{"id":49205,"date":"2020-12-10T19:48:14","date_gmt":"2020-12-10T18:48:14","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=49205"},"modified":"2020-12-10T19:52:02","modified_gmt":"2020-12-10T18:52:02","slug":"nick-hopkinson-mans-4th-best-hospital-a-powerful-reminder-of-the-moral-hazards-that-await-if-we-dont-look-out-for-each-other","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2020\/12\/10\/nick-hopkinson-mans-4th-best-hospital-a-powerful-reminder-of-the-moral-hazards-that-await-if-we-dont-look-out-for-each-other\/","title":{"rendered":"Nick Hopkinson: Man\u2019s 4th Best Hospital\u2014a powerful reminder of the moral hazards that await if we don\u2019t look out for each other"},"content":{"rendered":"

My copy of The House of God<\/em>, Samuel Shem\u2019s 1978 novel of medical training, disillusion, and resistance, has a quote from Cosmopolitan on the cover; a \u201cbawdy cult classic\u2014Catch-22 with stethoscopes.\u201d Given the critical reception that Closing Time, Joseph Heller\u2019s 30-year on sequel to Catch 22 received, is this a hostage to fortune for Shem\u2019s latest follow up <\/span>Man\u2019s 4th Best Hospital<\/span><\/a><\/em>, out now in paperback?<\/span><\/p>\n

I read The House of God<\/em> a few months after I\u2019d qualified, taking cathartic comfort from the feeling that, however much I was struggling, the healthcare system I was entering in the early 90\u2019s wasn\u2019t as appalling as the one that nearly crushes Shem\u2019s young protagonist\/alter ego, Roy Basch. Although imperfect, the sense that we were doing what could be done for patients while also protecting them from futile interventions seemed to provide a reasonable framework to try to do good, or at least no harm. At the House of God, Basch\u2019s patients endure an endless cycle of investigation, intervention and complication\u2014all driven by a need to maximise billing. As Thatcherism bled the NHS dry, the medical care we could offer seemed constrained by a lack of money, rather than corrupted by its pursuit.\u00a0<\/span><\/p>\n

The dark humour and one-line \u201cRules of the House of God\u201d that leaven the story mirror the temptation towards cruelty produced by these dehumanising conditions; medicine without its proper purpose. It\u2019s an insiders\u2019 book, and perhaps one that only doctors (and maybe their partners) ought to read\u2014Shem might as well be waving Goffman\u2019s <\/span>The Presentation of Self in Everyday Life<\/span><\/a> when he has one of the characters say \u201c<\/span>you can\u2019t use your inside jokes with the ones outside all this\u2026.they don\u2019t need to see and they don\u2019t want to<\/span><\/i>.\u201d\u00a0 The audience don\u2019t want to see backstage.<\/span><\/p>\n

In <\/span>Mount Misery<\/span><\/a> (1997) Shem described Basch\u2019s painful discovery that the practice of psychiatry is even more dehumanising than internal medicine. Man\u2019s 4<\/span>th<\/span> Best is set in the present day although only a few years have passed for the characters. In a further post-modern twist, Basch is also now the author of a scandalous medical novel called the House of God<\/em>, allowing Shem to indulge in a few authorial anecdotes (not least, that doctors always want to tell him about their experience of reading his book, as I\u2019ve just done). The sprawling BUDDIES Corporation that has taken over Man\u2019s Best Hospital, is bleeding it for cash and realizes that MBH can \u201c<\/span>no longer make any real money by honouring its mission of service to the sick poor<\/span><\/i>\u201d and must instead focus on ways to \u201c<\/span>make money off the healthy wealthy<\/span><\/i>\u201d. Having dipped in the rankings, Basch and colleagues from the House of God are reunited under the messianic Fat Man who has been charged with restoring it from 4<\/span>th<\/span> to 1<\/span>st<\/span>.\u00a0<\/span><\/p>\n

The Fat Man\u2019s project, to bring the human back to healthcare, runs up against a series of \u201crackets\u201d\u2014insurance, data miners, healthcare corporations, the pharmaceutical industry, all lined up to disempower healthcare workers and patients; \u201c<\/span>the fatal trickledown economics of \u201cno care.\u201d<\/span><\/i> Basch\u2019s improbably tolerant partner Berry is given a bit more agency this time, taking a key role in explaining Shem\u2019s concepts of good practice and good living to the team; \u201cconnection\u201d, \u201cbeing there\u201d, and using the \u201cwe.\u201d It\u2019s an expositional device to underline the ideas to the reader, but the healthcare workers all seem a bit more surprised by these insights than you would expect, especially as they presumably have read the House of God themselves. It\u2019s not completely clear that Chuck, an African American doctor\u2019s observation<\/span> \u201c<\/span>what, y\u2019mean that there\u2019s racial discrimination in American medicine? Damn!<\/span><\/i>\u201d is meant to be sarcastic.<\/span><\/p>\n

Shem has <\/span>described<\/span><\/a> his themes as \u201c<\/span>The risk of isolation, and the healing power of good connection\u2026a good connection is a mutual connection<\/span><\/i>\u201d. The biggest barrier the Fat Man\u2019s team face is the computer screen\u2014what is supposed to be a clinical support system is actually a billing and account system, sucking the user\u2019s attention down profit-driven algorithms of coding and away from the person in front of them. A new member of the team is praised because she \u201c<\/span>embodied the single best quality of a great doc, being able to type while looking at the patient.<\/span><\/i>\u201d\u00a0<\/span><\/p>\n

The book is fast-paced and funny\u2014Shem takes aim at power dynamics, Freudian analysis, racial prejudice, Israeli militarism and male-pattern thinking, while advocating for universal healthcare, alcoholics anonymous, and acknowledging a debt to his Oxford mentor <\/span>Denis Noble<\/span><\/a>. It\u2019s important to say that sexual politics has moved on quite a bit from the Watergate Summer when the original novel was set, or more pertinently in the 40 years since it was written. Although the need to achieve gender parity is highlighted throughout the book, it is striking that, Jo, the by-the-book House of God resident who insists on always doing the maximum for\/to patients (breaching Law XIII: \u201c<\/span>the delivery of Medical care is to do as much nothing as possible<\/span><\/i>\u201d), and who is cruelly treated by the interns including our hero, is not given a shot at redemption this time.\u00a0<\/span><\/p>\n

Shem\u2019s warnings about the corrupting effect of the market on healthcare have largely gone unheeded these last 40 years, but his work remains a powerful reminder of the moral hazards that await in medicine if we don\u2019t look out for each other and ourselves.<\/span><\/p>\n

Nicholas S Hopkinson<\/i><\/b>, Reader in Respiratory Medicine, National Heart and Lung Institute, Imperial College, London, medical director of the British Lung Foundation and Chair of ASH. <\/i>@COPDdoc<\/a><\/p>\n

Competing interests<\/strong>: none<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

My copy of The House of God, Samuel Shem\u2019s 1978 novel of medical training, disillusion, and resistance, has a quote from Cosmopolitan on the cover; a \u201cbawdy cult classic\u2014Catch-22 with […]<\/p>\n

More…<\/a><\/p>\n","protected":false},"author":66,"featured_media":47400,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[18889,18907],"tags":[],"class_list":["post-49205","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-nick-hopkinson","category-wellbeing"],"yoast_head":"\nNick Hopkinson: Man\u2019s 4th Best Hospital\u2014a powerful reminder of the moral hazards that await if we don\u2019t look out for each other - The BMJ<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/bmj\/2020\/12\/10\/nick-hopkinson-mans-4th-best-hospital-a-powerful-reminder-of-the-moral-hazards-that-await-if-we-dont-look-out-for-each-other\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Nick Hopkinson: Man\u2019s 4th Best Hospital\u2014a powerful reminder of the moral hazards that await if we don\u2019t look out for each other - The BMJ\" \/>\n<meta property=\"og:description\" content=\"My copy of The House of God, Samuel Shem\u2019s 1978 novel of medical training, disillusion, and resistance, has a quote from Cosmopolitan on the cover; a \u201cbawdy cult classic\u2014Catch-22 with [...]More...\" \/>\n<meta property=\"og:url\" content=\"https:\/\/blogs.bmj.com\/bmj\/2020\/12\/10\/nick-hopkinson-mans-4th-best-hospital-a-powerful-reminder-of-the-moral-hazards-that-await-if-we-dont-look-out-for-each-other\/\" \/>\n<meta property=\"og:site_name\" content=\"The BMJ\" \/>\n<meta property=\"article:publisher\" content=\"https:\/\/www.facebook.com\/bmjdotcom\/\" \/>\n<meta property=\"article:published_time\" content=\"2020-12-10T18:48:14+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2020-12-10T18:52:02+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/blogs.bmj.com\/bmj\/files\/2020\/05\/coronavirus_medic_stress.jpg\" \/>\n\t<meta property=\"og:image:width\" content=\"540\" \/>\n\t<meta property=\"og:image:height\" content=\"350\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/jpeg\" \/>\n<meta name=\"author\" content=\"julietwalker\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:creator\" content=\"@bmj_latest\" \/>\n<meta name=\"twitter:site\" content=\"@bmj_latest\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"julietwalker\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"5 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2020\\\/12\\\/10\\\/nick-hopkinson-mans-4th-best-hospital-a-powerful-reminder-of-the-moral-hazards-that-await-if-we-dont-look-out-for-each-other\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2020\\\/12\\\/10\\\/nick-hopkinson-mans-4th-best-hospital-a-powerful-reminder-of-the-moral-hazards-that-await-if-we-dont-look-out-for-each-other\\\/\"},\"author\":{\"name\":\"julietwalker\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/#\\\/schema\\\/person\\\/373707d32533c2cbca204980b8cd3493\"},\"headline\":\"Nick Hopkinson: Man\u2019s 4th Best Hospital\u2014a powerful reminder of the moral hazards that await if we don\u2019t look out for each other\",\"datePublished\":\"2020-12-10T18:48:14+00:00\",\"dateModified\":\"2020-12-10T18:52:02+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2020\\\/12\\\/10\\\/nick-hopkinson-mans-4th-best-hospital-a-powerful-reminder-of-the-moral-hazards-that-await-if-we-dont-look-out-for-each-other\\\/\"},\"wordCount\":980,\"commentCount\":0,\"publisher\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/#organization\"},\"image\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2020\\\/12\\\/10\\\/nick-hopkinson-mans-4th-best-hospital-a-powerful-reminder-of-the-moral-hazards-that-await-if-we-dont-look-out-for-each-other\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/files\\\/2020\\\/05\\\/coronavirus_medic_stress.jpg\",\"articleSection\":[\"Nick Hopkinson\",\"Wellbeing\"],\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"CommentAction\",\"name\":\"Comment\",\"target\":[\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2020\\\/12\\\/10\\\/nick-hopkinson-mans-4th-best-hospital-a-powerful-reminder-of-the-moral-hazards-that-await-if-we-dont-look-out-for-each-other\\\/#respond\"]}]},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2020\\\/12\\\/10\\\/nick-hopkinson-mans-4th-best-hospital-a-powerful-reminder-of-the-moral-hazards-that-await-if-we-dont-look-out-for-each-other\\\/\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2020\\\/12\\\/10\\\/nick-hopkinson-mans-4th-best-hospital-a-powerful-reminder-of-the-moral-hazards-that-await-if-we-dont-look-out-for-each-other\\\/\",\"name\":\"Nick Hopkinson: Man\u2019s 4th Best Hospital\u2014a powerful reminder of the moral hazards that await if we don\u2019t look out for each other - The BMJ\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2020\\\/12\\\/10\\\/nick-hopkinson-mans-4th-best-hospital-a-powerful-reminder-of-the-moral-hazards-that-await-if-we-dont-look-out-for-each-other\\\/#primaryimage\"},\"image\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2020\\\/12\\\/10\\\/nick-hopkinson-mans-4th-best-hospital-a-powerful-reminder-of-the-moral-hazards-that-await-if-we-dont-look-out-for-each-other\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/files\\\/2020\\\/05\\\/coronavirus_medic_stress.jpg\",\"datePublished\":\"2020-12-10T18:48:14+00:00\",\"dateModified\":\"2020-12-10T18:52:02+00:00\",\"breadcrumb\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2020\\\/12\\\/10\\\/nick-hopkinson-mans-4th-best-hospital-a-powerful-reminder-of-the-moral-hazards-that-await-if-we-dont-look-out-for-each-other\\\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2020\\\/12\\\/10\\\/nick-hopkinson-mans-4th-best-hospital-a-powerful-reminder-of-the-moral-hazards-that-await-if-we-dont-look-out-for-each-other\\\/\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2020\\\/12\\\/10\\\/nick-hopkinson-mans-4th-best-hospital-a-powerful-reminder-of-the-moral-hazards-that-await-if-we-dont-look-out-for-each-other\\\/#primaryimage\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/files\\\/2020\\\/05\\\/coronavirus_medic_stress.jpg\",\"contentUrl\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/files\\\/2020\\\/05\\\/coronavirus_medic_stress.jpg\",\"width\":540,\"height\":350,\"caption\":\"Healthcare personnel attend to a patient admitted to the ICU Intensive Care Unit of the Hospital Universitario Mtua Terrassa. April 30, 2020 in Terrassa, Barcelona in Spain. (Photo by Xavier Bonilla\\\/NurPhoto)\"},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2020\\\/12\\\/10\\\/nick-hopkinson-mans-4th-best-hospital-a-powerful-reminder-of-the-moral-hazards-that-await-if-we-dont-look-out-for-each-other\\\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Nick Hopkinson: Man\u2019s 4th Best Hospital\u2014a powerful reminder of the moral hazards that await if we don\u2019t look out for each other\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/#website\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/\",\"name\":\"The BMJ\",\"description\":\"Helping doctors make better decisions.\",\"publisher\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/#organization\"},\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"en-US\"},{\"@type\":\"Organization\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/#organization\",\"name\":\"The BMJ\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/\",\"logo\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/#\\\/schema\\\/logo\\\/image\\\/\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/files\\\/2018\\\/05\\\/The-BMJ-logo.jpg\",\"contentUrl\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/files\\\/2018\\\/05\\\/The-BMJ-logo.jpg\",\"width\":852,\"height\":568,\"caption\":\"The BMJ\"},\"image\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/#\\\/schema\\\/logo\\\/image\\\/\"},\"sameAs\":[\"https:\\\/\\\/www.facebook.com\\\/bmjdotcom\\\/\",\"https:\\\/\\\/x.com\\\/bmj_latest\"]},{\"@type\":\"Person\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/#\\\/schema\\\/person\\\/373707d32533c2cbca204980b8cd3493\",\"name\":\"julietwalker\",\"image\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\\\/\\\/secure.gravatar.com\\\/avatar\\\/34f10b717c81464cc7a2879c84cd30078f63b5a901e12905a02abd9d1ea9ec90?s=96&d=mm&r=g\",\"url\":\"https:\\\/\\\/secure.gravatar.com\\\/avatar\\\/34f10b717c81464cc7a2879c84cd30078f63b5a901e12905a02abd9d1ea9ec90?s=96&d=mm&r=g\",\"contentUrl\":\"https:\\\/\\\/secure.gravatar.com\\\/avatar\\\/34f10b717c81464cc7a2879c84cd30078f63b5a901e12905a02abd9d1ea9ec90?s=96&d=mm&r=g\",\"caption\":\"julietwalker\"},\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/author\\\/julietwalker\\\/\"}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"Nick Hopkinson: Man\u2019s 4th Best Hospital\u2014a powerful reminder of the moral hazards that await if we don\u2019t look out for each other - The BMJ","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/blogs.bmj.com\/bmj\/2020\/12\/10\/nick-hopkinson-mans-4th-best-hospital-a-powerful-reminder-of-the-moral-hazards-that-await-if-we-dont-look-out-for-each-other\/","og_locale":"en_US","og_type":"article","og_title":"Nick Hopkinson: Man\u2019s 4th Best Hospital\u2014a powerful reminder of the moral hazards that await if we don\u2019t look out for each other - The BMJ","og_description":"My copy of The House of God, Samuel Shem\u2019s 1978 novel of medical training, disillusion, and resistance, has a quote from Cosmopolitan on the cover; a \u201cbawdy cult classic\u2014Catch-22 with [...]More...","og_url":"https:\/\/blogs.bmj.com\/bmj\/2020\/12\/10\/nick-hopkinson-mans-4th-best-hospital-a-powerful-reminder-of-the-moral-hazards-that-await-if-we-dont-look-out-for-each-other\/","og_site_name":"The BMJ","article_publisher":"https:\/\/www.facebook.com\/bmjdotcom\/","article_published_time":"2020-12-10T18:48:14+00:00","article_modified_time":"2020-12-10T18:52:02+00:00","og_image":[{"width":540,"height":350,"url":"https:\/\/blogs.bmj.com\/bmj\/files\/2020\/05\/coronavirus_medic_stress.jpg","type":"image\/jpeg"}],"author":"julietwalker","twitter_card":"summary_large_image","twitter_creator":"@bmj_latest","twitter_site":"@bmj_latest","twitter_misc":{"Written by":"julietwalker","Est. reading time":"5 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"Article","@id":"https:\/\/blogs.bmj.com\/bmj\/2020\/12\/10\/nick-hopkinson-mans-4th-best-hospital-a-powerful-reminder-of-the-moral-hazards-that-await-if-we-dont-look-out-for-each-other\/#article","isPartOf":{"@id":"https:\/\/blogs.bmj.com\/bmj\/2020\/12\/10\/nick-hopkinson-mans-4th-best-hospital-a-powerful-reminder-of-the-moral-hazards-that-await-if-we-dont-look-out-for-each-other\/"},"author":{"name":"julietwalker","@id":"https:\/\/blogs.bmj.com\/bmj\/#\/schema\/person\/373707d32533c2cbca204980b8cd3493"},"headline":"Nick Hopkinson: Man\u2019s 4th Best Hospital\u2014a powerful reminder of the moral hazards that await if we don\u2019t look out for each other","datePublished":"2020-12-10T18:48:14+00:00","dateModified":"2020-12-10T18:52:02+00:00","mainEntityOfPage":{"@id":"https:\/\/blogs.bmj.com\/bmj\/2020\/12\/10\/nick-hopkinson-mans-4th-best-hospital-a-powerful-reminder-of-the-moral-hazards-that-await-if-we-dont-look-out-for-each-other\/"},"wordCount":980,"commentCount":0,"publisher":{"@id":"https:\/\/blogs.bmj.com\/bmj\/#organization"},"image":{"@id":"https:\/\/blogs.bmj.com\/bmj\/2020\/12\/10\/nick-hopkinson-mans-4th-best-hospital-a-powerful-reminder-of-the-moral-hazards-that-await-if-we-dont-look-out-for-each-other\/#primaryimage"},"thumbnailUrl":"https:\/\/blogs.bmj.com\/bmj\/files\/2020\/05\/coronavirus_medic_stress.jpg","articleSection":["Nick Hopkinson","Wellbeing"],"inLanguage":"en-US","potentialAction":[{"@type":"CommentAction","name":"Comment","target":["https:\/\/blogs.bmj.com\/bmj\/2020\/12\/10\/nick-hopkinson-mans-4th-best-hospital-a-powerful-reminder-of-the-moral-hazards-that-await-if-we-dont-look-out-for-each-other\/#respond"]}]},{"@type":"WebPage","@id":"https:\/\/blogs.bmj.com\/bmj\/2020\/12\/10\/nick-hopkinson-mans-4th-best-hospital-a-powerful-reminder-of-the-moral-hazards-that-await-if-we-dont-look-out-for-each-other\/","url":"https:\/\/blogs.bmj.com\/bmj\/2020\/12\/10\/nick-hopkinson-mans-4th-best-hospital-a-powerful-reminder-of-the-moral-hazards-that-await-if-we-dont-look-out-for-each-other\/","name":"Nick Hopkinson: Man\u2019s 4th Best Hospital\u2014a powerful reminder of the moral hazards that await if we don\u2019t look out for each other - The BMJ","isPartOf":{"@id":"https:\/\/blogs.bmj.com\/bmj\/#website"},"primaryImageOfPage":{"@id":"https:\/\/blogs.bmj.com\/bmj\/2020\/12\/10\/nick-hopkinson-mans-4th-best-hospital-a-powerful-reminder-of-the-moral-hazards-that-await-if-we-dont-look-out-for-each-other\/#primaryimage"},"image":{"@id":"https:\/\/blogs.bmj.com\/bmj\/2020\/12\/10\/nick-hopkinson-mans-4th-best-hospital-a-powerful-reminder-of-the-moral-hazards-that-await-if-we-dont-look-out-for-each-other\/#primaryimage"},"thumbnailUrl":"https:\/\/blogs.bmj.com\/bmj\/files\/2020\/05\/coronavirus_medic_stress.jpg","datePublished":"2020-12-10T18:48:14+00:00","dateModified":"2020-12-10T18:52:02+00:00","breadcrumb":{"@id":"https:\/\/blogs.bmj.com\/bmj\/2020\/12\/10\/nick-hopkinson-mans-4th-best-hospital-a-powerful-reminder-of-the-moral-hazards-that-await-if-we-dont-look-out-for-each-other\/#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["https:\/\/blogs.bmj.com\/bmj\/2020\/12\/10\/nick-hopkinson-mans-4th-best-hospital-a-powerful-reminder-of-the-moral-hazards-that-await-if-we-dont-look-out-for-each-other\/"]}]},{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/blogs.bmj.com\/bmj\/2020\/12\/10\/nick-hopkinson-mans-4th-best-hospital-a-powerful-reminder-of-the-moral-hazards-that-await-if-we-dont-look-out-for-each-other\/#primaryimage","url":"https:\/\/blogs.bmj.com\/bmj\/files\/2020\/05\/coronavirus_medic_stress.jpg","contentUrl":"https:\/\/blogs.bmj.com\/bmj\/files\/2020\/05\/coronavirus_medic_stress.jpg","width":540,"height":350,"caption":"Healthcare personnel attend to a patient admitted to the ICU Intensive Care Unit of the Hospital Universitario Mtua Terrassa. April 30, 2020 in Terrassa, Barcelona in Spain. (Photo by Xavier Bonilla\/NurPhoto)"},{"@type":"BreadcrumbList","@id":"https:\/\/blogs.bmj.com\/bmj\/2020\/12\/10\/nick-hopkinson-mans-4th-best-hospital-a-powerful-reminder-of-the-moral-hazards-that-await-if-we-dont-look-out-for-each-other\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/blogs.bmj.com\/bmj\/"},{"@type":"ListItem","position":2,"name":"Nick Hopkinson: Man\u2019s 4th Best Hospital\u2014a powerful reminder of the moral hazards that await if we don\u2019t look out for each other"}]},{"@type":"WebSite","@id":"https:\/\/blogs.bmj.com\/bmj\/#website","url":"https:\/\/blogs.bmj.com\/bmj\/","name":"The BMJ","description":"Helping doctors make better decisions.","publisher":{"@id":"https:\/\/blogs.bmj.com\/bmj\/#organization"},"potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/blogs.bmj.com\/bmj\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"en-US"},{"@type":"Organization","@id":"https:\/\/blogs.bmj.com\/bmj\/#organization","name":"The BMJ","url":"https:\/\/blogs.bmj.com\/bmj\/","logo":{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/blogs.bmj.com\/bmj\/#\/schema\/logo\/image\/","url":"https:\/\/blogs.bmj.com\/bmj\/files\/2018\/05\/The-BMJ-logo.jpg","contentUrl":"https:\/\/blogs.bmj.com\/bmj\/files\/2018\/05\/The-BMJ-logo.jpg","width":852,"height":568,"caption":"The BMJ"},"image":{"@id":"https:\/\/blogs.bmj.com\/bmj\/#\/schema\/logo\/image\/"},"sameAs":["https:\/\/www.facebook.com\/bmjdotcom\/","https:\/\/x.com\/bmj_latest"]},{"@type":"Person","@id":"https:\/\/blogs.bmj.com\/bmj\/#\/schema\/person\/373707d32533c2cbca204980b8cd3493","name":"julietwalker","image":{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/secure.gravatar.com\/avatar\/34f10b717c81464cc7a2879c84cd30078f63b5a901e12905a02abd9d1ea9ec90?s=96&d=mm&r=g","url":"https:\/\/secure.gravatar.com\/avatar\/34f10b717c81464cc7a2879c84cd30078f63b5a901e12905a02abd9d1ea9ec90?s=96&d=mm&r=g","contentUrl":"https:\/\/secure.gravatar.com\/avatar\/34f10b717c81464cc7a2879c84cd30078f63b5a901e12905a02abd9d1ea9ec90?s=96&d=mm&r=g","caption":"julietwalker"},"url":"https:\/\/blogs.bmj.com\/bmj\/author\/julietwalker\/"}]}},"_links":{"self":[{"href":"https:\/\/blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/posts\/49205","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/users\/66"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/comments?post=49205"}],"version-history":[{"count":0,"href":"https:\/\/blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/posts\/49205\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/media\/47400"}],"wp:attachment":[{"href":"https:\/\/blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/media?parent=49205"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/categories?post=49205"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/tags?post=49205"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}