- Gomers don't die
- Gomers go to ground
- At a cardiac arrest, the first procedure is to take your own pulse
- The patient is the one with the disease
- Placement comes first
- There is no body cavity that cannot be reached with a #14 needle and a good strong arm
- Age + BUN=Lasix dose
- They can always hurt you more
- The only good admission is a dead admission
- If you don't take a temperature you can't find a fever
- Show me a medical resident who only triples my work and I will kiss his feet
- If the radiology resident and the medical student both see a lesion on the CXR there can be no lesion there
- The delivery of good medical care is to do as much nothing as possible
(Shem, S. House of God Richard Marek Publishers, Inc., New York, 1978)
On twitter this week, Dr. Shem's 2012 article in The Atlantic made the rounds again - not quite sure why - but seemed to be in response to a number of discussions about physician health and evolution of medical training. In that great discussion piece, he added 4 "laws", which are worth the read (much more in his article):
- Connection comes first
- Learn empathy.
- Speak up
- Learn your trade, in the world
These align nicely with the themes raised in Return to The House of God: Medical Resident Education 1978–2008 which I reviewed for the Canadian Medical Association Journal in 2009. I was most struck by an essay by American scholar Dr. Kenneth Ludmerer and his recommendations for postgraduate medical education:
- residents need to see patients in more depth, not more quantity
- residents need to be relieved of noneducational work that can be done by others
- educational opportunities afforded to residents must improve in quality (content, delivery, evaluation), and
- programs need to respond better to the emotional needs of trainees and promote their health and sustainability
36 years after introducing Dr. Basch to the world, Dr. Shem continues to influence. Curious if he influenced you?
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