Bests & Worsts Reviews from Amazon

Disclaimer: I have been a physician for over 30 years. I read The house of god in college. I read it again in medical school. Reread it during the minuscule time available in internship as well as in residency. I have read the book over a half dozen times. The book was sarcastic, a bit crazy, cutting, very often truthful, and overall hilarious. Man's 4th best hospital is non of those things. It is a political screed pushing socialized medicine. Much of what is said about medicine, EMR's, and billing is blatantly false. It is not the least bit funny. Its sarcasm is boring. And the characters we loved in the first book haven't progressed at all as people. No physician I know loves the EMR with which we are tasked to work. I am stuck with EPIC which is referred to many times in the book. But what is portrayed in the book about the unholy alliance between billing and coding is so oversold it is outrageous. For example, while diagnosis codes allow hospitals to maximize billing for inpatients, this has nothing to do with outpatient medicine. You can code any diagnosis you please and it does not change how you bill a patient. But the book implies that it is the same. This is just a very small example of the many falsehoods that are rife within this book. What Shem conveniently omits is that the EMR and its used among physicians is the direct consequence of the government's involvement in medicine. The government mandated it's use. It punishes physicians that use paper charts by decreasing reimbursement. It rewarded hospitals and groups for using these comprehensive, clunky, flawed systems. All the click boxes that he goes on about are mostly due to the government and something they instituted called meaningful use. In order for a doc or a hospital to get fair reimbursement for a visit things like smoking status, body mass index, and dietary review get included in every note for outpatients and what is needed for inpatient notes is well beyond this discussion. And then he implies in the book that socialized medicine is the cure to the money grubbing companies that responded to the government's call to expand the use of electronic medical records. Samuel Shem then holds up the Indian Health Service (IHS) and the VA as models where doctors can take better care of patients. This is absolutely laughable. The Wall Street Journal has had multiple expose articles about incompetence and malpractice in the IHS. As a veteran of the military, I make it my business to know about the VA. And while there are good docs in the VA, the overall level of care that is offered to our men and women who served is disgraceful. I can get my care at the VA, and would never do so. So one of the main root causes of the problem (government mandates in medicine) is going to be the cure by giving us the same care as Native Americans get from the IHS and veterans get from the VA. Thanks Sam, I'll take a pass on that. If I could give this book zero stars, I would do so. I loved the house of god. It was on my list of 10 most influential books I have had the pleasure of reading. I really enjoyed Mount Misery which talked about his one year in a psychiatry residency. Both of those books rang true in a large way, despite the sarcasm and artistic license. This book does not do that in any way, shape or form. It is a political opinion poorly hidden in a story, much of which is frankly garbage. I'm sorry I spent the money buying it and even more sorry I spent the time reading it.