Reading recommendations for doctors

Here is a selection of books medics might enjoy over the holiday season

hristmas is coming, and I’m sure many Medical Independent (MI) readers would like a few books for over the festive period. If you’re looking for some late present ideas for the medics and nurses in your lives, or indeed for a personal treat, here’s a couple of suggestions.

First to a sequel to that incomparable book by Samuel Shem, The House of God. For many of us training in the 1980s and indeed since, the book echoed our experiences of 100-plus-hour working weeks.

The House of God was based on the experiences of Dr Stephen Bergman (Samuel Shem was a pseudonym) as an intern at the Beth Israel Hospital in Boston in 1973-1974. He explains how he and his colleagues were influenced by the civil rights movement, an influence that fostered a belief in their ability to change things for the better.

Forty years on, and in pre-publication publicity for Bergman’s new book, he reflects on the continuing relevance of his seminal work.

The House of God outlines 13 rules, or universal truths, of the hospital as seen through the eyes of intern Roy Basch and his senior resident, the ‘Fat Man’, who offers a counterweight of hope and humanity to the interns’ disconnected world. And while its amazing satirical aphorisms may explain the book’s continuing popularity, its longevity is also, sadly, due to how little the medical system has changed in the intervening years.

In the just-published sequel, Man’s 4th Best Hospital (Berkley), Bergman’s cast of characters from The House of God reunite late in their careers. They return to the hospital in an attempt to restore greatness to their struggling alma mater. Unsurprisingly, a central theme is the dehumanisation of physicians in their new role as maintainers of electronic medical records.

Bergman says he is “more appalled now… by the way house staff are forced to spend much of their time at computers, by the fact that patients have no idea that electronic health records are designed to optimise billing and insurance payments rather than their care, and by the way, non-physician executives at the top of hospital systems, having never been trained in patient care, dictate the terms of the profession.”

I’ve just started reading the new book, but I’m already convinced it absolutely hits the spot. It’s got the same irreverent humour — a good doctor today, the author says, is one “who can contort his or her body to touch-type while still making eye-contact with the patient”.

And in a powerful take-down of the all-powerful hospital electronic health record — HEAL — the Fat Man intervenes just in time to save the life of an older woman with treatment-induced low platelets. This he achieves by listening to the patient, something the hot-shot residents, completely obsessed with graphs of test results, deem unnecessary.

“The bad news is that we almost killed her with our ‘care’; the good news is that we saved her from our care. It’s called iatrogenica imperfecta,” the Fat Man observes as they review the close shave.

In what some readers might justifiably consider to be evidence of my hard neck, the second book I’m going to suggest is one I haven’t even got a copy of yet! It’s Twas the Nightshift before Christmas (Picador) by Adam Kay. A former senior registrar in obstetrics who has described how the death of a mother under his care made him leave medicine, this guy can tell a story. Some of you may even have attended his live show in Dublin earlier this year, which I hear was excellent.

Kay doesn’t spare the reader. “Most of my festive memories are of things that happened on the wards”, he writes. “I will never forget once gearing-up the Sonicaid probe I would use on an expectant mum’s abdomen to check for baby’s heartbeat. I flicked the on/off switch a few times but the Sonicaid made no noise at all. Bloody batteries. “Sorry, I think this one’s dead,” I said. As her face collapsed like a bouncy castle at closing time, I urgently clarified: “The Sonicaid! The Sonicaid!”

And there are the inevitable tales of items liberated from various orifices — “and I’m not talking babies”, Kay clarifies.

So while the 370-odd pages of Bergman’s latest offering will need a clear head, reading Kay’s festive tales sounds like it could be just the thing for that postprandial stupor on Christmas Day.

I would like to thank MI readers for reading and commenting on my regular ramblings during 2019. Have a happy and peaceful Christmas and I hope you enjoy the best of health for the New Year.