Shem’s darkly comic sequel to The House of God starts out at rock-bottom (literally!) and segues into flashback, reuniting most of the characters from his first novel. Unfortunately, that flashback format means that several major events have been revealed up front – a technique that tends to vitiate their emotional impact for the reader.

The backbone of the novel has the House of God crew reuniting to do battle against the corporate forces sweeping through modern medicine, emphasizing profit over all else and creating “doctor as adversary [whose] ‘work’ was the computer.” There’s a kind of ‘Catch-22’ flavor here as narrator Roy Basch, the Fat Man, the Irish cops Gilheeny and Quick (possibly the most interesting and certainly the most enjoyable characters in the book), and assorted other subversive teammates do battle against the hated computerized records system, bean-counters who want them to monetize medicine, and an egomaniacal surgeon who’s out to defeat Death, no matter how many test subjects he has to kill to do it.

Along the way, Shem takes healthy swipes at the general screen culture that has overtaken virtually all modern life. In his words, the iPhone (iPad, iMac, etc.) becomes the “I”-phone. What seems at first to just be a snarky swipe, or perhaps a mere authorial affectation becomes a way to make a deeper point about the shift away from community in our personal and professional lives. He also has his narrator (who, in this universe, “wrote” The House of God) ‘fess up to having edited reality in a few of the cases he cited in his book, explaining that at first he felt guilty about it, but ultimately decided that, since it was his universe, he could “edit” reality for a more satisfying outcome.

Which brings us to the pie-in-the-sky conclusion of the characters’ rage-against-the-machine odyssey. In Shem’s “edited” reality, common sense, dedication, and teamwork do bring about the fall of Big Med, Big Pharma, and Big Insurance, and everybody (well, almost everybody) gets to live happily ever after.

As poet e.e. cummings told us, “…there's a hell of a good universe next door; let's go”. Shem has definitely gone there, and this sudden about-face from blackest of black humor to unicorns and rainbows is a jarring resolution that not all readers will find satisfying. ( )

If you have never read The House of God, funniest book ever penned by a doctor for a general audience, please do so before picking up this 42-years-later-sequel. Boston readers will immediately recognize Mass General and Brigham and Women's (the former Partners consortium, unsuccessful and now abandoned) as the fictional BUDDIES, a messy medical morass of profit-driven excess. The hero attending physician of the prior book's setting (Boston's Beth Israel Hospital, now also part of a pustular profit pile including Lahey Clinic), Fats, has made a fortune in biotech curing dementia and is bringing back his old team to make doctoring fun and humane again. Dr. Roy Basch, the fictitious doc using Samuel Shem as a non de plume, who is really a doctor and really Stephen Joseph Bergman - stay with me - begins to have hope again for his profession when the electronic records system's billing component OUTGOING is disabled and the medical staff gets to spend their time learning from patients instead of hiding behind screens. This is a complex novel that scurries off in multiple directions simultaneously, the most surprising being recognition of the harm of gender imbalance and the value of working cooperatively. A worthy sequel to a true classic.

Quotes: "The new model was health care only for the healthy, the Fewer-Better-Patient Model." ( )

(6) Loaned to me by a colleague - its been an age since I read 'House of God.' In fact, I may have read it in medical school or residency which is why it resonated. This is 'the sequel.' But frankly, I forgot everything about the original except for 'Gomers go to ground.' Either this was a lot worse than 'House' or I have a flawed recollection. The crew from the original story of intern year are reunited at 'Man's 4th Best hospital' - Clearly a satirical swipe at the Harvard system which is always the "Best" - but they have fallen in the rankings and a consultant is hired to put the 'human' back in medicine.

The entire absurdist satire is a thinly veiled criticism of electronic medical records and the health care 'industry.' The enormous profits going into the pockets of health care administrators, EMR CEO's, insurance industry execs and shareholders - crazy; none of it having anything to do with good patient care. In fact, the opposite -- It is bad for patients; bad for doctors.

The satire hits home and nails many things - such as the experience of going to the doctor and watching their back as they click their screens and the realization that we care for screens not patients for over half our time at work is spot on. Unfortunately, the plot is ridiculous, overbearing with Buddhist philosophy and pretension at times, and almost needlessly crude or puerile at others. I think the book tried to do too much - you don't need to have something to say about everything - gun violence in America, big Pharma, I-phones/technology, social justice, in addition to a wholesale critique of modern medicine. exhausting.

A generous 3 stars because he is preaching to the choir from a 'resister' - the day I look at a computer screen instead of at my patient is the day I quit - and my "PATSATs" reflect this. But it is hard for me to recommend the book itself as parts of it required skimming to endure. ( )