A Country Doctor Reads: July 12, 2019

Basch Unbound—The House of God and Fiction as Resistance at 40 | Humanities | JAMA | JAMA Network

The 1978 novel The House of God is a fictional account based on the internship experience of Samuel Shem (Stephen Bergman) at Beth Israel Hospital in 1973-1974.

I am more appalled now than in 1973 by our national politics, 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 optimize billing and insurance payments rather than their care, and by the way nonphysician executives at the top of hospital systems, having never been trained in patient care, dictate the terms of the profession.

Chekhov described the best of writers as those who convey “life as it should be in addition to life as it is.”3 The impulse to resist, reform, and create a view of life as it should be still inspires my writing and has carried me through everything I’ve done. I’m trying to hand that fight over now to the younger generation, in my teaching at NYU Med, in public speaking, and in a forthcoming new sequel to House called Man’s 4th Best Hospital.4 I talk to anyone who will listen about the electronic health record and the takeover of medicine by money and the opportunities that exist to resist it.

“We doctors are the workers, I tell them. Without us, there’s no health care.

We have power and can shape the fate of medicine.

My generation is almost gone, we’re out the door, so this is your fight now, your life.

What will you do with it?”

— Read on https://jamanetwork.com/journals/jama/fullarticle/2738069

1 Response to “A Country Doctor Reads: July 12, 2019”


  1. 1 Dr. Jim July 18, 2019 at 11:47 am

    Our struggle(s) with the EHR call to mind the story of the Blind Man and the Elephant. Each of us, depending on our role, perceives a part of it, but no clinical person perceives the whole.

    As I have written before, what business invests mid-seven figures in a product with no return on investment? None, is the answer.

    So, just what IS the ROI? Is it interconnected records for faster and better patient care? No. Is it better, more accurate (truthful) notes? Everyone knows that’s not true. Is it (other than simulated) quality? Don’t be ridiculous.

    What it is is organized upcoding, payment farming, and rent seeking, and that’s all it is. Our dissatisfaction with it grows, while the purchasers are very content with their investment.

    That fact alone should tell you what you need to know.


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Osler said “Listen to your patient, he is telling you the diagnosis”. Duvefelt says “Listen to your patient, he is telling you what kind of doctor he needs you to be”.

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