For those of you who have read The House of God, you will recognize this reference.
The novel, published in 1978 under the pseudonym Samuel Shem, has been a seminal read for medical students since I was in school; more than 2 million paperback copies have been sold. It chronicles the life of a group of interns in an urban teaching hospital. In a 1995 foreword, John Updike wrote that The House of God did for medical training what Catch-22 did for military life, and notes that “the book’s concerns are more timely than ever, as the American health-care system approaches crisis condition….”
Medical education has evolved significantly since The House of God was published. There is greater scrutiny of young physicians’ hours and work conditions, even as they are faced with the very human aspects of illness, death, and dying. Detractors say the training process leads to the desensitization of providers. On the contrary, it is a time where young physicians run smack into the reality wall, become deeply embedded in their patients’ lives, have the greatest exposure to life-and-death decisions, and develop coping mechanisms for themselves so they can effectively counsel patients’ families.
Medical students spend their lives mastering challenges and meeting goals and expectations set by others. Throughout their residencies, they reach deep into their ethical cores to make decisions where often there is no “right” answer. These struggles sharpen med students like a stone to a knife. They build their professional personas on these experiences and begin to shape themselves as the physicians they want to be, rather than what others want them to be. They take pleasure in their accomplishments as they master their specialties and enjoy camaraderie with their colleagues on this shared journey.
We become better physicians when we recognize behaviors we want to model and those that we don’t want to incorporate into our professional behaviors. We are shaped by every patient that we interact with, but the most difficult patients shape us the most; the ones where we wonder if we did the right thing 30 years later. They teach us humility, compassion and leadership. We never forget them.
So why “Wing of Zock?” Throughout The House of God, there are references to the jackhammers, construction workers, and the overall mayhem created by the construction of a new wing of the fictional hospital, financed by the astronomically wealthy philanthropists, the “Family of Zock.” Amidst all the chaos, Shem portrays this wing as a symbolic new beginning, “ultimately signifying hope.”
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 building this blog, we hope to create a space for innovation, creativity, and lively discussion as contributors share stories of what has worked for them.
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Joanne Conroy, MD, is chief health care officer at the Association of American Medical Colleges. She can be reached at email@example.com.