Treat The Illness - Never the Patient

'The House of God' by Samuel Shem (Stephen Bergman), published in 1978, is a satirical novel written to call attention to the abuse and dehumanization of physician trainees. It is incredibly sexist, oversexed, and over the top, things one can begin to forgive when it's put in historical perspective - the 1970's. Nevertheless, it is an incredibly immature, self-indulgent, and two-dimensional novel, that its author and millions of physicians and physician trainees thought hilariously clever. 

It wasn't clever, not really. And in the end the book just served to contribute to medicines long, proud, tradition of self-aggrandizement, pomp, showmanship, and arrogance.  

Whereas the book sets out to expose the effect medical training has on its trainees - abusing them until they become dehumanized and two dimensional - exactly as their trainers had become with their training - all in an attempt to properly numb them to the abuse heaped on to their patients by western medicine's fundamental approaches to illness. But despite the authors original intent, the book somehow manages to do the opposite - evoking the sort of legend heard in frat houses and basic training camps - thank you sir may I have another?   

In the end it serves to lionize America's ridiculous approach to medical training and to care - making it legend, instead of indicting it. Whereas it is true training is different today, perhaps in part due to this book, doctors are nevertheless no more humane, no less callous, no less arrogant and certain in the face of ignorance, and no less two-dimensional, than ever before. Long hours and disrespect were never the issue. It was and still is medicines fundamental approach to patients that dehumanizes its trainees - something the book failed miserably at pointing out.

At the time of its publication giggles and laughter emanated from call rooms all across the country as medical students and interns read it's pages with glee - wow I'm a part of this insanity and that's cool, learning along the way that being clever, stuffing your brain with facts, and towing the party line was much more important than humaneness, wisdom, or compassion - all the while learning to ignore the dehumanizing effects western medicine's approach has on patients. It made them more famous in a funny and clever way - despite the book revealing their collective sociopathy. 

Black humor has to be a part of medical care if one is to hang on to even a shred of humanity, but 'The House of God' used it to glorify a band of brothers (and one female) traumatized to callousness, serving to encourage an underlying dictum seen even today in the halls of academia - that clinical medicine is nasty and beneath 'real' academics. That patients really are gomers, obesity and most chronic illness is to be ridiculed, that doing is the go-to when the talentless meet suffering humanity - testing, operating, just one more round of chemo, one more course of antibiotics - all much more important than quality of life or often, even dignity.

The House of God never really taught us anything new. It lionized black humor, pedigree, arrogance, and heartlessness, in medicine, and helped to cement a culture of inhumanity in the delivery of medical care while enshrouding it in legend. But arrogance, certainty in the face of ignorance, callousness, and an approach that involves treating the disease not the patient is a long sorted one, well-established for millennia in medicine - nothing new - and if anything, the book just made it worse.