Man's 4th Best Hospital

By: Samuel Shem

Narrated by: Sean Runnette

Length: 15 hrs and 39 mins

Publisher's summary

The sequel to the best-selling and highly acclaimed The House of God

Years after the events of The House of God, the Fat Man has been given leadership over a new Future of Medicine Clinic at what is now only Man's 4th Best Hospital, and has persuaded Dr. Roy Basch and some of his intern cohorts to join him to teach a new generation of interns and residents. In a medical landscape dominated by computer screens and corrupted by money, they have one goal: to make medicine humane again. 

What follows is a mesmerizing, heartbreaking, and hilarious exploration of how the health-care industry, and especially doctors, have evolved over the past 30 years.

©2019 Samuel Shem (P)2019 Penguin Audio

Critic reviews

“Samuel Shem has challenged generations of doctors in his writing to think deeply about why they chose medicine. His novels illuminate the humanistic core of clinical care, and serve as a bulwark against a system increasingly characterized by avarice and anonymity.” (Jerome Groopman, MD, author of How Doctors Think) 

“If you want to know why the doctor spends all visit looking at a computer instead of you, and if you want to know how the doctor feels about it, this is the book for you: a mordantly funny tour through modern medicine with a powerful prescription for how to change." (Bill McKibben, best-selling author of The End of Nature and Radio Free Vermont)

“As he did in The House of God, Samuel Shem provides a bitter, caustic and overdue update on the cold and bureaucratic world that awaits the sick and the dying if they are lucky enough to be able to afford it.” (Arthur Caplan, professor of Bioethics at New York University Langone Medical Center)

Not the greatest

I listened to this since, like all docs I loved the House of God. I believe it came out when I was a resident.

This book is more of a sermon than a story about healthcare. He has many valid points but very exaggerated and oversimplified.

Particularly his opinions about electronic records are valid but way too exaggerated. In the setting in which I practiced they did improve the quality of care and actually reduce work. I knew that’s not typical.

His idea of changing the eligibility age from 65 to 0 for Medicare is way too simple.

His focus on physician burnout is spot on but exaggerated as well.

I think this is a good book for healthcare workers since we can see past the exaggeration and focus on the useful ideas but I suspect it’s too much for the layperson.

So validating for a middle aged doc like me

I read The House of God when I was a med student back in the early 90s. The cynicism of many of the characters was shocking, but I could recognize all of it throughout my own training, which helped me know I wasn’t crazy for questioning what this process was doing to us. Now that I’m 22 years out of training, I’m equally aghast at what medicine has become thanks to forces beyond us. We are enslaved by our electronic medical records, valued for our billing rather than the quality of our care, reduced to “service providers” and denigrated by a wave of anti-science culture that denies the value of expertise (Google = “research”??) Many of us question why we put in so many difficult years just to become data entry clerks. That’s why this book is so powerfully validating. Those of us who still try to do the right thing for our patients in a caring manner — like the characters in this sequel — feel beaten down by an uncaring system that’s all about revenue. This story makes me feel seen, heard, inspired, maybe a little bit hopeful, and definitely not crazy for wanting better healthcare for our country and our future. I wasn’t expecting to feel so moved by this book. A must read for docs of my generation and those who come after us.

Modern spin on "House of God"

I remain partial to the original "House of God," but it was nice to see Shem return with the modern update.

Fantastic Sequel!!

If you have lost hope in the way the US health care system is run please read/listen to this book. it is fictional but based on no fiction events. this shows what we struggle with when it come to the care part of Healthcare. amazing...

All too true

First, I love listening to Sean Runette (the voice of Roland Merullo's Buddha series - also first rate).
As a health care provider with over 50 years experience, I loved this. The decline of the American medical system is all too real. I have my own set of horror stories about insurance companies, billing errors, and the worst of all: electronic medical records! Yes, it takes 65 clicks to write a simple prescription!
While this is a fictional tale, the situations are all too real, and getting worse. The almightly dollar reigns supreme, and we are not patients but customers, often unable to decipher the maze of medical/legal information.
The stories do wander a bit but overall, this is a great snapshot of medical practice today.
I think this quote from one of docs is the summary of the medical dilemma today: Their mission is monetary!

Fantastic sequel to the House of God

Lovely book with a bittersweet ending. Talks a lot of truth about modern medicine using the characters of our very beloved first book. It’s lovely to see how they all turned out.

Don't waste your credit

This was terrible. I struggled to finish it. Skip this one is my advice. That is 15 hours I will never get back.

sad satire of acute medical care in US

Sad but accurate commentary of current US health care system. Calls a spade a spade here.

Great stuff

I loved House of God, and I loved this story as well. 40 years and medicine has changed a lot, but I do not think it is for the better. It is nice to imagine that WE are not alone as healthcare providers.

Oh Hell, no...

Author should've wrote, House of God and quit. What a waste. Disappointment is an understatement.