Most of the group are reunited in this sequel to the 1978 blockbuster, The House of God: narrator Dr. Roy Basch and his girlfriend (now wife) Berry, former fellow interns (Eat My Dust Eddie, Hyper Hooper, the Runt, Chuck), surgeon Gath, the two articulate police officers (Gilheeny and Quick), and the Fat Man (a brilliant, larger-than-life former teaching resident). As interns, Basch and his comrades were a crazy, exhausted, cynical crew just trying to survive their brutal internship. Years later, the midlife doctors have changed but remain emotionally scarred.

The Fat Man (“Fats”), now a wealthy California internist who is beginning a biotech company targeting memory restoration, is recruited to reestablish the fortunes – financial and prestige – of Man’s Best Hospital which has slipped to 4th place in the annual hospital rankings. He calls on his former protégés to assist him in an honorable mission, “To put the human back in health care” (p34). Fats enlists other physicians (Drs. Naidoo and Humbo) along with a promising medical student (Mo Ahern) to staff his new Future of Medicine Clinic (FMC), an oasis of empathic medical care that strives to be with the patient.

Every great story needs a villain. Here the main bad guys are hospital president Jared Krashinsky, evil senior resident Jack Rowk Junior, and CEO of the BUDDIES hospital conglomerate Pat Flambeau. The electronic medical records system dubbed HEAL is a major antagonist, and the FMC docs wage war against it and the “screens.”

Poor Roy Basch works long hours, deals with family problems, has trouble paying bills, and experiences health issues (a bout of atrial fibrillation, a grand mal seizure, and alcohol use). Fats has warned of a “tipping point when medical care could go one way or another, either toward humane care or toward money and screens” (p8). Alas, the computers and cash appear victorious. A major character is killed. Many of the doctors working in the FMC including Basch leave the clinic. And fittingly, Man’s Best Hospital plummets in the latest rankings from 4th to 19th place.


Doctor-writer Stephen Bergman (pen name Samuel Shem) is a deft demolitionist who understands that to rescue or reform something occasionally requires first an act of destruction. His dynamite The House of God was a wrecking ball to the harsh, dehumanizing system of medical training. Roughly four decades later, his Man’s 4th Best Hospital is a bulldozer exposing and excavating the suffocating strata of the contemporary medical-industrial complex: greed, bureaucracy, and capitulation to the all-powerful electronic medical records system (EMR). But a bigger bulldozer (perhaps a national strike by doctors and nurses) or maybe countless smaller ones (intense individual physician activism) are going to be needed to restore humanity to modern medical care and to reverse the increasing incidence of physician burnout.

The novel takes direct aim at the EMR and how it diminishes the role of doctors as healers, instead shifting greater amounts of the physician’s energy to inputting data. “Treating the screens, not the patients. Our work is screens” (p308), Bergman writes. Sadly true. An estimated 40-60% of a doctor’s shift might now be spent in front of a computer screen. Bergman also bemoans how the monetization of medicine hurts patient care and negatively impacts the doctor-patient relationship.

Survival – physical, mental, emotional, spiritual – weighs heavily on the author’s mind. Cynicism, a lack of enthusiasm, and an absence of a sense of accomplishment contribute to physician burnout. Increased connection to family, friends, colleagues, and self can help relieve some of these features of burnout. Like the mythological Pandora’s Box, Bergman’s novel has a crucial place for hope (and empathy) amidst the unleashed medical/economic mayhem. Physicians are wise to latch onto those virtues.



Place Published

New York



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