Man's 4th Best Hospital

September 2, 2019
After 41 years, Shem turns in a satisfying sequel to his cult novel, The House of God, a M*A*S*H-like look at the lives of a group of interns at a big city hospital. Now, these same interns are veteran doctors who are brought back together by their former mentor, the Fat Man, to teach a new generation of interns, this time at Man’s 4th Best Hospital, a venerable medical institution hemorrhaging prestige and money. Narrated by Shem’s stand-in, Roy Basch, he and his fellow older docs also see action staffing a walk-in clinic for the poor. Shem dramatizes in gonzo fashion how the big enemy isn’t death or disease, but BUDDIES, the hospital conglomerate that triages profits before patients; HEAL, the difficult-to-navigate computer program used to keep track of patients and costs; and doctors who double- and triple-book surgeries to line their own pockets. In the end, Roy, Fats, and the other characters must face up to their own mortality as well as their patients’. As an author and psychiatrist, Shem never met an acronym he didn’t want to exploit for comic effect. And he tends to make the same points over and over again—employing the humorous sensibility of an old Hope and Crosby routine. Nevertheless, this is a hilarious, horrifying, but always humanistic, take on a healthcare system that is in critical condition.

September 1, 2019
The madness of life in a busy urban hospital. With the issue of health care atop the American political agenda, the time couldn't be better for a darkly comic look at some of the worst excesses of the current system. Shem (The House of God, 1978, etc.) gathers the cast of that earlier novel in a hospital owned by a rapacious conglomerate known as BUDDIES. There, at the Future of Medicine Clinic: Care, Compassion, and Cancer conceived by their former mentor, Fat Man, their goal is to "put the human back in health care." In the spirit of Catch-22 and M.A.S.H., narrator Roy Basch and fellow physicians with nicknames like Eat My Dust Eddie and Hyper Hooper struggle to subvert the operation of a system that tethers doctors to keyboards and monitors, where they find themselves "treating the screens, not the patients," jeopardizing both their patients' well-being and their own in the process. Daily life is a war between the hospital and insurance companies, each side single-mindedly dedicated to maximizing its profit, with the doctors collateral damage in that ceaseless conflict. But when HEAL, the $2.6 billion electronic health records system at Man's 4th Best Hospital, crashes and stops transmitting OUTGOING data, forcing the doctors to connect with the vulnerable human beings in their care, there's a hint of what a patient-centered world might look like. The novel is infused with manic activity, but with the exception of Fat Man, Roy, and Roy's wife, Berry, a psychologist whose Buddhist beliefs can't wean her from an unhealthy attachment to what Roy calls her " 'I'-phone," the characters tend to get lost in the swirl of the crisis-driven plot. Shem's comic touch is broad, his villains the usual suspects, and his prescription for curing what he sees as the disease of a system driven by the unceasing imperative to earn more money facile, but perhaps his vision of a medical world that applies a human touch to technology will inspire those seeking to achieve it. A veteran physician performs radical surgery on American health care in this uneven satire.

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Starred review from October 15, 2019
What used to be "Man's Best Hospital" is now "Man's 4th Best." After a slide down the rankings, the hospital president, hoping to regain the institution's former glory, hires his boyhood nemesis, the Fat Man, who brings along his old crew from Shem's earlier The House of God (1978), including Dr. Roy Basch. Fiction and reality tend to merge here: in The House of God, Basch writes a tell-all fictionalized book about his medical residency, while, in reality, that novel dramatized the residency of one Dr. Stephen Bergman, the real person behind the pseudonym Samuel Shem. Having returned to medicine at New York University's School of Medicine, Bergman/Shem witnessed the ravages that the twin evils of money and computer screens were causing in the profession and set about writing this sequel, in which the nearly indefatigable Fat Man and his do-or-die crew resist the money-grubbing interfaces that force doctors to spend more time checking boxes on their screens than talking to patients. When, shortly after the Fat Man's arrival, the doctors conveniently lose all access to the system for filing outgoing information, their new checkbox-free utopia leads to happier staff and better patient reviews. But their struggle against a powerful system is only just beginning. Filled with unforgettable characters and the shocking reality of the many rackets running through the medical industry, this sobering yet hilarious satire manages to offer a glimmer of hope for putting humans back into health care.(Reprinted with permission of Booklist, copyright 2019, American Library Association.)