"House of God" is one of the most influential books in the history of Medicine.
This satirical fiction novel written by a future Psychiatrist about his Intern year of medicine is both beloved and hated by the medical community.
Here are 12 lessons I learned:
First things first,
The novel was written in 1978 and is a fictional depiction of Samuel Shem, an intern at Beth Israel Hospital.
It describes the harm and misery doctors suffer during their residency training.
It also gives a peak behind the curtain of hospital medicine.
This novel is reviled by many, including the NY Times who still writes hit pieces about this book to this day.
It gives readers a semi-accurate view of the way their doctors view them, attacking the myth of doctoral perfectionism head on.
Let's get into it.
1) GOMERs don't die
GOMER = "get out of my ER"
These are the patients admitted over and over with uninteresting chronic conditions.
COPD, congestive heart failure, pneumonia, etc. All the conditions a doc see's 1000 times in their intern year.
Despite being chronically ill and visiting the ED 20 times per year, they never die.
They are kept alive by the healthcare system, or more accurately, their bodies own innate healing ability.
They often come from a skilled nursing facility with no apparent reason why.
2) Stay Calm
This comes from the third "law" of HoG:
At a cardiac arrest, take your own pulse
If you don't stay calm in chaos, you're only gonna hurt more than you help.
Do no harm. Stay calm.
3) The Patient has the Disease
You are caring for a patient who is sick. It's not your fault. Do your best to help them.
At the end of the day, not everyone can be saved.
At least you get to go home at the end of the day.
4) Case Workers are Key
"Placement comes first"
This couldn't be more true. After a patient is treated, they have to go somewhere.
The case workers find placement, set up home care, physical therapy, etc.
They decide when a patient leaves, not the doctor,
5) "The only good admission is a dead admission"
This HoG Law enraged people with no sense of humor.
The law is a provocative way of saying, "paperwork sucks."
When a patient dies, paperwork dies with them.
Don't take it so seriously.
6) Don't test for things you don't want to find
If you test for everything, you'll find something. Don't look for disease in an asymptomatic patient.
When you find it, you have to treat it. That extends the stay and harms the patient.
7) We waste a lot of time and money
"The delivery of good medical care is to do as much nothing as possible"
We run tests that don't change the treatment plan all the time for "academic interest"
This hurts the patient's and prompts more useless tests (see lesson 6).
8) LOL in NAD's should stay home
"Little old lad in no apparent distress" is better suited staying home after a minor fall or illness.
When she comes to the hospital she risks iatrogenic disease and subsequent death.
If you aren't seriously ill, stay home.
9) Zebras are rare
"If you hear hoof beats, thing horses, not zebras"
Common ailments are common, rare ones are rare. Most people won't ever see an illness with 1:100,000 prevalence. So don't look for them.
10) Chart buffing is a pandemic
Buffing a chart means adding a bunch of crap to make it look like you did something.
This is rampant nowadays (and apparently in 1978) in order to get better insurance payouts.
11) Turf and Bounce
When doctors don't know what's going on they "turf" aka "punt" them to another team or department.
When that department doesn't know either, the patient bounces back.
If turfed then bounced, discharge and let them heal.
12) Some doctors' are better than others
Some doctors know the body has incredible healing abilities. These are doctors you want treating you.
Others think you are only alive because of their God-like ability to heal. Avoid them like the plague.
What's the main lesson learned from House of God?
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House of God shows that humans have incredible ability to heal on their own.
If they do absolutely nothing, they will likely get better on their own eventually.
Live a healthy life and you may never see a doctor or go to a hospital.
Enduring message after the last 2 years.
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