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The Arts and Medicine
July 10, 2019

Basch Unbound—The House of God and Fiction as Resistance at 40

Author Affiliations
  • 1NYU Medical School, New York, New York
JAMA. 2019;322(6):486-487. doi:10.1001/jama.2019.9499

There’s a saying you should read nonfiction for facts and fiction for the truth. The novel The House of God is a true account of my internship experience at Beth Israel Hospital (the BI) in 1973-1974. The book has sold 3 million copies to date and counting, popular because of its authentic portrayal of medicine and postgraduate training, its rowdy sex and bawdy comedy, and its characters’ (my friends’) attempt to stay human and honor our patients’ humanity in a dehumanizing year.

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    8 Comments for this article
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    Was The Fat Man Really a Fabrication?
    Peter Kaufman, MD, AGAF | Suburban Hospital, Johns Hopkins University
    I loved House and read it as a med student, a resident, and after my fellowship - getting different takes each time. I've recommended it to every physician-in-training I've met. Thank you!

    But I wish to take issue that The Fat Man was "a literary invention." I had been told (by the author's brother) that a specific gastroenterologist I knew was the basis for The Fat Man, and when we met at his nephew's (and my son's) Bar Mitzvah, he confirmed that to me. In fact, when I asked him what he was like as a resident, he replied
    (I may be paraphrasing but I'm close): "He was exactly like The Fat Man. I took some license with the other characters, but not him." Then I gave him his phone number so he could call him.
    CONFLICT OF INTEREST: None Reported
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    So Timely
    Marni Friedman, MD | Private Practice
    I just so happen to be halfway through a re-reading of this classic, having picked it up again after 20 or more years. The details of life on the wards bring my training years back to me vividly--the emotions, the smells, the battle for sleep and sanity--despite the fact my residency was a decade and a half after the depicted era. So much vocabulary was codified in The House of God: block, wall, sieve, Gomer, turf, buff.

    How little has really changed in the American system of medicine! Placement is still the key and
    money is the driver of care.
    CONFLICT OF INTEREST: None Reported
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    Pocket of My White Coat
    Alan Wartenberg, MD, FACP, DFASAM | Retired, Affiliated Faculty, Brown Center for Alcohol and Addiction Center
    I did my internship between 72-73, and then took 5 years off to do what I like to refer to as my "field research in chemical dependency." When I got out of treatment and went back into residency (IM, 78-80) The House of God was out. I couldn't put it down. I ended up having the Washington Manual in one pocket of my white coat, and The House of God in the other (I also sometimes kept a copy of Catch-22, which I also considered a medical text). Several years ago I got the opportunity to "play-act" with Dr. Bergman on his play about Dr. Bob and Bill W. at an ASAM meeting, a moment that will forever be burned into my memory. Bravo!
    CONFLICT OF INTEREST: None Reported
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    The House of God movie
    Daniel Essin, MA, MD | USC Keck School of Medicine
    The video mentioned that a movie was made from the book. It did not, however, mention that the movie was never commercially released and was only shown on a cable channel for a few weeks in 1983-84. Perhaps someone chanced to record it. I have been led to believe that it was a rough cut, shown for the purpose of attracting the funds necessary to “buff” it for commercial release, which it apparently failed to do.
    CONFLICT OF INTEREST: None Reported
    1971 Movie "The Hospital"
    Robert Tomsak, MD, PhD | Wayne State U School of Medicine and Kresge Eye Institute
    "The House of God" bears a strong resemblance to Paddy Chayefsky's 1971 movie "The Hospital" with George C. Scott and Diana Rigg. Did the movie influence the book, which appeared a few years later?
    CONFLICT OF INTEREST: None Reported
    Health Care
    Renee Holleran, ENP-BC, PhD | VHA Salt Lake City, Utah
    I appreciate this author's editorial and observations. We are probably in the same generation. I have been a nurse for over 44 years. However, health is NOT only physicians. As the author noted, his wife, a nurse, played a pivotal role in his education and view of patient care. Florence Nightingale led the way to better health care centuries ago. (However, she did not let the soldiers' horses stay with them, although evidence continues to support service animal's role. I see it everyday with the veterans I work with). As was noted, it is time to work together to provide "care," not make money with health. Thank you for this inspiring editorial and I look forward to the book sequel.
    CONFLICT OF INTEREST: None Reported
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    Loved the Book
    Gordon Banks, MD |
    I first read the book as a student in 1977. We were told it would make us cynical, but if you trained at an inner-city hospital, you already were. I'd say the book helped us keep our sanity under stressful conditions of internship.

    I had some residents a lot like the Fat Man, and also (unfortunately) some a lot like Jo. And I rotated though hospitals with private attendings (we called them "slicks".)

    The only thing I questioned as unrealistic was the amount of sex going on in the call rooms. I
    mentioned this once to one of my junior residents and his take was that he was sorry that I had missed out on that.
    CONFLICT OF INTEREST: None Reported
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    People Remain The Same, Technology Moves On
    Robert Mulcahy, MD | Retired, Lake Health System
    The patients, caregivers, financial interests, personalities, strains, conflicts, victories and defeats are all as identifiable in today’s medical environment as they were in The House of God.

    The major change has been the technology, which Dr. Bergman says will be a theme in his upcoming book.

    The Fat Man anticipated the demand for Dr. Jung’s Anal Mirror. In today’s world he would be feverishly working to perfect his iColon app and fiber optic accessories with a real-time upload of each image to the physician’s mobile device.
    CONFLICT OF INTEREST: None Reported
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