I was given a copy the movie version of “House of God” which I watched the other night. I read the book in 1984 before I started my clinical rotations and reread it in 1990, so it has been a while since I have been exposed to it.As I watched it, it struck me that there are aspects of the movie (and by extension the book) that are extremely relevant 30 years later.
The emphasis in the movie was placed on the construction of the new “Wing of Zock.” In the movie, the Wing denoted progress. It was going to be a modern setting to provide access to technological advances in health care, financed by grateful and wealthy benefactors.However, in the movie as well as in medicine today, there is a tension. The adminstration realized that having such a Wing meant paying for the care delivered in the Wing. The Interns in the movie were encouraged to “Putzelize” patients. This was a term for admitting a patients with no known medical illness to the hospital solely for attention and their ability to pay for the care rendered. Although it was unnecessary and expensive, it was clear that these patients were an important part of the business plan to pay for the new wing.
The other overarching theme was the replacement of a caring doctor with technological intervention. The Fat Man, kind of a Zen Master for the Interns, instructs the Interns on the importance of doing less rather than more at the beginning of their training. So important is this, in fact, that the last of the Fat Man’s Rules is “THE DELIVERY OF GOOD MEDICAL CARE IS TO DO AS MUCH NOTHING AS POSSIBLE.” Unfortunately, as in medicine today, the Fat Man loses to the sterile, technologically driven world of modern health care. To bring home the point, Wayne Potts, who is an Intern from Charleston, South Carolina, does not perform the technologically correct (at the time) therapy of giving steroids to a patient dying of fulminate hepatitis and the patient eventually does die. Wayne has a very touching scene where he and Roy (the main character and also an Intern) discuss why they went into medicine. Wayne poignantly discusses how “All I wanted to be was a country doctor.” Ultimately, the hierarchy at the House of God are unable to forgive him for making their numbers look bad, he is unable to forgive himself for the patient’s death, and he commits suicide by jumping off the Wing of Zock.
In a new blog named “Wing of Zock,” the LCME, the organization of medical schools, identifies the needs for medical education in the new era:
Academic medical centers and teaching hospitals are at a crossroads in redesigning our health care system and examining how they educate medical professionals. They are experiencing tremendous discontinuity: Current payments, incentives, and value systems don’t reward excellence in care delivery and medical education. They are constantly engaged in building the next Wing of Zock as they seek to define a future that signifies hope.
In creating the next Wing of Zock, I hope we can avoid “putzelizing” America in hopes that it will pay for the education of medical students and residents. In addition, we in medical education need to support the Wayne Potts of this world. We need to nurture those who want to be “someone’s doctor.” Turns out that steroids in the case of the “yellow man” would really not have made a difference in his survival. Putting a Wayne Potts in a country town for 40 years makes a huge difference. Now more than ever we need to figure out how to teach the right people to deliver exceptional care and hopefully the money will follow.