Mount Misery doesn't come up to the high standards of Shem's first book, "The House of God". Despite that it is a fascinating account of the personal development of a young pyschiatrist's first year of training at a prestigous East Coast private psychiatric hospital, his own personal development and the development of his relationship with his long term not quite live-in lover. For the British reader the novel provides a chilling insight into the working of an insurance based health care system, with the perpetual struggle of the medics trying to get funding for the care of particular from the apparatchiks at the Insurance company or the Health Maintenance Organisation who authorise the payement for their health care forming a recurrent theme. Since primary care groups are HMOs by another name, is this novel a warning of what those working in hospitals in England & Wales are going to have to face up to as the latest set of health service reforms start to bite? This is an excellent book that should be read by everyone involved in training young doctors, young doctors in training (any specialty, not just psychiatry), in providing or managing health services or who might finish up needing to claim on their health insurance.