Separate names with a comma.
Discussion in 'General Residency Issues' started by tibor75, Mar 3, 2007.
I vote no.
Absolutely not. It's actually a pretty tame term comparatively to what can and is often used.
I vote yes. Find another way to "laugh and survive" that doesn't involve being an @$$hole.
I use insensitive words like "gorked," "crump," and "all ****ed up," but I don't feel right calling patients "gomers." I admit, it's arbitrary as hell, but verbs and adjectives are okay with me, but nouns are not.
Oh, BTW, the worst is calling gorked out patients "heads." I don't know why that burns me so much, but it does.
must admit that I haven't heard that one.
I like rocks. As in I have a nice rock garden, it's quiet. And yes it's okay to use any word you want. Don't alter your treatment and talk to them with respect, outside of that I'll reserve my right to talk however I want. If a descriptive term fits I'll use it.
GOMER is an acronym for Get Out Of My Emergency Room, applied by American physicians to anyone coming in for a fraudulent or trivial reason. This phrase is believed to have been coined by Samuel Shem in his 1978 classic "The House of God".
Therefore the term doesn't make you an @$$hole. It just means that it's a patient you'd just as soon not have to deal with, so you can do what you went to medical school for and see patients that really need your help.
I have read House of God and I know what Gomer means. I also know that the term is used almost exclusively to refer to elderly patients with decreased mental capacities, and it's derogatory.
I'm usually in agreement with your opinions, but not here.
I've heard the same explanation given for why it's OK to use the n-word and tell racist jokes. I am by no means saying that you're racist or anything, and I recognize that your statement is mostly innocent and 100% unrelated, but I just think it's spooky that you used the same explanation to qualify your behavior.
Honestly, I feel that as medical professionals, we have to be careful about which slang terms we allow ourselves to become comfortable with.
The House of God, awesome book. All medical students should read this book!!!
I can somewhat see this point. I don't use n-word myself, likely because my SO would smack the **** out of me but I don't get offended when I hear other people use it (chris rock, most any young black man with his friends in the ER etc.). I WOULD be offended if someone used the word in a directed fashion to denegrate another person. I guess I just can't see the whole-sale avoidance of a word that may be used in an offhand way just because someone else may be offended. I think individual uses should be judged as flipant remarks with some humoral value vs. malignant and detrimental. One is ok, the other is not.
Gosh. I guess you wouldn't like our expression, "Rejected at the Net."
You know, when Jesus is about to take one of your patients who is circling the drain and through good ACLS you reject him at the net.
Gotta tell ya', I started reading it and don't like it that much. Too "over the top." Maybe it applied way back when it was written but things have changed a lot since then, mostly for the better.
Residency is just not like that anymore if it ever actually was. I'm not saying it's not well written but reading "House of God" to gain insight into residency is like watching "Patch Adams" to get an insight into medical school.
Residency is a lot like a job nowadays. A sucky one, to be sure, but I don't think most of the residents I know are as obsessed with residency as the characters in House of God. I'd say half of my peers are married and a lot of them have kids too so it's a different atmosphere, at least in my experience.
Does anyone else use the terminology "d/c to Jesus"?
Also, SLU, what do you refer to trolls as?
I've heard "D/C to heaven" or to sky, but not to Jesus.
One of the most common ones we use is "slug". As in, "she's a slug. Get PT to work with her and make her get out of bed".
I admit I've used the term gomer once or twice (and felt bad about it), for pts with such poor capacities and poor QOL that I feel sad that the families want us to do "the works" on. A 95 yo pt with a PMH too long to list, end-stage Alzheimers, stage 4 bedsores at all pressure points, unable to swallow, incontinent, you-name-it, that the family requests elective surgery on....it's hard to believe anybody wants to live like that.
I've been known to refer to trolls as squirrels (as in they're looking for their nuts in the form of narcs) and as groundhogs.
As a funny sidenote, one of the more experienced nurses in the ED decided to rename the rolodex with the drug seekers names in it to the "trollodex". And it is thusly referred to by all now.
No, but I've heard the family meetings the "come to Jesus talks" and when the patients die, "transferred them to the ECU (Eternal Care Unit)"
Transferred to the 13th floor ( we only have 12)
And yes, I use GOMER, but in the acronym sense.
"Admit patient to Pathology service..."
Oh, and I just read "House of God", but still don't really understand how the acronym of a command (Get Out...) becomes a noun.
If a patient is female, she should be called a gomere according to the House of God.
EMS, police, military and other people who deal with high stress, physical and emotional fatigue, death and gruesome situations and alienation from friends, family and normal siciety all have critical incident stress debriefing, counseling time off etc and now those of us in medicine who get none of that aren't even allowed to say "GOMER?" To hell with that.
I don't even want to know what you think about the term "SHPOS."
I like "high slug titre". Our PTs were used to hearing me say that about a lot of the patients I referred to them.
Ah, yes "D/C to JC". A term used frequently on my surgery rotation. I am intimately familiar.
I work in peds, which gets around the gomer question quite nicely. But I fully expect to be a gomer at sometime in the future. And I'm okay with that. I will have oy-fib (possibly even advancing to oy-tach), a positive Q sign and the amazing ability to go to ground at any second.
And speaking of the ultimate discharge, we frequently use 'discharged to a higher level of care.' Since we're the highest level of care in the region by a pretty good margin, the meaning is pretty clear. I rather like the phrase since I'm atheist, so 'discharge to JC' doesn't work well with me.
Going through -P school, we occasionally used the phrase "Transfer to the ECU" (Eternal Care Unit), but not "Transfer to Jesus"...
You know, I didn't think anyone else used that term. I certainly stopped after having to explain it to too many people.
Doesn't make it right.
Thinking "GOMER" and saying it are 2 different things. While I defend everyone's right to free speech, you should consider that the wrong people may overhear you - worst case the patient or patient's family (how will you feel when some intern refers to your mother or father as a GOMER?) best case some impressionable medical student (and the tradition will continue...)
As physicians we are professional adults providing a valuable service. Act accordingly. If you need to unwind or deal with the stress, go for a jog or get some personal attention from someone special.
a. The House of God is not awesome. It is a vicarious fantasy romp through a world that none of us will ever experience. There is no reason for this book to be continued to be worshipped by pre-meds everywhere.
b. When I was a pre-med/M1/M2 I would have been indignant about terms like "gomer." As an M3, I use it with relish. Many of your pt's in the hospital are nice, normal folks who are just having a bit of a tough time - it is fun/rewarding to take care of them. Many of them are manipulative sociopaths without care or concern for anyone but themselves. Still more should have died during their first bout with pneumonia 5 years ago but thanks to their tracheostomy, J-tube, and vancomycin they are still laying around in a gross mockery of human life. Calling people "gomers" is an indictment of the system, not the patient.
Can we add a category to the poll, "I Laugh at Patients because some of them are funny," without trying to justify it by calling it a survival reaction or the outward manifestation of some deep angst.
I mean, seriously, some of them are so idiotic you can't hep' laughing at 'em. Like my patient who refused to use his subligual nitroglygerin because his friend told him his head would explode.
I thought it was a rather funny book and I enjoyed it less for the "real medicine" aspects and more because of the characters. I can see similar personalities in the hospital where I rotated. And yeah, sometimes I laugh at patients because they do dumb $hit. Its one thing to laugh at some idiot doing backyard wrestling moves with this 24 year old buddies who comes in for some lacs or a broken bone and another thing to laugh/poke fun at a woman with metastatic breast cancer with PNA. I think most of us know when humor is appropriate and when it isn't. Pretending that you are somehow "more enlightened" by stating the obvious in (b) is semi-obnoxious.
Medicine is a microcosm of life. Life is NOT all serious and staid - there IS serious, funny, sad, curious/quizzical, angry, indignant, and a host of other emotions. To say that doctors have to be serious all the time is illogical - no matter what, some things ARE funny (such as what people will stick up their butts), and the truism (because it plays out day after day after day) of the "LOL in NAD" with "WADAO" does become the "GOMER" - and that does NOT mean "back to the nursing home" but nursing home, home, admitted, whatever - just out of the ED.
I have a strong feeling that the idealist types here are students who haven't actually seen the range of emotion (mostly banal/low levels of high and low, with occasional spikes) that you see across most fields of medicine daily, in practice.
I remember a Duke 2nd year medical student (they do their clinical in 2nd year instead of 3rd, like everywhere else) who would not eat lunch provided by drug reps, to keep herself "untainted". I ate the food, and cannot recall - even vaguely - who provided what, except for, affirmatively, Xopenex did NOT stick with me, as I have NEVER ordered it. Not even once. And, if I recall, that drug rep was married to a woman that is a pastry chef, and he brought in these sweet rolls that were cater-quality - boy howdy, was they sweet (literally and figuratively)! Even so, I was more interested in talking to the guy himself, instead of about the medicine he was repping, because he was so expressive about his toddler daughter, and she is a cute kid - he's just a nice guy to talk to. Don't give a damn about what he's peddling.
Now that I'm an attending, if there are doughnuts or pizza, no one knows/cares if I provided them, or a drug rep did - they're just there. Then again, the formulary I have in the ED is "any color, as long as it's black" - for a bunch of things, if I write it, the pharmacy will change it to what P&T has decided is equivalent. Likewise, I have never ever checked the "DAW" (dispense as written) on a prescription; it's always "substitution permitted".
Agree with the funny bit - lots of humor in day-day medicine, much of which I laugh at as well. However, GOMER is a derogatory term commonly used to refer to old and infirm patients - not, as you say, exclusively applied in the ED.
Hmm. Gomer I don't really like, I don't know why....but I don't get offended when I hear somebody refer to some 80 year old with a GCS of four, 2 ostomies, a rectal pouch,multiple myeloma, a sacral decub and an iron clad "FULL CODE" as such. Sorry. If that makes me a heartless b*stard, I guess I am.
Earmuffs on for the "gomer detractors", but in the unit instead of saying we are going to do rounds we say that we are "Going to water the garden".
frankly, gomers are people that are already dead. By the time I'm in diapers and my mind is gone and my kids are too self-served to pull the plug, make fun of me all you want. I won't know the difference.
We've shortened it to "G" for niceness.......
That way you can just say "ol' G" and it kinda makes ya feel like Snoop Dogg too!
Black humor is as old as medicine itself. I've never met a physician who didn't appreciate it.
Indeed. I think we are talking about two different things here, however. I believe that Shem's intention was to portray hospital life in this fashion - as a dark, comedic fantasy. Much in the same way Heller takes on war, Pynchon addresses the military-industrial complex and conspiracy theorists, and Altman satirizes war and medicine. If the word GOMER was used as a dark comedic vehicle to enlighten us to the absurdity of life in the ED or the hospital or to the ludicrousness of healthcare in general, I would be the first one to applaud the effort; and if I could be witty enough to join in, I would.
That being said, in my experience, 19 out of 20 times the word is representing the bitterness and scorn of some tired and angry medical student/intern/resident/attending and it is targeting some infirm, old patient on the ward. There is nothing comedic about that.
Remember, the key to a joke is the delivery.
Honestly though my bitterness and repressed rage need outlets just like my sense of humor.
Just take it and either rip off a chunk of (or add it to) your big ball of hate.
But it's SO big already. I look like Atlas hauling my ball of hate around the ED.
Wow, I cannot believe some people are so sensitive over this term. I've used it hundreds of times, and never really felt guilty about it. I've also used the terms "road pizza" at traffic accidents, "taking a dirt nap" to express a patients demise to my coworkers, and "crispy critter" to describe an incinerated body. I suppose I could go on and on. Despite this, I am kind to my patients and treat both them and their family with sincere respect and compassion, not some artificial smile while they happen to be in view.
Relax. Just because you hear these terms come from your colleagues does not imply you are dealing with heartless, dispassionate people. These terms are common in high stres jobs. As long as you never see your colleagues disparage a patient to his face, as I have seen multiple times, don't bash them for having a dry or dark sense of humor.
I used to think the same. Then a patient family member overheard us talking at the nurses station. Although no harm was meant by it, harm was done. To people outside the field, these terms can be incredibly hurtful.
Well, it goes without saying that you should use good judgement. I wouldn't expect anyone outside of medicine to understand or appreciate this sort of thing, and I certainly wouldn't talk about "GOMERs" or anything else like that within earshot of patients or their families.
Can you say the same for the impressionable residents and students that hear you say it? Of course not, but will that stop them from doing it? You don't have to agree with me, and I admit that it sounds very self-righteous (especially from an intern), but I think it's important to set a good example.
The use of Gomer in the House of God was funny and represented "dark humor," but it was also based on fictional characters, which makes it more acceptable. Also, it's not like we should emulate all behavior that we find humorous.
I use plenty of slang, but I try my best not to use terms that reduce your patients to such a low level. LOL in NAD doesn't really bother me.....
I'm sure it would bother somebody. It's tough to draw the line, isn't it?
Is it wrong? No
Might it be insensitive? Maybe