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To the Editor: I enjoyed the Literatim essay on The House of God by Dr Markel.¹ As a senior medical student in 1979, I also eagerly read this book. Its seemingly exaggerated perspective was disturbing, engaging, and entertaining.

As a first-year internal medicine resident at a large county medical center in 1980, I tried to reread The House of God but found it too painful. What I had perceived as exaggeration as a medical student now cut too close to the bone. The physical and emotional exhaustion I felt facing more than 100 hours per week on the wards, trying to manage too many patients with complex serious illnesses, experiencing deaths and losses without adequate time to grieve, transformed me into Roy Basch. Even now, it is hard to relive those experiences.

Privately, I too used derogatory terms to describe patients, and I believed on one level that "they could . . . [Full Text of this Article]

Alan R. Katz, MD, MPH
katz@hawaii.edu
Department of Public Health Sciences
John A. Burns School of Medicine
University of Hawaii
Honolulu

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