Why is House of God Still a Seminal Text for Med Students?

Dec 22, 2020

Written by Ross Lomazov

Ross Lomazov is a 4th year medical student at the University of Melbourne.

For the past forty years, with over 2 million copies sold, The House of God has become almost a rite of passage for med students, but a MD3 student questions if it's deserving of its cult following.  

About 6 weeks out from end of year exams, I was in a rut. The year was ending, but like an infection due to a resistant strain of bacteria, it wasn’t ending fast enough. All formal assignments were submitted, and due to the year being simply pass/fail in recognition of the pandemic, my motivation to study was non-existent. Lamenting my boredom to my housemates, I was offered a book to read, one which my housemate had just finished. Fantastic — in the mad rush of the year, the only books I had read were my signed copy of Talley and O'Connor's Clinical Examination, and my not-signed Oxford Handbook of Clinical Medicine.

After popping into his room to retrieve the novel, I sat on the couch to get stuck into The House of God, written by Stephen Bergman, under the pseudonym of Samuel Shem. I had heard of this book since the beginning of med school, with countless teachers, supervisors and doctors I was shadowing recommending it to me as a must read of medical literature - a ‘sacred text’, passed down from generation to generation of interns.

Ten minutes into reading the book, I knocked on my housemate’s door and asked, “Is all of it this pornographic?”

Whilst not all pornographic, the novel left me curious why it was held in such high regard. Based on Bergman’s time as a junior doctor, as well as that of his fellow interns, it can be found on many shelves within the medical community — a generation of doctors grew up reading this novel, spawning an almost cult-like following. Quotes from the book often find themselves in medical education and in hospital rooms.

And yet, the book failed to charm me. The House of God is evidently a vestigial remnant of the 70s. It's contemporaneously sexist, misogynistic, and lewd. Female characters have only two roles; as support networks for the author— either emotionally or sexually— or as emasculating figures of authority who actively harm patients. In The House of God, women are either sexual objects or foils to the greatness of the male physician. Nurses are not members of a multidisciplinary team responsible for the care of the patient, but simply objects to be fantasised about when not actively having sex with doctors. 

The novel's treatment of women raised many questions. Is this the standard we want to be instilling in upcoming doctors? Even worse, how do my female colleagues feel about being recommended a book that so actively demeans their gender? Is this the impression we want to leave to the general public of what medicine is? What does it say about our profession that this book is still so highly recommended and read? And more importantly, why is it so highly recommended and read, more than forty years after its publication?

The only redeeming quality of the novel is its approach to burnout, mental health, and the dehumanising process of medicine, which largely explains the cult following it has achieved. Saying that medicine is hard and taxing is an understatement. 

The House of God is evidently a vestigial remnant of the 70s. It's contemporaneously sexist, misogynistic, and lewd.

The reason The House of God is popular is because of its frank and uninhibited revealing of the dehumanisation of the career — people read it for a sense of release, catharsis, and to know they are not alone. The author’s sadness, desperation and alienation from both his peers and his work desperately ring true for any modern healthcare worker. 

The House of God is often recommended to students and young doctors because our teaching does not adequately prepare us for burnout and frustrations that we will encounter in our profession, the oftentimes absurd and paradoxical goals of healthcare delivery. The novel holds no punches, with story lines that sadly many can relate to. Feelings of helplessness and failure resonate within a profession where a single mistake or lack of knowledge lead to injury and death. 

Yet despite the above, I still would not recommend it to future students, or at least not as a ‘first line’ suggestion. More compassionate books such as This is Going to Hurt or The Intern Blues would likely do a better job of preparing new doctors for a grinding and isolating experience. If one truly wants a medical ‘sacred text’, I would consider the show Scrubs.

Takeaways do exist from the books. The line that “the delivery of good medical care is to do as much nothing as possible” has been told to me by many doctors over the years in many different forms. Yet I know many students were not able to reach these pearls of clinical wisdom, choosing to put the novel down instead of enduring the literary male gaze for another 300 pages.

Whilst for some it may be an interesting read, if only as a window into the old days of our profession, it should not be held as a gold standard in medical literature. Better, more inclusive, and less alienating works exist to inspire a new generation.


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