For a young woman aspiring to be a doctor, Samuel Shem’s “The House of God” served as a warning of the implicit threats levied against women who seek medical careers. Photograph by H. Armstrong Roberts / ClassicStock / Getty

In 1978, the psychiatrist Stephen Bergman published the novel “The House of God,” written under the pen name Samuel Shem. Based on Bergman’s experiences as an intern at Harvard’s Beth Israel hospital, the book rapidly became a staple of any medical resident’s required-reading list; to date, it has sold more than two million copies. A 2003 edition included an introduction by John Updike, who wrote that “The House of God” “could probably not be written now, at least so unabashedly; its lavish use of freewheeling, multiethnic caricature would be inhibited by the current terms ‘racist,’ ‘sexist,’ and ‘ageist.’ Its ’70s sex is not safe.”

For Updike, for those who made this argument before him, and for those who continue to make it today, a measure of freedom has been lost in a culture that requires writers to watch their words for unintended cruelty. An army of chiding librarians seems to have arisen, tsk-tsk-ing the poor writer’s bawdy, outrageous imagination. Updike’s concern is embodied in the real phenomena of Twitter pile-ons and sensitivity readers, but it is also Foucauldian: the chiding librarian is within us, suppressing the writer’s creativity before it even makes it to the page. In the panopticon where every action can be seen, known, and embedded in a tweet, no actual chains are required. Ultimately, we control ourselves.

“The House of God” is “not a great book,” the literary critic Kathryn Montgomery has written, “but it is an important book.” Bergman claims that it shows how residents are dehumanized in the course of their sleepless, gruelling medical training, and in turn begin behaving cruelly or carelessly toward their patients. As the physician and poet Jack Coulehan has pointed out, however, Bergman undercuts his argument somewhat when his narrator, Roy Basch, refers to patients as “a heifer” and “a hippo” on his first day of work. If the narrator’s callous attitude toward patients is a product of the dehumanizing power of residency training, how did Basch get there so quickly? Coulehan argues that the novel does a disservice to medical-student readers, who “internalize the message that clinical training is dehumanizing without sufficiently noticing that the group most dehumanized is patients.” Others, such as the emergency physician Jay Baruch, argue that the novel’s descriptions of the disgust, shame, and horror that patient care sometimes evokes comprise a badly needed articulation of the lived experience of residents. “The House of God” likely contributed to some of the reforms in medical training that have come about since the nineteen-seventies, particularly in regard to long work hours that lead to sleep deprivation. The book is taught in medical schools and quoted by physicians; whether we realize it or not, we are quoting “The House of God” when we say, for example, “The first procedure in any cardiac arrest is to take your own pulse.”

More than forty years after its publication, many of the book’s episodes, such as the suicide of an intern, still feel contemporary. Other bits are frighteningly dated or always felt slanted, particularly the portrayal of women. The book’s nurses have none of the clinical insight or skill of actual nurses, but they’re eager to reveal their montes pubis for the interns. There is just one female physician, a frigid, universally loathed character named Jo. The last of the women is Roy Basch’s partner, Berry, who is intelligent but inexplicably content to serve as a surrogate mother for Basch, while displaying no expectation that he might broaden her horizons in turn, or even refrain from copulating with nurses.

As sympathetic as I am to Updike’s concerns about social control, and as nostalgic as I may be for the time when I wrote like a child—blithe, mindless of consequence, the only audience in my mind an audience of people who already loved me—I am no longer a child. These days, I write not only for my best friends but for general readers. Growing up involves coming to realize that others are as human as oneself, with inner lives at least as rich as one’s own. The realization that others have inner lives is a developmental milestone that we humans are supposed to achieve around age four. But, as it turns out, many of us are still working on it, decades later. Or perhaps we gain the ability to imagine the lives of others around age four, but we may or may not put that ability into practice.

I look to literature to attune my mind to the inner lives of other people, and it is painful when a book falls so short of deeply imagining the other that it portrays some whole wings of the world as flat, airless, not truly worth inhabiting. It is ironic, in a sick way, when the art that ought to bring us closer accidentally insists that some of us are not really worth the effort. I read “The House of God” in medical school, as many of us do, and was left looking askance at my chosen field. Because the book is lionized so uncritically in my profession, I could only suspect that my future colleagues did not hold women in particularly high regard.

Bergman and his apologists (including many of my women colleagues in medicine) say that “The House of God” was simply a novel of its time. When asked about the novel’s sexism in a recent interview, Bergman replied, “I was roundly criticized for the way women were seen” in the book, then launched into an anecdote about a doctor and nurse having sex in an on-call room in the nineteen-seventies. “Things have changed,” Bergman added. The anecdote is telling, with its implication that feminist thinkers object to sex itself, rather than to the portrayal of women as sex objects. The accusation that women who display the capacity for critical thought must be frigid is a tired one, and one given full treatment in the character of Jo—the only woman in “House” who occupies a position of authority, the “lonely single woman” whose supervision of Basch and her other male subordinates equates to “lop[ping] a bit off his schlong daily by telling him what he’d failed to do.”

Other authors have managed to see women in health care as complex humans: Aleksandr Solzhenitsyn, in “Cancer Ward”; Michael Ondaatje, in “The English Patient”; Elizabeth Norman, in the beautiful and deeply researched “We Band of Angels.” As more women have trained as medical professionals, physician writers such as Danielle Ofri, Pauline Chen, the former Surgeon General Joycelyn Elders, and the Navajo surgeon Lori Arviso Alvord have told our stories in memoirs. Part of a book’s essential work is to bring readers deeply into the worlds of others, and thus it is fair to criticize authors who make no attempt to examine the worlds of whole categories of people. As Eudora Welty said of her stories and novels, “What I do in writing of any character is to try to enter into the mind, heart, and skin of a human being who is not myself. Whether this happens to be a man or a woman, old or young, with skin black or white, the primary challenge lies in making the jump itself. It is the act of a writer’s imagination that I set most high.” It is odd to blame the times, then, for a failure of imagination—that freewheeling, unabashed thing that Updike prized.