A 2019 short essay by Shem and accompanying online documentary document the origins of the book and the characters it is based on. The story is autobiographical, as the BMS is a thinly veiled Harvard Medical School (commonly called HMS), and The House of God representing the Beth Israel Hospital, now a part of Beth Israel Deaconess Medical Center, one of the HMS-affiliated hospitals in Boston, Massachusetts; "Man's Best Hospital" (MBH) represents Massachusetts General Hospital (MGH). There are also references to a community hospital called Mt. St. Elsewhere or Mt. St. E.'s, which likely represents Boston City Hospital, St. Elizabeth's Medical Center or Mount Auburn Hospital (Cambridge) which was part of the Harvard Medical School teaching hospital system.