Wednesday, 11 February 2009

The House of God

I was talking to a colleague the other day about a patient who happened to be a 'GOMER' and not only did she not know the definition of a 'GOMER' but had not even heard of the "House of God" never mind actually read it.


Either I'm to old to be doing this wait...I am too old...

Anyway...for the benefit of the Poms ,who do not believe that anything good ever came out of the USA;and for the benefit of readers under 40...who do not believe that anything funny was said before 1999... herewith...The Rules of the House of God

By the way , a "GOMER" is an acronym for Get Out Of My Emergency Room and is a slang term for a patient who, -according to the original book -, "has lost--often through age--what goes into being a human being" -typically an extremely ill, extremely old, Alzheimer's ridden/demented, mute and non-communicative patient.

When GOMERS come into the hospital they are unable to communicate so the admitting doctor will order many, many, lab tests hoping to discover why the patient was sent to the hospital. GOMERS never come to the hospital, they are only ever sent by someone else. This battery of tests is sometimes called a "Gomer-Gram."

I. Gomers don't die

II. Gomers go to ground (ie fall out of bed at the first possible opportunity)

III. At a cardiac arrest ,the first procedure is to take your own pulse

IV. The patient is the one with the disease

V. Placement comes first (ie, getting the patient accepted by another service)

VI. There is no body cavity that cannot be reached by a size 14 needle and a good strong arm

VII. Age + BUN = Lasix® dose (a bit dated but still a useful guide)

VIII. They can always hurt you more (by pulling out their only working IV line)

IX. The only good admission is a dead admission

X. If you don't take a temperature , you can't find a temperature

XI. Show me a BMS* who only triples my work and I will kiss his feet

* Medical Student from the "Best Medical School."

XII. If the radiology resident and the BMS* both see a lesion on the CXR , there can be no
lesion there

XIII. The delivery of medical care is to do as much 'nothing' as is possible

And the point of the rules is to "Buff and Turf" the patient...find the most 'saleable' diagnosis , massage the results and findings, and 'sell' the patient to another service...anywhere else but here !

from 'House of God' by Samuel Shem,1978 by Samuel Shem

He also wrote 'Mount Misery' , in which he takes on psychiatry. Dr. Roy Basch (protagonist of Shem's earlier novel) has decided to become a psychiatrist and is taken on at the prestigious Mount Misery, where, he quickly learns, "psychiatrists specialize in their defects" and "the worst psychiatrists charge the most, and world experts are the worst."

Not as funny as the House of God,-in fact often dark and depressing- , its still worth reading!

1 comment:

  1. i enjoyed mount misery too, but it was a bit disturbing.