Man's 4th Best Hospital

PUBLISHERS WEEKLY SEP 2, 2019

After 41 years, Shem turns in a satisfying sequel to his cult novel, The House of God, a M*A*S*H-like look at the lives of a group of interns at a big city hospital. Now, these same interns are veteran doctors who are brought back together by their former mentor, the Fat Man, to teach a new generation of interns, this time at Man's 4th Best Hospital, a venerable medical institution hemorrhaging prestige and money. Narrated by Shem's stand-in, Roy Basch, he and his fellow older docs also see action staffing a walk-in clinic for the poor. Shem dramatizes in gonzo fashion how the big enemy isn't death or disease, but BUDDIES, the hospital conglomerate that triages profits before patients; HEAL, the difficult-to-navigate computer program used to keep track of patients and costs; and doctors who double- and triple-book surgeries to line their own pockets. In the end, Roy, Fats, and the other characters must face up to their own mortality as well as their patients'. As an author and psychiatrist, Shem never met an acronym he didn't want to exploit for comic effect. And he tends to make the same points over and over again employing the humorous sensibility of an old Hope and Crosby routine. Nevertheless, this is a hilarious, horrifying, but always humanistic, take on a healthcare system that is in critical condition.