The House of God is a work of fiction. It is not an autobiography, nor is it polemical nonfiction, but it does contain elements of both. Over twenty years after its publication the book remains controversial, primarily because of its irreverent tone and the fact that Shem opens to public scrutiny how the culture of residency training can actually work against compassionate caregiving, or what he calls "learning to 'be' with people." Instead of compassion, a fatigued cynicism, indifference, and even callousness are evoked in residents by the hospital rituals exposed through the narrator's ironic and often blistering observations.

By any standards, Roy Basch's attitudes and behaviors, along with those enacted daily in The House of God by most of its professional inhabitants, particularly the enigmatic Fat Man, are ageist, sexist, and occasionally racist. And while the practices that form the basis of much of the book's strong critique of residency education are well known to anyone affiliated with academic medicine (call schedules; overuse of technology; abuse of power between and among doctors, nurses, and patients), it is the book's humor around sacrosanct medical phenomena that evokes strong responses in readers. Medical students and residents continue to read it and recommend it--over two million copies of the book have been sold, and it has been translated into over 20 languages.