Introduction

I remember playing the game “The Sims” back then when I was little. I typically remember the overall view of the neighborhood (Figure 1)!

The Sims is a life simulation video game series, developed by Maxis and published by Electronic Arts [1], [2]. The first game, simply called “The Sims” was released on February 2000 by game designer Will Wright. You probably all know this game. Some of you might have spent countless hours building your dream house, starting with a modest life then getting a job and buying more luxury furniture. And of course, our ears were always pleased with such a wonderful soundtrack many of us still listen to (at least, I do for some tracks!) thanks to composers Jerry Martin and Marc Russo.

Will Wright had the idea of developing that game while building up his life again after losing his own home during a firestorm in 1991. When he presented that idea to Maxis board of directors, they did not believe in the concept and only gave little financial support. Electronic Arts (EA) bought Maxis in 1997. At that time, EA already released SimCity game, and envisioned the possibility to build an entire “Sim” franchise. We can nowadays absolutely say they were right! Sims franchise is considered as one of the best selling video game franchise all over the world, with more than 200 million games sold [3]. So, never lose hope and confidence in your ideas!

Sims live in a modern era

Indeed, looking at the media production job in The Sims 4 (Figure 2), it looks pretty similar to most modern youtubers set up!

We can assume they have high speed internet connection to share their work. Sims also have smartphone and tablets that looks like Apple’s one. Therefore, we can easily assume that The Sims’s world is set in our current era!

Stay healthy with 6 fundamental needs

There is no “health” bar in Sims games. Instead, in order to stay “healthy”, you have to pay attention to six fundamental needs (Figure 3): go to toilets (Bladder), eating (Hunger), sleeping (Energy), staying sane (Fun), having friends (Social) and have showers (Hygiene).

Life would be so easy right? I only have to go to pee every day, then washing myself, eat the breakfast, play games, chit chat with some friends then sleep, and everything is gonna be alright…

Sim can die of… embarrassment

For some reasons, it can be fun to kill a Sim. Don’t tell me you never tried to or at least thought about it, I won’t believe you. Making your Sim going into the swimming pool, then try to remove the ladders or to put fences all around? Well, you have actually 30 ways to kill a Sim in the Sims 4 [4]. However, besides some few “serious” death (such as death by fire, by eating poisoned pufferfish or by electrocution), most of the deaths are comical. You can literally die of embarrassment. God, in real life I would be dead many times now…

And there is no actual contact with hospital in The Sims game. You can choose to become a doctor, but when your Sim goes to work each morning, time accelerates and he comes back at the end of the day. You don’t control him as he is working…. Unless…

Become a “real” doctor with the expansion pack

Unless there is an expansion pack that allows you to follow you Sim at work [5]! What a wonderful idea (Figure 4)!

For the first time in Sims games, you can “really” become a doctor, welcome patients, examine them, run tests, make diagnosis and cure patients (Figure 5)!

If you choose to become a doctor, you start as an Intern in the Sims “Willow Creek” Hospital (Figure 6).

It is currently the only known hospital in Sims game. According to the general map of the Sims hospital available on the internet, patients are welcomed in the central hall. Then, there are 6 examinations beds, 2 medical treadmills, 2 next-generation surgery machine, 2 biological samples processing machines, 2 next-generation X-ray machines (Figure 7). Well, I would say it is a pretty small medical clinic.

Sims healthcare system is the future of medicine

What strikes me is that there is no “hospitalization bed” in the Sims hospital, meaning patients cannot sleep and be monitored in the hospital. The way it functions rather suggests that patients are managed in an ambulatory care environment. “Ambulatory” means patient go in and out without sleeping in the hospital.

Then, there is no emergency department either. Anyway, to have an emergency department, the hospital should be able to hospitalize patients, which is not the case. Thus, The Sims hospital cannot technically have an emergency department. Sure, in the game as a doctor, you will sometimes have “emergency” cases (Figure 8).

Strangely, collapsed sim are always treated by surgery. But after surgery, which does not require any anesthesiologist thanks to the next-generation surgery machine (AI for medicine is coming…), patients just walk away home. How wonderful!

The medical studies standards have changed according to the Sims Medical School curriculum [6]. Indeed, as the healthcare system is now ultra effective, there was a drastic cut on every level. Only one hospital in the entire town is sufficient to manage all patients. There is no need for too many staff, so all the different jobs have been merged into one. You now start as an “intern”, before climbing up to a “medical technologist”, then an “assistant nurse”, a “doctor”, and finally a “chief of staff”. One who aspires to become a doctor will now undergo through all the different jobs in the hospital. What else to deepen our understanding of the medical system? Indeed, doctors now examine the patient, go to the lab to perform chemical tests, also perform the x-rays imaging or the coronary assessment with the medical treadmill, perform any surgery and deliver babies as well, and finally clean the bed and the floor. What a dream for any government to have this kind of very efficient doctor!

Educational facts: medical studies in France.
Of course, this is not the reality at all… I don’t know about UK, US or Japan healthcare system. But in France, at 18 years old, you apply to medical school university. At my time back in 2008, everyone could apply but there was a final exam where students were allowed to go to 2^ndyear of medical school only if their ranking was in the top 5%-10%. During 5 years, you learn every medical disciplines and go to hospital every morning to examine patients. You don’t manage them, but you learn how to examine, and discuss about diagnosis and treatment with senior physician, learn technical skills under supervision, such as blood sampling, performing lumbar punctions, stitching wounds etc. Then, there was another exam at the end of the 6^th year of medical school. According to your ranking, you could choose your medical specialty and the city where you will be a medical doctorate resident for 3 years (for general practitioner), 4 years (for medical specialist) or 5 years (for some other medical specialists or surgery). Then if the head of the department likes you, you can be a senior doctor chief of staff for 2 years. After that, either you stay in the university hospital / academic world, or you work as a hospital full-time physician employee without teaching / doing research.

Being a doctor in The Sims is financially rewarding!

According to several sources [7]–[11], physicians have an annual average income of roughly 300 000$ (281 685€ in march 2023) in USA,  and 110 000 $ (103 284 €) in France. Physicians work on average more than 52 hours a week  in the US [12], and between 52 to 60 hours a week in France [13]. There are about 52 weeks in a year. The vast majority of US physician took on average 2 weeks of vacation in 2020 [14], [15], while French physician took on average 6 weeks of vacation in 2019 [16].

So, physicians earn on average per week about 6000 $ (5633 €) in the US, and about 2391 $ (2245 €) in France. In my experience, physician work approximately 9 to 10 hours a day, and also work on weekends most of the time, with night shift etc. So, let’s say physician work 6 days a week.

In the end of the road, physician earn on average 100 $/hour (94 €) in the US and 40 $/hour (38 €) in France.

According to The Sims Medical salary, a medical intern earns 18 $/hour, a doctor earns 135 $/hour and a chief of staff earns 280 $/hour [17]. That is nearly three-fold higher than being a physician in the US. Compared to that, French physician earnings appear like peanuts… Well, with respect that The Sims money is equivalent to US dollars.

Being a doctor in The Sims is easy, ‘no burn out’!

Sims only suffer from 9 diseases: raches, sweaty shivers, bloaty head, starry eyes, Llama flu, gas and giggles, triple threat, itchy plumbob and burnin’belly [18], [19]. In our world, when solely taking into account the rare diseases (defined as having a ‘prevalence’ or ‘frequency of sick people’ of at least 1/2000 [20]), there are at least 10 000 different diseases [21]. So, I let you imagine the total number of all the diseases when taking into account the most common one (such as diabetes, cardiovascular diseases, cancers, infections etc). Well, no offense to The Sims doctors but… well it is much easier to diagnose and cure patients for them than for us! Basically, the only medical book you have to learn is the “Doctor diagnosis list” which can be printed in 2 word pages ([19], Figure 9).

In comparison, one of the most famous and referred book in medicine is the “Harrison’s Principles of Internal Medicine” you can buy on Amazon [22], which contains over 4000 pages… and it does not contain all the surgical disorders, all the rare genetic disorders, and the pediatric disorders! It costs 217 $, so a Sims doctor can easily afford it after 1 hour of work.

Is The Sims world a model of healthcare?

Somehow, The Sims world managed to get rid of some of the deadliest diseases of our modern society, namely: cancers, cardiovascular disorders (diabetes, high blood pressure, strokes), infectious diseases.

Educational facts
Do you know what diseases lead to most deaths over the world? According to the World Health Organization, the first leading causes are the cardiovascular diseases starting with ischemic heart disease (when artery irrigating your heart are block, causing the ‘heart attack’) and strokes (Figure 10).

The third cause is the chronic obstructive pulmonary disease (mainly caused by smoking), followed by pulmonary infections. Neonatal disorders come at the 5^thplace. Cancers only comes at 6^th position, with respiratory cancers (mainly enhanced by smoking).
It is also marvelous that Sims newborns always come to life without any issue whatsoever. Public health policies are not worried about Sims misbehavior: Sims people don’t drink alcohol and they don’t smoke. Sims don’t seem to be that obese neither… That can explain why there is no cancer, no diabetes, no chronic respiratory diseases. There is no dementia either! Cancer? Never heard about it… No Sims caught or sneeze either! The probability of a pandemic in The Sims is 0: no lockdown, no restriction, no masks, no vaccines.

Why being so healthy when you can add tuberculosis, meningitidis and other deadly stuff…

In the same way you have already thought about killing your Sim, other people found that Sims were too clean. ‘adeepindigo’ and ‘aroundthesims’ issued a patreon account to raise funds for The Sims 4 Mod they have created, called ‘Healthcare Redux’ (Figure 11, [23]). And guess what? They added tons of diseases your Sims can catch!

Sims will have a “natural immune system level” that determine the tendency to contract illness. They can have bacterial sinusitis, bronchitis, gastroenteritis, allergies, tuberculosis and all other fun stuff. On their smartphone, they can directly make an appointment to the doctor (but you won’t be able to follow them such as in “Get to Work” expansion), or buy drugs at the pharmacy.

If you are frequently sick and don’t want to ruin yourself in medical care and medicines, you can also buy health insurance! Now, The Sims now starts to look like real life… Games are for having fun right (Figure 12)?

CONCLUSION

The Sims brings us a relatively realistic healthcare system with some variations to ours. Again, in the same way as for Super Mario (read the article here), all diseases are curable so the healthcare system is 100% efficient! Imagine having such a system in our society, how would the world look like? There will be no chronic diseases. Each ailment would be treated once and that’s it.

Are there any disadvantages in The Sims 4 healthcare system? Well, if Sims only hospital is translated to our modern world, I can see some drawbacks:

· Shortage of staff. Due to our modern society high medical care demand, working conditions will be worsened, the hospital won’t be as clean and beautiful after few months. There are clearly not enough doctors in this hospital. They will need to recruit more physicians.

· Incurable diseases. Since the Sims physicians only know 9 diseases (and maybe some 30 more thanks to the new “Healthcare Redux” medical book), I wonder how Sims physician would manage cancers, strokes and ischemic heart diseases. First, I think they would have to create hospitalization beds. Then, they would have to set an “interventional platform” with interventional coronarography and arteriography. They would also have to implement not only X-rays but MRI technologies that better diagnose strokes. For cancers, they might be able to cure them with the next-gen surgery machine. Sims physician would have to learn the Harrison’s principles of internal medicine and read the whole 4000 pages… sorry Sims!

· Medical public instances and public safety warning. First, when performing X-rays analysis on patients, people that don’t need to be irradiated do not wear protection (such as the doctor behind the consoles). Patients undergo 1 or 2 X-rays irradiation. But doctors potentially perform many X-rays imaging a day, several days a week. That possibly leads to cancers (which Sims physician ignore the existence of) and infertility!

· Health becomes less important. If any disease is curable, then why bothering about eating healthy, exercising more, washing our hands after toilets or after sneezing and so on? Simply go to the doctor and get the medicine, et voilà! Cured. Then people can repeat themselves, and go to the doctor again.

At the end of the journey, I think that Sims hospital’s working pipeline will slowly fade into our modern world hospital one in order to survive. Or it will simply close… unless…

Unless the Sims “Elixir” that miraculously cure any disease is revealed! Our pharmaceutical industries would harshly fight to buy over the Sims hospital to get over the secret behind that potion (read the article about potions here). That would generate tension and violences!  This Elixir could also be just a placebo thing… And remember to wash your hands after toilets!

Cheers

REFERENCES

[1]         “The Sims (video game) - Wikipedia.” https://en.wikipedia.org/wiki/The_Sims_(video_game) (accessed Mar. 04, 2023).

[2]         “The Sims - Wikipedia.” https://en.wikipedia.org/wiki/The_Sims (accessed Mar. 04, 2023).

[3]         Wikipedia, “List of best-selling video game franchises,” [Online]. Available: https://en.wikipedia.org/wiki/List_of_best-selling_video_game_franchises.

[4]         “The Sims 4: All Possible Ways To Kill A Sim.” https://gamerant.com/sims-4-all-possible-ways-kill-sim/ (accessed Mar. 04, 2023).

[5]         “Buy The Sims^TM 4 Get To Work Expansion Packs - Electronic Arts.” https://www.ea.com/games/the-sims/the-sims-4/store/addons/the-sims-4-get-to-work (accessed Mar. 04, 2023).

[6]         “Guide To The Doctor Career In The Sims 4: Get To Work.” https://www.thegamer.com/sims-4-get-to-work-guide-to-doctor-career/ (accessed Mar. 04, 2023).

[7]         “Salaries for Doctors: Top 10 Countries in the World.” https://www.careeraddict.com/top-5-countries-with-the-highest-paid-salaries-for-doctors (accessed Mar. 04, 2023).

[8]         “How Do US Physician Salaries Compare With Those Abroad? - Physician’s Weekly.” https://www.physiciansweekly.com/how-do-us-physician-salaries-compare-with-those-abroad/ (accessed Mar. 04, 2023).

[9]         “10 highest paying countries for doctors - Medic Footprints.” https://medicfootprints.org/10-highest-paying-countries-for-doctors/ (accessed Mar. 04, 2023).

[10]      “10 Highest-Paying Countries For Doctors | Medvocation.” https://medvocation.com/en/blog/10-highest-paying-countries-for-doctors/4 (accessed Mar. 04, 2023).

[11]      “Doctors’ salaries: Which countries pay the most and least in Europe? | Euronews.” https://www.euronews.com/next/2023/01/03/doctors-salaries-which-countries-pay-the-most-and-least-in-europe (accessed Mar. 04, 2023).

[12]      D. O. Staiger, D. I. Auerbach, and P. I. Buerhaus, “Trends in the Work Hours of Physicians in the United States,” JAMA, vol. 303, no. 8, pp. 747–753, Feb. 2010, doi: 10.1001/JAMA.2010.168.

[13]      P. Le Fur, Y. Bourgueil, and C. Cases, “Le temps de travail des médecins généralistes. Une synthèse des données disponibles,” 2009, Accessed: Mar. 04, 2023. [Online]. Available: http://www.sante.gouv.fr/htm/.

[14]      “Physicians’ vacation weeks taken per year U.S. 2020 | Statista.” https://www.statista.com/statistics/1089569/physician-amount-of-vacation-per-year-us/ (accessed Mar. 04, 2023).

[15]      “Why Physician Vacation Time is Vital | JAMA Career Center.” https://careers.jamanetwork.com/article/why-physician-vacation-time-is-vital (accessed Mar. 04, 2023).

[16]      “54 heures par semaine, 18 mn par consultation et 6,2 semaines de vacances : voilà l’agenda 2019 du généraliste ! | Le Quotidien du Médecin.” https://www.lequotidiendumedecin.fr/liberal/exercice/54-heures-par-semaine-18-mn-par-consultation-et-62-semaines-de-vacances-voila-lagenda-2019-du (accessed Mar. 04, 2023).

[17]      “The Sims 4: Doctor Career Guide — SNOOTYSIMS.” https://snootysims.com/wiki/sims-4/the-sims-4-doctor-career-guide/ (accessed Mar. 04, 2023).

[18]      “The Sims 4 Get to Work: Doctor Career (Active).” https://www.carls-sims-4-guide.com/careers/gettowork/doctor/ (accessed Mar. 04, 2023).

[19]      “The Sims 4: Doctor diagnosis list.” https://www.ggrecon.com/guides/sims4-doctor-diagnosis-list/ (accessed Mar. 04, 2023).

[20]      “Orphanet: About rare diseases.” https://www.orpha.net/consor/cgi-bin/Education_AboutRareDiseases.php?lng=EN (accessed Mar. 04, 2023).

[21]      C. I. E. Smith, P. Bergman, and D. W. Hagey, “iScience Estimating the number of diseases-the concept of rare, ultra-rare, and hyper-rare,” 2022, doi: 10.1016/j.isci.

[22]      “Harrison’s Principles of Internal Medicine, Twenty-First Edition (Vol.1 & Vol.2): 9781264268504: Medicine & Health Science Books @ Amazon.com.” https://www.amazon.com/Harrisons-Principles-Internal-Medicine-Twenty-First/dp/1264268505/ref=sr_1_1?crid=3AJALN9CA6TRQ&keywords=harrison+internal+medicine&qid=1677950791&s=books&sprefix=harrison+internal+medicin%2Cstripbooks-intl-ship%2C153&sr=1-1 (accessed Mar. 04, 2023).

[23]      “Healthcare Redux | a.deep.indigo sur Patreon.” https://www.patreon.com/posts/healthcare-redux-49278885 (accessed Mar. 04, 2023).