Almost everyone who goes into medicine does so to try to help people. But doctors are trained as medical students, interns and residents in ways that are sometimes arbitrary and humorless, not to mention sleepless. While young doctors start off with the best of intentions, most of us struggle during the early parts of our careers to preserve and protect our identities. Our mechanisms for survival include what life-affirming struggles always include—love, sex, deprecating humor and deep bonds of friendship.
This dynamic was perfectly captured in “The House of God,” a 1978 satirical novel by a psychiatrist-in-training writing under the pen name Samuel Shem, M.D. In a just-published sequel—“Man’s 4th Best Hospital”—the fictional landscape has changed to reflect the strange new reality of being a physician in the 21st century. Technology has created barriers between doctors and patients.
In “Man’s 4th Best Hospital,” young doctors are trained to use HEAL, a computer system that does anything but. HEAL is the preferred tool of a hospital conglomerate called BUDDIES, whose only purpose is profit-making and is hardly a doctor or a patient’s actual buddy. These soulless parasites are attached to a failing health system that overwhelms and sucks the life blood from Samuel Shem’s doctors, thereby destroying the quality of care for patients.
As a practicing physician in the real world, I wish I could say that this profound parody reads or feels like fiction. Rather, patient visits where the doctor faces a computer screen the whole time are the new reality in the medical trenches. By contrast, real treatments and real cures still involve the art of medicine, which, according to Dr. Shem, actually saves money in the long run. Man’s Best Hospital—a stand-in for a Boston hospital with similar initials—is only profitable when HEAL is partly deactivated and both quality and efficiency return, as bills are once again delivered by paper. How ironic is it to consider that the cumbersome systems devised to save money in medicine actually lose it.
Medicine was never intended to be like this. With all the political hand-waving and jargon about taking care of patients, the expansion of government and private insurance companies into health care has put all of our best intentions in jeopardy. Administrators can strategize hypothetical systemwide solutions, but if doctors are beleaguered and overwhelmed, these solutions will always be compromised.
Innovations in robotics and genetic engineering, immunotherapy and artificial intelligence are creating opportunities in medicine that seem like science fiction, but none of them will fly without the literal hand-holding that only a flesh-and-blood physician can provide. Patients won’t accept some of the more dystopic innovations on the horizons of personalized care—retina scans, nanomedicine, bioengineered immunities—unless their treatment is being driven by actual doctors who learned their jobs the old-fashioned way.
At the heart of Samuel Shem’s new novel, as in the original, is the Fat Man, a brilliant, entrepreneurial, slovenly and solution-oriented physician who is also tragically self-destructive. His noble attempts to work within the hospital, and even to profit from it, ultimately make him a threat to the system he is trying to navigate. His inevitable destruction tells us that we must dismantle and remake the health-care system. We can’t continue simply to patch it.
Dr. Siegel is a clinical professor of medicine and medical director of Doctor Radio at NYU Langone Health and a medical correspondent for Fox News.
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