MAN'S 4TH BEST HOSPITAL

The madness of life in a busy urban hospital.

With the issue of health care atop the American political agenda, the time couldn’t be better for a darkly comic look at some of the worst excesses of the current system. Shem (The House of God, 1978, etc.) gathers the cast of that earlier novel in a hospital owned by a rapacious conglomerate known as BUDDIES. There, at the Future of Medicine Clinic: Care, Compassion, and Cancer conceived by their former mentor, Fat Man, their goal is to “put the human back in health care.” In the spirit of Catch-22 and M.A.S.H., narrator Roy Basch and fellow physicians with nicknames like Eat My Dust Eddie and Hyper Hooper struggle to subvert the operation of a system that tethers doctors to keyboards and monitors, where they find themselves “treating the screens, not the patients,” jeopardizing both their patients’ well-being and their own in the process. Daily life is a war between the hospital and insurance companies, each side single-mindedly dedicated to maximizing its profit, with the doctors collateral damage in that ceaseless conflict. But when HEAL, the $2.6 billion electronic health records system at Man’s 4th Best Hospital, crashes and stops transmitting OUTGOING data, forcing the doctors to connect with the vulnerable human beings in their care, there’s a hint of what a patient-centered world might look like. The novel is infused with manic activity, but with the exception of Fat Man, Roy, and Roy’s wife, Berry, a psychologist whose Buddhist beliefs can’t wean her from an unhealthy attachment to what Roy calls her “ ‘I’-phone,” the characters tend to get lost in the swirl of the crisis-driven plot. Shem’s comic touch is broad, his villains the usual suspects, and his prescription for curing what he sees as the disease of a system driven by the unceasing imperative to earn more money facile, but perhaps his vision of a medical world that applies a human touch to technology will inspire those seeking to achieve it.

A veteran physician performs radical surgery on American health care in this uneven satire.