‘The House of God’: reflections 40 years on, in conversation with author Samuel Shem

Abstract

The House of God is a seminal work of medical satire based on the gruelling internship experiences of Samuel Shem at the Beth Israel Hospital. Thirteen 'Laws' were offered to rationalise the seemingly chaotic patient management and flow. There have been large shifts in the healthcare landscape and practice since, so we consider whether these medical truisms are still applicable to contemporary National Health Service practice and propose updates where necessary:People are sometimes allowed to die.GOMERs (Get Out of My Emergency Room) still go to ground.Master yourself, join the multidisciplinary team.The patient is the one with the disease, but not the only one suffering.Placement (discharge planning) comes first.There is no body cavity that cannot be reached with a gentle arm and good interventional radiologists.Fit the rule to the patient rather than the patient to the rule.They can always pay you less.The only bad admission is a futile one.If you don't take a temperature you can't find a fever and if you are not going to act on it, don't do the test.Show me a BMS (best medical student) who ONLY triples my work, and I'll show you a future Foundation Year 1 doctor (FY1) who is an asset to the firm.Interpret radiology freely, but share your clinical findings with the radiologist and in a timely fashion.Doing nothing can be a viable option. These were developed in conversation with Samuel Shem, who also offers further insight on the creation of the original laws.

Testing House of God’s Law VII: Was the Fat Man Right?

“…7 The proposed change to Law VII by Ward et al, "Fit the rule to the patient rather than the patient to the rule," is supported by our data. 8 We think that even the "Fat Man" must get up, see the patient, and estimate the optimal furosemide dose based on physical examination, laboratory test values, and medical history. Figure 1.…”