books I actively hate, and this is one that qualifies for sure.
Full review to come soon, as I have a lot more to say. For now: just a lot of disappointment.
December 9, 2019
Prefacing this review by noting that House of God is one of my all-time favorite books. I did not expect this book to live up to its prequel, but I expected that it would still be entertaining and insightful. Sadly, I disliked this book so much that I did not finish reading it. FWIW, I did skim the rest of it and found that the ending made me glad I'd put it down.
Whereas HOG is raw, real, and fresh; M4BH is trite, stale, and...preachy? It sometimes reads like a social justice treatise (including everything from foreign wars to guns to sexism), sometimes like a curmudgeonly old dude lamenting the changes in medicine since "his day" (ironically), and sometimes as a new-age treatise on the benefits of Buddism and staring into one another's eyes at length.
While I agree with Shem about many of the problems with the current health care system, the way in which he uses examples is awkward and cumbersome. Furthermore, Shem's solution to everything seems to be to hold the patient's hand and listen to their story. While this is undoubtedly a valuable interaction, it is not a panacea.
I was seriously out when Shem seemed to tout patient satisfaction scores as a good thing and when he introduced the ortho resident as able to do anything including ob/gyn. Just... no.
Admittedly HOG has some fair criticisms leveled at it, but at the end of the day it is real, vulnerable, and very human. M4BH seems to be trying to over-compensate for the criticisms leveled at HOG (i.e. sexism), but it falls flat. If you love HOG, do yourself a favor and don't read this book.
Whereas HOG is raw, real, and fresh; M4BH is trite, stale, and...preachy? It sometimes reads like a social justice treatise (including everything from foreign wars to guns to sexism), sometimes like a curmudgeonly old dude lamenting the changes in medicine since "his day" (ironically), and sometimes as a new-age treatise on the benefits of Buddism and staring into one another's eyes at length.
While I agree with Shem about many of the problems with the current health care system, the way in which he uses examples is awkward and cumbersome. Furthermore, Shem's solution to everything seems to be to hold the patient's hand and listen to their story. While this is undoubtedly a valuable interaction, it is not a panacea.
I was seriously out when Shem seemed to tout patient satisfaction scores as a good thing and when he introduced the ortho resident as able to do anything including ob/gyn. Just... no.
Admittedly HOG has some fair criticisms leveled at it, but at the end of the day it is real, vulnerable, and very human. M4BH seems to be trying to over-compensate for the criticisms leveled at HOG (i.e. sexism), but it falls flat. If you love HOG, do yourself a favor and don't read this book.
December 13, 2019
Probably the most appropriate book to read during Epic super user training...
September 16, 2022
"...it's not burnout, it's doctor abuse."
Quick takeaways from this book:
- The commodification/corporatization (word?) of medicine has made the suits richer, the patients poorer and sicker, and the doctors more depressed.
- Doctors need to take a page out of the nurse's book and organize/unionize.
- Power with, not power over.
- Connect deeply with your coworkers/teammate - build resilience. The only threat to the dominant group is the quality of the connections of the subordinate group.
- Write out a vision of resistance against corporate medicine. Act on it.
- Quality, compassionate healthcare for all is a human right.
Quick takeaways from this book:
- The commodification/corporatization (word?) of medicine has made the suits richer, the patients poorer and sicker, and the doctors more depressed.
- Doctors need to take a page out of the nurse's book and organize/unionize.
- Power with, not power over.
- Connect deeply with your coworkers/teammate - build resilience. The only threat to the dominant group is the quality of the connections of the subordinate group.
- Write out a vision of resistance against corporate medicine. Act on it.
- Quality, compassionate healthcare for all is a human right.
July 24, 2024
I don’t think that anyone would argue that America’s health system is dangerous, inequitable, and unsustainable. It’s not the fault of the doctors. (In fact, as I read this book, I couldn’t help but realize how lucky I’ve been with my doctors.) It’s the for-profit insurance and hospital systems. Healthcare should not be for-profit. Samuel Shem, in his funny and heartbreaking Man’s 4th Best Hospital (sequel to The House of God and Mount Misery) shows us precisely why. Roy Basch is a battered and scarred veteran of American medicine. Just as he has started to feel healed, his old friend Fats pulls him into another venture in big medicine with promises of no night shifts and protection from hospital administration. But, as we know from the shape Roy is in in the prologue, things will end in some kind of disaster...
Read the rest of my review at A Bookish Type. I received a free copy of this book from the publisher via NetGalley, for review consideration.
Read the rest of my review at A Bookish Type. I received a free copy of this book from the publisher via NetGalley, for review consideration.
November 22, 2019
I won this book through Good Reads First Read program.
This is the third book of the medical trilogy which attempts to put a humorous spin on working in the medical field. The first book covered Roy Basch's internship, the second his residency and the final (hopefully) book is Dr. Basch reuniting with many of his comrades to try and save a hospital that has significantly slipped. They all reunite based on the leadership of the Fat Man.
This wasn't nearly as funny as the previous books. I got tired of reading about the fights with insurance and the new computer program that took away from patient care. You can tell Dr. Basch was older since there wasn't much sexual escapades as in the previous books. Not nearly as much in my life either since I have gotten older.
I found the book a struggle to complete. I wasn't looking forward to reading it and finishing it so with 100 pages left I just gave up. Maybe it had a fantastic ending which I will never know about but from what I read Dr. Shem should go back to concentrating on his medical practice.
This is the third book of the medical trilogy which attempts to put a humorous spin on working in the medical field. The first book covered Roy Basch's internship, the second his residency and the final (hopefully) book is Dr. Basch reuniting with many of his comrades to try and save a hospital that has significantly slipped. They all reunite based on the leadership of the Fat Man.
This wasn't nearly as funny as the previous books. I got tired of reading about the fights with insurance and the new computer program that took away from patient care. You can tell Dr. Basch was older since there wasn't much sexual escapades as in the previous books. Not nearly as much in my life either since I have gotten older.
I found the book a struggle to complete. I wasn't looking forward to reading it and finishing it so with 100 pages left I just gave up. Maybe it had a fantastic ending which I will never know about but from what I read Dr. Shem should go back to concentrating on his medical practice.
December 3, 2020
I was given this book in exchange for an honest review.
Ugh. Im not going to lie, this was a rough one for me. Honestly, i wanted to like it more than I actually did. I will say, in my opinion, it worse than the first book “House of God”. Something just didn’t work for me. It took me a long time to finish because i kept it at work, and only read it on my breaks occasionally.
It just really fell flat for me. At least HOG felt more real. This book felt more metaphorical...like it was playing at making different “points” over telling a story. I get that making points is part of storytelling, but it felt so forced here. If I didn’t feel obligated to finish it, I probably wouldn’t have. We will just leave it at that.
Ugh. Im not going to lie, this was a rough one for me. Honestly, i wanted to like it more than I actually did. I will say, in my opinion, it worse than the first book “House of God”. Something just didn’t work for me. It took me a long time to finish because i kept it at work, and only read it on my breaks occasionally.
It just really fell flat for me. At least HOG felt more real. This book felt more metaphorical...like it was playing at making different “points” over telling a story. I get that making points is part of storytelling, but it felt so forced here. If I didn’t feel obligated to finish it, I probably wouldn’t have. We will just leave it at that.
January 9, 2020
Not nearly as good as House of God, Man’s 4th Best has flashes of a great book, but instead reads more like a New Yorker OpEd clumsily merged with a novel. Shem could have been a lot more artistic and subtle with his viewpoints - I agree with him on many points, but in a novel one should come to see the authors reasoning through the development of the characters, like in HoG. In M4BH, the characters end up lecturing each other and agreeing in a groupthink that they have the perfect solution to medicine’s problems, if only everyone else was as smart as them. A think piece in a newspaper would have done more to advance this cause than a clumsily written novel.
February 9, 2020
Really wanted to like this. Loved HOUSE OF GOD, one of the best books for my generation of doctors. This book is overblown, overdramatic, unrealistic, and full of self-absorbed blowhard characters who ultimately are hard to believe and relate to. The postulate of a special clinic bringing together all these characters from nearly a generation ago is rediculous, and their intensity and single-mindedness strains your credulity. Mostly a waste of a few hours. Could only get through it by skimming the last half.
Big disappointment!!!
Big disappointment!!!
May 13, 2021
I just finished The House of God and I absolutely loved it, as I learned so much reading through it. With 4th Best, I feel it took a turn toward the business side of medicine including involvement of insurance companies and their associated intricacies. It was definitely slower than The House of God, which I couldn’t put down; however, it encompasses the financial medical system as well as the humanity that is to be preserved in the field. Great read overall.
This entire review has been hidden because of spoilers.
April 15, 2021
Perhaps I should have had lower expectations, but this just didn’t compare to House of God. Sequels are usually not very good, and this was definitely true in this case. Although I agree with many of his complaints about our healthcare system, this book read as an old man complaining about his job.
September 29, 2020
Since House of God, Shem’s debut, is one of my favourite novels ever, and I recently went through Mount Misery, I’ve been excited for this one.
It’s an imperfect book, in some ways. There are too many names, acronyms, and references to the past, though on this last point Shem does a fairly good job helping people who haven’t read HoG and Mount Misery get up to speed. But it’s hard to track who is who, and especially hard for someone who doesn’t live in the US, ie: this guy, understand various convoluted aspects of the American health care system.
Structurally, the novel is a curious mix of the episodic, with several larger plot strands upon which said episodes hang like clothespins on a wire. Shem’s pretty adept working like this - the two previous novels I mentioned have similar structures, though House of God has FAR fewer characters, and does a better job of gradually teaching you hot to read it.
Another curious aspect of the novel is it feels, I don’t know, slightly dated in its vernacular. Sometimes the characters speak in a kind of weirdly antiquated way, if the 70s could be called antiquity. The attempts to capture accents can be annoying, too. Especially the Irish. This is another holdover from another era - the satirical push that doesn’t quite fit what’s going on in literature and culture right now.
To pivot to the novel’s strengths, the return of the Fat Man is a definite plus. And the end is very, very moving.
Like its predecessors, the novel effectively exposes the flaws in both the medical system and, more pleasing to me, the flaws in the ways we interact, and are in some ways enslaved, by technology.
Berry, Roy’s partner, is into Buddhism and meditation but finds herself just as controlled by her “I”-phone as the staff at Man’s 4th Best are by the insane computer programs they have to spend hours trying to master.
Berry is an interesting character - at times she seems like one of these archetypal ‘new age’ spirit ladies who can’t help but make everything about mindfulness and self-actualization and so on and so forth. Shem is probably right that this kind of thing needs more of a place in medicine, in a Jon Kabatt-Zinn kind of way. But I think culturally I’ve been so pummelled by the messaging that Berry kind of annoys me sometimes.
Roy does too, don’t get me wrong. But it’s clear I’m supposed to be annoyed by Roy, who, in a delightful twist, is famous for having written a book not unlike House of God, in which he himself starred.
I’m not sure where I rank this novel.
Since it deals so much with insurance, and billing systems, and problems that someone who deals with the American health care system on a regular basis, and since I find this stuff slightly tedious and unrelated to my life as a non-American, the novel feels weighed down to me.
On the other hand, I love these characters, have grown with Roy and longed for a return of Fats to my life. The end is very lovely, and the book is indisputably filled with much wisdom.
This, I think, outweighs its flaws.
It’s an imperfect book, in some ways. There are too many names, acronyms, and references to the past, though on this last point Shem does a fairly good job helping people who haven’t read HoG and Mount Misery get up to speed. But it’s hard to track who is who, and especially hard for someone who doesn’t live in the US, ie: this guy, understand various convoluted aspects of the American health care system.
Structurally, the novel is a curious mix of the episodic, with several larger plot strands upon which said episodes hang like clothespins on a wire. Shem’s pretty adept working like this - the two previous novels I mentioned have similar structures, though House of God has FAR fewer characters, and does a better job of gradually teaching you hot to read it.
Another curious aspect of the novel is it feels, I don’t know, slightly dated in its vernacular. Sometimes the characters speak in a kind of weirdly antiquated way, if the 70s could be called antiquity. The attempts to capture accents can be annoying, too. Especially the Irish. This is another holdover from another era - the satirical push that doesn’t quite fit what’s going on in literature and culture right now.
To pivot to the novel’s strengths, the return of the Fat Man is a definite plus. And the end is very, very moving.
Like its predecessors, the novel effectively exposes the flaws in both the medical system and, more pleasing to me, the flaws in the ways we interact, and are in some ways enslaved, by technology.
Berry, Roy’s partner, is into Buddhism and meditation but finds herself just as controlled by her “I”-phone as the staff at Man’s 4th Best are by the insane computer programs they have to spend hours trying to master.
Berry is an interesting character - at times she seems like one of these archetypal ‘new age’ spirit ladies who can’t help but make everything about mindfulness and self-actualization and so on and so forth. Shem is probably right that this kind of thing needs more of a place in medicine, in a Jon Kabatt-Zinn kind of way. But I think culturally I’ve been so pummelled by the messaging that Berry kind of annoys me sometimes.
Roy does too, don’t get me wrong. But it’s clear I’m supposed to be annoyed by Roy, who, in a delightful twist, is famous for having written a book not unlike House of God, in which he himself starred.
I’m not sure where I rank this novel.
Since it deals so much with insurance, and billing systems, and problems that someone who deals with the American health care system on a regular basis, and since I find this stuff slightly tedious and unrelated to my life as a non-American, the novel feels weighed down to me.
On the other hand, I love these characters, have grown with Roy and longed for a return of Fats to my life. The end is very lovely, and the book is indisputably filled with much wisdom.
This, I think, outweighs its flaws.
June 25, 2020
Highly recommended. With less of the mordant and the outrageous humor of The House of God, this is a satire of urban American medical practice of the early 21st C . The electronic medical record has taken over over everything. Billing has become the be-all and the end-all. I should say as a retired physician that the EMR has pluses compared to paper charts. Retrieving lab results and radiology reports is a breeze. Finding the note from cardiology from two weeks ago is possible. The downside is that clinical notes have too often became formulaic and facile templates, depersonalized. Communication among institutions, even those using the same central server, remained poor when I last looked, for reasons of privacy or coding problems.
But I digress. In Man's 4th, the burnt-out team from the House of God has regrouped years later. Roy and Berry are still together, which I'm glad to see. Under the leadership of the Fat Man, who gave up his California practice, they form a group dedicated to old-style medicine. The patient comes before the medical record, before the computer, before the billing system, before the higher-ups dictating whom to treat where. A key moment comes when a patient asks her doctor eye to eye "Why aren't you looking at your computer? Am I not important enough?"
Several sub-plots, a shocking denouement and the love story of Berry and Roy and their daughter weave through this timely plea for a national health system in our country.
A reader unfamiliar with the author's first book, The House of God, may have trouble getting started in Man's 4th, not knowing some of the in-jokes and the acronyms. Whether clinician, patient or both, he or she will catch on fast and share the author's unhappiness with over-computerized medical practice. People like me, with an internist not in a boutique practice who interacts with the patient much more than with the laptop, count our blessings.
But I digress. In Man's 4th, the burnt-out team from the House of God has regrouped years later. Roy and Berry are still together, which I'm glad to see. Under the leadership of the Fat Man, who gave up his California practice, they form a group dedicated to old-style medicine. The patient comes before the medical record, before the computer, before the billing system, before the higher-ups dictating whom to treat where. A key moment comes when a patient asks her doctor eye to eye "Why aren't you looking at your computer? Am I not important enough?"
Several sub-plots, a shocking denouement and the love story of Berry and Roy and their daughter weave through this timely plea for a national health system in our country.
A reader unfamiliar with the author's first book, The House of God, may have trouble getting started in Man's 4th, not knowing some of the in-jokes and the acronyms. Whether clinician, patient or both, he or she will catch on fast and share the author's unhappiness with over-computerized medical practice. People like me, with an internist not in a boutique practice who interacts with the patient much more than with the laptop, count our blessings.
August 5, 2020
In 1978, just after finishing his residency, Sam Shem (his pen name) wrote a bestseller called 'House of Gd'. For anyone who lives in Boston, it was easy to guess that he had worked at Beth Israel Hospital. What made the book so popular was Shem's irreverent take on becoming a doctor. This was not Ben Casey or Dr Kildare, this was the raw truth.
Unless you've spent time working in an Emergency Room, you would find it hard to believe the things that go on, MASH was not that far off. Besides dealing with people at the worst time of their life you are making decisions in split seconds that no one is prepared for in Medical School. What this leads to is a type of lunacy that is necessary to keep you from loosing your sanity.
Additionally to dealing with the daily mayhem of the incoming patients, you have to deal with the medical establishment, the admitting/attending physicians, the administration and everyone's nightmare-the billing department. Doctors who have spent the day up to their armpits in peoples guts, looking to stop bleeding from care accidents and gunshots/stabbings, at the end of the day are being harassed by people from Medical Records to complete you patient notes. They are looking for the most complications so they can increase billings, while you have just finished working for 48 straight hours.
Now an experienced veteran physician, Shem is once more at the mercy of the almighty dollar. But things are even worse now because your also on a time-clock. No matter how ill the patient you only have time (like 8-10 minutes) to examine, cure or admit. And Lord protect anyone who admits a patient with a low intensity medical problem. This is the true horror for a modern doctor, medicine takes a backseat to everything else.
Yes, there is the same craziness as in the first book, (some things never change) because all you need to do is spend one weekend with a full moon in an ER to realize that werewolves do exit and the word 'lunatic' is very fitting. Enjoy.
Unless you've spent time working in an Emergency Room, you would find it hard to believe the things that go on, MASH was not that far off. Besides dealing with people at the worst time of their life you are making decisions in split seconds that no one is prepared for in Medical School. What this leads to is a type of lunacy that is necessary to keep you from loosing your sanity.
Additionally to dealing with the daily mayhem of the incoming patients, you have to deal with the medical establishment, the admitting/attending physicians, the administration and everyone's nightmare-the billing department. Doctors who have spent the day up to their armpits in peoples guts, looking to stop bleeding from care accidents and gunshots/stabbings, at the end of the day are being harassed by people from Medical Records to complete you patient notes. They are looking for the most complications so they can increase billings, while you have just finished working for 48 straight hours.
Now an experienced veteran physician, Shem is once more at the mercy of the almighty dollar. But things are even worse now because your also on a time-clock. No matter how ill the patient you only have time (like 8-10 minutes) to examine, cure or admit. And Lord protect anyone who admits a patient with a low intensity medical problem. This is the true horror for a modern doctor, medicine takes a backseat to everything else.
Yes, there is the same craziness as in the first book, (some things never change) because all you need to do is spend one weekend with a full moon in an ER to realize that werewolves do exit and the word 'lunatic' is very fitting. Enjoy.
January 16, 2020
This is a wonderful sequel to “The House of God”. It could be read independently, but is best read in sequence.
From the gods of the 70s, the [now] modern doctors have been reduced to a small wheel in the gigantic medical industry. The purpose of the docs of the new millennium is to crank out more and more money for insurance companies and Big Pharma. Patient care is reduced to ordering as many expensive tests as possible and also to prescribing a multitude of drugs. Additionally, since clinics and hospitals are now owned and managed by huge for-profit entities, doctors must see an inordinate number of patients to achieve the best monetary return.
Personally I have seen this happen and have been so very thankful for the doctors I’ve found who have stood up to and have not “gone with the flow” of what passes for modern medical care.
A large part of dehumanizing the doctor-patient relationship is the ubiquitous computer now located in every exam room so that the doctor’s back is to the patient and he is asking the [required] questions on the screen rather than interacting with the patient. Shem described this well.
It’s a brave new world that we live in. I appreciate Shem’s revelations about the medical industry and that there are plenty of people still out there wanting life as well as medical care to be more personal and relational. This is a good book for everyone.
From the gods of the 70s, the [now] modern doctors have been reduced to a small wheel in the gigantic medical industry. The purpose of the docs of the new millennium is to crank out more and more money for insurance companies and Big Pharma. Patient care is reduced to ordering as many expensive tests as possible and also to prescribing a multitude of drugs. Additionally, since clinics and hospitals are now owned and managed by huge for-profit entities, doctors must see an inordinate number of patients to achieve the best monetary return.
Personally I have seen this happen and have been so very thankful for the doctors I’ve found who have stood up to and have not “gone with the flow” of what passes for modern medical care.
A large part of dehumanizing the doctor-patient relationship is the ubiquitous computer now located in every exam room so that the doctor’s back is to the patient and he is asking the [required] questions on the screen rather than interacting with the patient. Shem described this well.
It’s a brave new world that we live in. I appreciate Shem’s revelations about the medical industry and that there are plenty of people still out there wanting life as well as medical care to be more personal and relational. This is a good book for everyone.
January 19, 2020
This book is a doozy and a must read for any one in health care, entering health care or even considering entering health care.
I read House of God in the middle of nursing school and it put a of things in perspective in regards to working in health care. The book was what helped me continue on in health care as I was questioning my choices.
This book rings so true about billing, numbers and money and how we are treating screens and not the patients. Parts made me laugh and parts made me angry. I strongly recommend this book for doctors, nurses and anyone else involved in patient care.
I read House of God in the middle of nursing school and it put a of things in perspective in regards to working in health care. The book was what helped me continue on in health care as I was questioning my choices.
This book rings so true about billing, numbers and money and how we are treating screens and not the patients. Parts made me laugh and parts made me angry. I strongly recommend this book for doctors, nurses and anyone else involved in patient care.
December 7, 2019
It’s certainly not the best writing ever, but as a doctor I wish it was required reading for hospital administration and EMR designers. It is an absolute truth that practicing medicine these days is full of tasks to make the hospital money that take away from why we love our jobs. It’s sad that this is what our insurance company-driven health care in America has come to.
February 8, 2020
Truly awful "sequel" to one of my favorite satire works of all time. "What if we had the author of House of God write an extremely boring condescending lecture aimed at convincing junior high students that corporations are evil cartoons? Whats that you say, a blog post? Heck no, lets make this bad boy 380 pages!"
December 19, 2019
Could not read past page 92
January 11, 2024
I read “House of God” at the end of my medical school journey and found it jarring. It was a dark, albeit funny, satire of the 1978 idealized view of medicine through the eyes of an immature, brash, and egotistical autobiographical first year resident at a world renown academic hospital. It was uncomfortable and disturbing, but it told truths about a life of medicine I had not seen except for the rawest pages of “When Breath Becomes Air.” The book revealed nuanced flashes of humanity in a field of alleviating suffering in a system that seems to leave both patients and doctors behind. It showed the anguish and hope against hope that all healthcare workers battle with: distancing yourself from patients enough to survive, while trying not distance yourself from your own humanity.
“Man’s 4th Best Hospital” was written as a sequel 41 years later. I read it during the beginning of my first year of residency. It was written by the same author about the same characters but near the end of their careers. It carried all the insightful, quippy humor that I loved about HoG but with the air of maturity and wisdom that comes from 41 years of passing. At risk of over-hyping it, I will say it had a plot that was as complex as HoG (meaning not very) and was overly teachy at times causing far too many eye rolls as it drilled in different points the author was trying to make. It was overly simplistic in how it often characterized doctors as heart of gold martyrs and suits as greedy villains. However, I loved it. It read as a book written out of penance for HoG. The author, instead of showing the rotten insides of an idealized 1970s doctor, showed the beauty, hope, resilience, and resistance lying deep within the current ugly, rotten American healthcare system today. It was a eulogy for medicine before computers, private equity, and for profit medicine. It was a love poem for patients from doctors. It was a 95 theses, demanding changes not out of anger but out of love. I feel like I am a better person and a better doctor for having read this book. That being said, I could totally see how this book would be disliked by many people, doctors and non-doctors alike.
“Man’s 4th Best Hospital” was written as a sequel 41 years later. I read it during the beginning of my first year of residency. It was written by the same author about the same characters but near the end of their careers. It carried all the insightful, quippy humor that I loved about HoG but with the air of maturity and wisdom that comes from 41 years of passing. At risk of over-hyping it, I will say it had a plot that was as complex as HoG (meaning not very) and was overly teachy at times causing far too many eye rolls as it drilled in different points the author was trying to make. It was overly simplistic in how it often characterized doctors as heart of gold martyrs and suits as greedy villains. However, I loved it. It read as a book written out of penance for HoG. The author, instead of showing the rotten insides of an idealized 1970s doctor, showed the beauty, hope, resilience, and resistance lying deep within the current ugly, rotten American healthcare system today. It was a eulogy for medicine before computers, private equity, and for profit medicine. It was a love poem for patients from doctors. It was a 95 theses, demanding changes not out of anger but out of love. I feel like I am a better person and a better doctor for having read this book. That being said, I could totally see how this book would be disliked by many people, doctors and non-doctors alike.
May 24, 2024
Ugh.
I Loved “House of God.” When I first started it as a medical student I was completely offended and stopped reading it. Then I tried it again during my intern year and it hit home. Satire rooted in reality. Some scenes from that book live with me to this day. So I was excited to see a “sequel” - a satire about corporate medicine and the business of healthcare. But man, was this tough to read. I again took a break, thinking maybe I wasn’t at the right point in my life to appreciate the humor. Definitely still satirical writing here, but it often felt like philosophizing, and sometimes like sitting in a lecture. Almost nothing light hearted to break up the slog against corporate greed. I’m in medicine and had a hard time remembering exactly what BUDDIES and HEAL and OUTGOING, etc. were all supposed to represent.
There was some truth hidden in the maze.
*”Monetizing of whether y’live or y’die.”
*Our health care is only “the World’s Best” in highest cost per patient.
*The “Doctor’s Dilemma” losing face to face contact to screens, screens that are there to make money, not to make healthcare better. “Worse for your care and -for sure- worse for the care of your doctor. It is only better for the money, the health-care industry.”
*Some of the “laws” still hit home:
Isolation is deadly; connection heals.
Without health-care workers, there’s no health care.
Squeeze the money out of the machines.
Put the human back in medicine.
Shem is clearly making a call for much needed American health care reform, and the Fat Man makes his case on a potential solution. The book, however, fell short on presenting these ideas in a manner that could hold my interest.
I Loved “House of God.” When I first started it as a medical student I was completely offended and stopped reading it. Then I tried it again during my intern year and it hit home. Satire rooted in reality. Some scenes from that book live with me to this day. So I was excited to see a “sequel” - a satire about corporate medicine and the business of healthcare. But man, was this tough to read. I again took a break, thinking maybe I wasn’t at the right point in my life to appreciate the humor. Definitely still satirical writing here, but it often felt like philosophizing, and sometimes like sitting in a lecture. Almost nothing light hearted to break up the slog against corporate greed. I’m in medicine and had a hard time remembering exactly what BUDDIES and HEAL and OUTGOING, etc. were all supposed to represent.
There was some truth hidden in the maze.
*”Monetizing of whether y’live or y’die.”
*Our health care is only “the World’s Best” in highest cost per patient.
*The “Doctor’s Dilemma” losing face to face contact to screens, screens that are there to make money, not to make healthcare better. “Worse for your care and -for sure- worse for the care of your doctor. It is only better for the money, the health-care industry.”
*Some of the “laws” still hit home:
Isolation is deadly; connection heals.
Without health-care workers, there’s no health care.
Squeeze the money out of the machines.
Put the human back in medicine.
Shem is clearly making a call for much needed American health care reform, and the Fat Man makes his case on a potential solution. The book, however, fell short on presenting these ideas in a manner that could hold my interest.
January 26, 2020
Woof. Could not finish for fear of ruining my impression of House of God, which despite its flaws, was funny and sarcastic and culture-defining. This was an opportunity for Shem to complain about EVERYTHING through his characters, instead of letting the story show the downfalls of modern medicine. The complaints, at their base true, were so incredibly overblown that it was completely unrelatable.
January 15, 2023
This book was SO hard to read and to get through. I have never felt so unexcited to read a book in my life. It took a LOT of willpower to open this book everytime I did and even more to finish. Meh narrative voice, too on the nose like almost complainy/preachy, not comical at all. Storytelling is not good.
Was a rough read for sure
Was a rough read for sure
November 18, 2021
Even though this book had some real issues with the healthcare industry, I was not familiar and did not know about the author's first book and that this is kind of a sequel. Did not like religious aspect in this either. Cannot recommend.
February 8, 2023
I loved this book and I think it highlighted some of the most realistic challenges healthcare workers face in today. It was definitely a change of pace in comparison to House of God, but I loved this narrative and felt that it put words to the feelings many in healthcare struggle with.
December 31, 2023
Definitely not the spark that Shem usually has. Kind of slow and textbooky at times
December 16, 2022
While I loved House of God, Man’s 4th Best Hospital is just overly done satire, and not in a good way. It highlights the issues of current medicine in an over the top way, and tries to speak to Every. Single. Issue. That currently plagues medicine.
I finished this book, but barely.
I finished this book, but barely.
July 4, 2022
Man's 4th is a deeply flawed sequel to The House of God, with moments of greatness and tangential diatribes that should never have made a second draft, let alone publishing, in about equal proportions. Read every other chapter and it's a solid 3.5 stars.
Twenty years after the House of God, Roy Basch and the Fat Man get the old crew together to open the Fat Man's clinic, an attempt to restore glory to what's now Man's 4th Best Hospital.
The House of God dealt with the practicalities, economics, and ironies of practicing medicine at a big-name tertiary care hospital, complete with its moral hazards, ulterior motives, and petty politics. Roy's humanism and compassion were stretched to and beyond their limits during his residency training and medical initiation, his only consolatory supports being his girlfriend Berry and his pragmatically cynical senior resident Fats.
Man's 4th has a great premise, recreating the key features of HOG. He uses his same characters (starring Roy Basch as Danny Ocean) as experienced older docs who go back to their alma mater (from Indian health and private practice) to open the informatics-infused Future of Medicine clinic.
Running the clinic instead of working for the hospital, they're now terrorized by the sy$tem-level aspects of American healthcare: healthcare conglomerates, "BIG PHARMAFDA," research departments, billing and coding enforcers, insurance, and electronic medical records systems. He left out corporate staffing companies because as a Harvard doc I guess he hasn't experienced their particular evil personally.
This part of the book actually works. It's a heavy-handed at times, but has most of the best laughs, and feels vital, as he exposes the government-endorsed racketeering and profiteering inherent in the American system. These evils of course cause moral hazard for the doctors, nurses, and hospitals, that have to fight to survive in the jungle.
What should be easy is where the book falls flat. In describing his characters interactions, backstories, and fatigue as they fight the system, he fails hard. Sidebars on the environment and social justice cause eye-rolling, and his stereotyped minor characters and hate for all things WASP are huge turn-offs. He preaches on environmentalism as if us reading his book are in a position to advocate for change, and not the very same powerless pawns as his characters. If I wanted to feel depressed, David Attenborough at least shows pretty pictures. Every time he outlines the ways corporate medicine doesn't care about the poor or the sick, he reminds his readers that the poor and sick are mostly people of color. Every. Damn. Time. Like four times a chapter.
If you just skip every other chapter (including the trainwreck opening chapter), I think this book is worth checking out and reading, especially if you're interested in why doctors are killing themselves or why American medicine is so expensive. It has humor, some fun characters, and good insight into how the sausage gets made and where the money goes.
Twenty years after the House of God, Roy Basch and the Fat Man get the old crew together to open the Fat Man's clinic, an attempt to restore glory to what's now Man's 4th Best Hospital.
The House of God dealt with the practicalities, economics, and ironies of practicing medicine at a big-name tertiary care hospital, complete with its moral hazards, ulterior motives, and petty politics. Roy's humanism and compassion were stretched to and beyond their limits during his residency training and medical initiation, his only consolatory supports being his girlfriend Berry and his pragmatically cynical senior resident Fats.
Man's 4th has a great premise, recreating the key features of HOG. He uses his same characters (starring Roy Basch as Danny Ocean) as experienced older docs who go back to their alma mater (from Indian health and private practice) to open the informatics-infused Future of Medicine clinic.
Running the clinic instead of working for the hospital, they're now terrorized by the sy$tem-level aspects of American healthcare: healthcare conglomerates, "BIG PHARMAFDA," research departments, billing and coding enforcers, insurance, and electronic medical records systems. He left out corporate staffing companies because as a Harvard doc I guess he hasn't experienced their particular evil personally.
This part of the book actually works. It's a heavy-handed at times, but has most of the best laughs, and feels vital, as he exposes the government-endorsed racketeering and profiteering inherent in the American system. These evils of course cause moral hazard for the doctors, nurses, and hospitals, that have to fight to survive in the jungle.
What should be easy is where the book falls flat. In describing his characters interactions, backstories, and fatigue as they fight the system, he fails hard. Sidebars on the environment and social justice cause eye-rolling, and his stereotyped minor characters and hate for all things WASP are huge turn-offs. He preaches on environmentalism as if us reading his book are in a position to advocate for change, and not the very same powerless pawns as his characters. If I wanted to feel depressed, David Attenborough at least shows pretty pictures. Every time he outlines the ways corporate medicine doesn't care about the poor or the sick, he reminds his readers that the poor and sick are mostly people of color. Every. Damn. Time. Like four times a chapter.
If you just skip every other chapter (including the trainwreck opening chapter), I think this book is worth checking out and reading, especially if you're interested in why doctors are killing themselves or why American medicine is so expensive. It has humor, some fun characters, and good insight into how the sausage gets made and where the money goes.
December 4, 2019
How disappointing!!!
I just recently re-read (and reviewed!) Samuel Shem's acutely observant and profoundly hilarious first book "House of God." Great trip down memory lane. It is difficult to overestimate the influence this book has had on my generation of physicians, mostly those of us who were in and/or entering training when this book came out. Indeed, I mentioned this new book to my now senior physician friends, and I was deluged with return e-mails, each recalling favorite lines from "House of God." Everyone remembers to take his own pulse. Always.
So - what's wrong? Roy Basch, famous intern, has now returned to Boston (this time to Man's Best Hospital, lightly disguised Mass General) to carry out a mission set forward by his erstwhile mentor, the now famous Fat Man. The concept: to bring humanity back to medical practice. As in “House of God”, so much of what Mr. Shem describes is absolutely true. At every turn, well-meaning physicians are distracted by screens and computers, medical record keeping, patient satisfaction surveys, and the "business" of medicine as it is practiced in the USA in 2019.
Good intentions, just does not work. Not sure why. Maybe because "House of God" was amazing because it was fresh and provocative and provided an inside look at medical care that was largely hidden from the lay public. By contrast "Man's 4th Best Hospital" simply slogs along, and doesn't have the right stuff.
I think even Mr. Shem is aware of this, as "Man's 4th Best Hospital" is heavily peppered with references to events and characters from the earlier book.
So sorry about this!!! I was hoping to be laughing and crying in despair and recognition of truths as only Mr. Shem can tell them.
Maybe next time?
I just recently re-read (and reviewed!) Samuel Shem's acutely observant and profoundly hilarious first book "House of God." Great trip down memory lane. It is difficult to overestimate the influence this book has had on my generation of physicians, mostly those of us who were in and/or entering training when this book came out. Indeed, I mentioned this new book to my now senior physician friends, and I was deluged with return e-mails, each recalling favorite lines from "House of God." Everyone remembers to take his own pulse. Always.
So - what's wrong? Roy Basch, famous intern, has now returned to Boston (this time to Man's Best Hospital, lightly disguised Mass General) to carry out a mission set forward by his erstwhile mentor, the now famous Fat Man. The concept: to bring humanity back to medical practice. As in “House of God”, so much of what Mr. Shem describes is absolutely true. At every turn, well-meaning physicians are distracted by screens and computers, medical record keeping, patient satisfaction surveys, and the "business" of medicine as it is practiced in the USA in 2019.
Good intentions, just does not work. Not sure why. Maybe because "House of God" was amazing because it was fresh and provocative and provided an inside look at medical care that was largely hidden from the lay public. By contrast "Man's 4th Best Hospital" simply slogs along, and doesn't have the right stuff.
I think even Mr. Shem is aware of this, as "Man's 4th Best Hospital" is heavily peppered with references to events and characters from the earlier book.
So sorry about this!!! I was hoping to be laughing and crying in despair and recognition of truths as only Mr. Shem can tell them.
Maybe next time?
March 16, 2025
The original “House of God” is a classic, using its very dark humor to outline a very deep-seated outrage. It is a pained evisceration of how dehumanizing the healthcare system and medical training can be, transitioning from being darkly humorous in its first half to just plain dark in its latter half. It may be a product of its time, but it continues to resonate 50 years since its publication on the strength of its humanity.
“Man’s 4th Best Hospital” is a profoundly missed opportunity. Rather than tapping into the humanity of its characters and appealing to our better angels, this “novel” is essentially a series of unedited tirades. It is chapter upon chapter of lamenting how much things were better “back in my day,” not just in medicine but all aspects of life. What could have been great moments of witty, thoughtful criticism of some of the biggest flaws of modern American healthcare are merely superficial talking points. Some of the speeches are positively luddite.
Shem forgets the #1 rule for storytellers: “Show, don’t tell.” And here he doesn’t even tell effectively, and it’s aggravating to read, even if you agree with him.
I reserve 1-star reviews for books I actively dislike and this is one of them.
“Man’s 4th Best Hospital” is a profoundly missed opportunity. Rather than tapping into the humanity of its characters and appealing to our better angels, this “novel” is essentially a series of unedited tirades. It is chapter upon chapter of lamenting how much things were better “back in my day,” not just in medicine but all aspects of life. What could have been great moments of witty, thoughtful criticism of some of the biggest flaws of modern American healthcare are merely superficial talking points. Some of the speeches are positively luddite.
Shem forgets the #1 rule for storytellers: “Show, don’t tell.” And here he doesn’t even tell effectively, and it’s aggravating to read, even if you agree with him.
I reserve 1-star reviews for books I actively dislike and this is one of them.
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