Episode #78 – “Writing in Resistance” to Humanize Healthcare – with Dr. Sam Shem

Dear Friends & Colleagues,

Our guest this week is Samuel Shem.  Many of you will immediately recognize the pseudonym for the author of the classic piece of medical fiction – The House of God. 

I grew up in healthcare reading his book over and over again. For those of you who are unfamiliar with that piece of fiction, I would urge you to read it. It is a brutally honest, true-to-life, incredibly humorous depiction of the unjust abuses of medical training in one of the most prestigious and prototypical internship/residency programs in our country. It is also one of the most empathetic gifts anyone has ever offered up to those of us who endured medical training.

Now, nearly four decades after the publication of that classic novel, Dr. Shem has published another book, Man’s 4th Best Hospital.  Whereas the House of God chronicled the trauma inflicted on doctors (and nurses) in training, this book provides some unique perspective on the dehumanizing aspects of healthcare delivery for patients and providers.

Shem is currently Professor of Medicine in Medical Humanities at the NYU School of Medicine.  He is a novelist, playwright, and, for three decades, a member of the Harvard Medical School faculty. His novels include The House of God, Mount Misery, and Fine. He and his wife, Janet Surrey, co-authored the award-winning Off-Broadway play Bill W. and Dr. Bob, the story of the founding of Alcoholics Anonymous.  Dr. Shem is a graduate of Harvard College and Harvard Medical School; and earned a PhD as a Rhodes Scholar at Oxford.

In this interview, you’ll hear:

• Shem’s understanding of writing as a way to empathetically resist the dehumanization of healthcare delivery.
• The unique way in which Shem distills and articulates the fundamental problems facing doctors and patients in healthcare today.
• The “big resist” and the solutions Shem shares to counter the root cause problems facing healthcare delivery today.

Some of Shem’s opinions will, no doubt, be controversial, and some may consider his solutions extreme. I found Dr. Shem’s analysis to be thought provoking and disarming in its honesty and simplicity.  And while many of his observations are not earth shattering, he finds a way to say them in new and insightful ways. Whether you agree with him or not, what’s clear is that Shem is coming from a place of tremendous respect and empathy for patients and providers.

Shem’s novel and his commentary are incredibly topical and timely.  Many, if not most, would agree that our healthcare delivery system is inadequate, poorly aligned to the healthcare needs of our populations, financially unsustainable, and in need of significant disruption.

What I found most compelling about his book and this interview is Dr. Shem’s unrelenting hopefulness. He deeply believes that as long as we are connected with one another in just pursuits; as long as we can all have a voice in honest, open dialogue; as long as we are able to speak truth to power; as long as we can be critical thinkers and creators, and as long as we maintain a mutual empathy and a respectful sense of humor, we can change the world for the better. What his recent critics have misunderstood about Shem is that he is a human rights activist as much as he is an artist. He is not, in my opinion, writing for the purpose of winning awards or critical acclaim, although that may occur. He is here to actively resist the dehumanizing forces in healthcare, to catalyze positive change, and to make the world different and better.

We recently honored the memory of Martin Luther King Jr who said, “Our lives begin to end the day we become silent about things that matter.”  Sam Shem, in the tradition of MLK, refuses to be silent. He is calling us to resist silence and become active participants in the creative effort to humanize healthcare for all.

Until Next Time, Be Well.

Zeev Neuwirth MD