Talk:The House of God

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Contents 1 Citation needed 2 Explaining the laws 3 Influence on Scrubs TV show? 4 Terminology

[edit] Citation needed

no citations for following claim:

"it made a substantial impact on public opinion, and has arguably been an instrument in reforming medical training in the 1980s."

impact how? what reforms?

[edit] Explaining the laws

Doctors will get the in-jokes and half-truths wisdom of the laws, but do we need to explain some of the (sensible) aspects to some of these laws. With no particular regard for well crafted English, some initial thoughts are:

1. GOMERS DON’T DIE.
   •  ?add the converse to this "...only the young get fatal illnesses"
   • Elderly patients are often seen by medical services, often with recurring treatable chronic conditions, whereas more robust younger patients are often less frequent attendees but with potentially more serious life-threatening acute conditions.
2. GOMERS GO TO GROUND.
   • Elderly patients mat be at risk of falls, which may be exacerbated by polypharmacy, sedation and blood-pressure treatment. amended interpretation Nomen Nescio^{Gnothi seauton} 10:04, 8 July 2006 (UTC)
3. AT A CARDIAC ARREST, THE FIRST PROCEDURE IS TO TAKE YOUR OWN PULSE.
   • To manage effectively emergency treatment it is important for the medical team not to loose clear objective approach to their decisions and actions.
   • Keep a cool head.added interpretation Nomen Nescio^{Gnothi seauton} 10:04, 8 July 2006 (UTC)
4. THE PATIENT IS THE ONE WITH THE DISEASE.
   • A warning against transference and becoming excessively involved or attached to particlar patients.
   • A warning against self-pity, getting caught up in your own problems over your patient's care.Kenzilla
5. PLACEMENT COMES FIRST.
   • Particularly in elderly care, successful treatment of the presenting problem may still not make the patient’s previous residence appropriate for current needs, resulting in prolonged hospital admission whilst alternative arrangements are arranged by social services. It is therefore important in the formulation of an overall care plan to consider discharge aspects and these need be set in place early on during an admission rather than at the last moment when the patient no longer requires the specialised services of a hospital.
   • It is not uncommon that relocating a patient to another departement is considered more important than finding adequate treatment.added interpretation Nomen Nescio^{Gnothi seauton} 10:04, 8 July 2006 (UTC)
   • A direct quote from one of my attendings: "Start planning their discharge the second they get on my floor."Kenzilla
6. THERE IS NO BODY CAVITY THAT CANNOT BE REACHED WITH A #14 NEEDLE AND A GOOD STRONG ARM.
   • A warning that any area of a patient's body may be invaded for investigation purposes, but at the risk of possibly considerable unnecessary discomfort.
7. AGE + BUN = LASIX DOSE.
   • In acute left ventricular failure, the response to diuretics is often poorer in older patients with poorer kidney function
8. THEY CAN ALWAYS HURT YOU MORE.
   • A further warning against overreaching what one can reasonably give of oneself as patients will gratefully accept evermore of ones time and energies expended upon their behalf. Doctors must consider their own personal, family, health & happiness needs and establish realistic limits on their work-home balance.
   • As resident you are dependent on others. So, whatever you do remember that patients, nurses and medical staff will always have a position in which they can hurt you, therefore consider that before doing politically unfortunate things.added interpretation Nomen Nescio^{Gnothi seauton} 10:04, 8 July 2006 (UTC)
9. THE ONLY GOOD ADMISSION IS A DEAD ADMISSION.
   • A reflection on excessively long shift hours that can so fatigue junior doctors that they risk loosing empathy with their patients and wish instead that they may be left alone to recover from sleep deprivation.
10. IF YOU DON’T TAKE A TEMPERATURE, YOU CAN’T FIND A FEVER.
    • If one looks hard enough, everyone has some aspect that diverges from the average norm.. This is a warning against excessive and unnecessary investigation that may reveal non-important findings that are acted upon, so possibly leading to iatrogenic disease.
    • By investigating something without probable cause doctors may find something and are then obligated to act upon that. Posing a dilemma, since this may result in serious problems for the patient. Example: testing for HIV, without cause, and finding the patient to be positive has serious repercussions. 1 What do you tell the patient if he is not aware of any test? 2 Can you afford to NOT tell the patient? A huge ethical problem, 3 What is the effect this will have on the chances of this patient getting/retaining a mortgage? 4 What are the social consequenses? Et cetera. In other words, every investigation has consequenses (therapeutic and social and legal), and have you thought about all that while ordering a certain test? added interpretation Nomen Nescio^{Gnothi seauton} 10:04, 8 July 2006 (UTC)
    • corollary: don't order a test unless you know what to expect.Kenzilla
11. SHOW ME A MEDICAL STUDENT WHO ONLY TRIPLES MY WORK AND I WILL KISS HIS FEET.
    • The old Hippocratic oath required doctors to pass on their knowledge to others for free. However overworked junior staff may not have the time to properly supervise medical students which results in additional work tutoring and undoing the mistakes made by the students.Amended this interpretation Nomen Nescio^{Gnothi seauton} 10:04, 8 July 2006 (UTC)
12. IF THE RADIOLOGY RESIDENT AND THE MEDICAL STUDENT BOTH SEE A LESION ON THE CHEST X-RAY, THERE CAN BE NO LESION THERE.
    • If it takes a specialist or someone freshly taught by academics to over-interpret subtle findings, then the feature is unlikely to reflect a significant disease process. Conversely a collapsed lung, large collection of pus in an abscess or large cancerous tumour will be obvious to anyone .
13. THE DELIVERY OF GOOD MEDICAL CARE IS TO DO AS MUCH NOTHING AS POSSIBLE.
    • Most conditions are minor and self limiting. Medicalising such conditions is unhealthy for the patients and doctors alike (see Medical Nemesis by Ivan Illich). In more commercially-aware times, spending money on patients who will not benefit from an activity is seen as money poorly spent.
    • Most interventions are not necessary but do present extra risk. Consider not intervening in accordance with first, do no harm. Even serious conditions do not warrant hazardous treatment per se, and we should always ask ourselves, is treating a patient more dangerous than not treating a patient?added interpretation Nomen Nescio^{Gnothi seauton} 10:04, 8 July 2006 (UTC)

David Ruben ^Talk 13:46, 2 June 2006 (UTC)

[edit] Influence on Scrubs TV show?

Seems like there could be some influence on Scrubs (TV series) re harried resident sarcastically mentoring newbie interns.—The preceding unsigned comment was added by 67.112.122.233 (talk • contribs).

1. Of course. There are direct quotes from the book in the show, such as "SHOW ME A MEDICAL STUDENT WHO ONLY TRIPLES MY WORK AND I WILL KISS HIS FEET." and "IF YOU DON’T TAKE A TEMPERATURE, YOU CAN’T FIND A FEVER."

User:Kenzilla 08:48, 31 October 2006

I don't think this section should have been removed. How can you justify that it 'does not relate'?? Simon 07:50, 24 February 2007 (UTC)

[edit] Terminology

Did the book really introduce terms like buff and turf, or were the terms used, and just popularised by the book? Winstonwolfe 08:34, 12 March 2007 (UTC)