I don’t think that anyone would argue that America’s health system is dangerous, inequitable, and unsustainable. It’s not the fault of the doctors. (In fact, as I read this book, I couldn’t help but realize how lucky I’ve been with my doctors.) It’s the for-profit insurance and hospital systems. Healthcare should not be for-profit. Samuel Shem, in his funny and heartbreaking Man’s 4th Best Hospital (sequel to The House of God and Mount Misery) shows us precisely why. Roy Basch is a battered and scarred veteran of American medicine. Just as he has started to feel healed, his old friend Fats pulls him into another venture in big medicine with promises of no night shifts and protection from hospital administration. But, as we know from the shape Roy is in in the prologue, things will end in some kind of disaster.
Fats reassembles the old team from House of God, a Jewish hospital that competes with Man’s Best Hospital—which is now called Man’s 4th Best because it’s fallen in the national rankings. All of these team members are as battered as Roy. They’re really only willing to give things a try at Man’s 4th Best because of their trust in Fats. Of course, as they have to deal with HEAL—a tablet-based medical records system designed for maximum billing—a resident with Nazi-medical-experiment tendencies, and an overriding pressure to make money, Roy et al. have serious misgivings. All the Fats-team wants is to heal people, to connect with their patients and it seems like everything in modern medicine is working against them. It’s really just Fats determination to bring the humanity back to medicine.
There is an overarching plot to Man’s 4th Best Hospital. Mostly that plot is Roy’s struggle to maintain sanity and sobriety. The prologue lets us know in advance that this adventure won’t have a happy ending. And yet, this book is highly episodic, centered on days in Fats’ Future of Medicine Clinic. There are some truly funny stories. (I laughed so hard at an incident involving a lizard that I had to put my iPad down for a moment to recover myself.) There are also a lot of moving scenes in which Roy manages to do some good in the lives of his patients.
Once I figured out who people were and read enough clues about their past histories (I haven’t read either of the previous books), I was completely hooked on Roy’s story and the gang at Fats’ clinic. At the end of the book, Fats begins to outline his plan to take on the national health crisis. This plan shows just how much any would-be revolutionary would have to take on. It’s like a turtles-all-the-way-down situation. To take on for-profit hospitals, you have to take out for-profit insurance. To take on for-profit insurance, you need to get legislatures to either replace them with a single-payer system and/or regulate the hell out of for-profit insurance. To get the legislature, you have to take on lobbying and Wall Street. It’s hard not to see Fats as Don Quixote. But also, like Don Quixote, I couldn’t help but root from him and Roy and the team–I, too, want a fair health system where people don’t have to worry about paying for the treatments that will keep them alive and well.
I would definitely recommend this book to readers looking for meaningful satire, although I might suggest picking up at least The House of God first, to save them some in medias res confusion.
I received a free copy of this book from the publisher via NetGalley, for review consideration.