LAWS OF THE HOUSE OF GOD
The House of God is a fictional 30+ year old book by Samuel Shem (AKA Dr. Stephen Bergman). My med school mentor insisted I read it before starting internship. It simultaneously fascinated and depressed me. I still randomly think of it today. Most of these rules were passed down from a jaded chief resident to the new intern.
- 1.GOMERS DONT DIE.“Get Out of My Emergency Room” = GOMER. Frequent flier patients who keep coming into the ER with complicated and incurable medical conditions. And they keep living!
- 2.GOMERS GO TO GROUND.“Go to turf.” "Turf" the patient to another department to take over the medical care.
- 3.AT A CARDIAC ARREST, THE FIRST PROCEDURE IS TO TAKE YOUR OWN PULSE.Don't panic.
- 4.THE PATIENT IS THE ONE WITH THE DISEASE.Put your fears about your own mortality aside and treat the patient in front of you.
- 5.PLACEMENT COMES FIRST.Where is this patient going to be placed? Another service? Nursing home? Better start the paperwork now!
- 6.THERE IS NO BODY CAVITY THAT CANNOT BE REACHED WITH A #14G NEEDLE AND A GOOD STRONG ARM.Get that biopsy if you need it!
- 7.AGE + BUN = LASIX DOSE."Blood urea nitrogen" = an indication of kidney health. Urea is made by the liver during protein processing and filtered by the kidney. Lasix (furosemide) is a diuretic medication that makes you pee out more fluid. Lasix is used in patients with congestive heart failure, edema or fluid overload. Doctors love simple algorithms and solutions. (Unfortunately, the cases aren't always that simple.)
- 8.THEY CAN ALWAYS HURT YOU MORE."They" = the patients
- 9.THE ONLY GOOD ADMISSION IS A DEAD ADMISSION.A very cynical statement. Admission and discharge paperwork can be tedious and overwhelming.
- 10.IF YOU DON'T TAKE A TEMPERATURE, YOU CAN'T FIND A FEVER.Don't look for problems because then you'll find some.
- 11.SHOW ME A BMS WHO ONLY TRIPLES MY WORK AND I WILL KISS HIS FEET."Best Medical Student" from a "Best Medical School" (like Harvard). I love teaching, but it's true that med students and new interns slow everything down. In addition, you have to double/triple check everything they do. In the book, a BMS will also come up with a rare diagnosis (zebra) instead of the most common diagnosis (horse). Essentially: "if you hear hoof beats, think horses, not zebras." If this sounds familiar, it's because they said it on Scrubs (❤️).
- 12.IF THE RADIOLOGY RESIDENT AND THE MEDICAL STUDENT BOTH SEE A LESION ON THE CHEST X-RAY, THERE CAN BE NO LESION THERE.LOL
- 13.THE DELIVERY OF GOOD MEDICAL CARE IS TO DO AS MUCH NOTHING AS POSSIBLE.In some cases, too much testing and interventions do more harm than good. I know in my field, Gynecology, we are moving away from over-testing. That's why we start Pap tests for cervical cancer screening at 21 years old (no matter when the patient started saving sex) and only do paps every 3 years if they're normal. Although this rule sounds great, you've got to have the research data to back you up!!
- 14.Read this NY Times article to understand why doctors are still talking about this book over 30 years later.