“Less Is More” and The House of God: Was The Fat Man Right Again?

To the Editor Set in the early 1970s, The House of God is a semi-autobiographical account of Stephen Joseph Bergman’s (aka, Samuel Shem’s) medical internship in Boston.¹ One of the residents, “The Fat Man,” is the moral center of the story. His seemingly paradoxical mantra is that better care for elderly and demented patients means administering fewer tests and treatments. Early in the book, Roy, the intern narrator, unwisely rejects this mantra and pursues an aggressive workup of an elderly, demented patient with devastating results^1(p96):