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Rapid Responses: Rapid Responses published:
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WU WEI - the TAO of Medicine.
- Friedrich Flachsbart (27 February 2004)
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Less is better
- Judith Deutsch (27 February 2004)
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Etiology of 'gomer'
- Peter H.M Brooks (28 February 2004)
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Nothingness may be everything!
- Robert A. McCollom BSc. Pharm, Richmond B.C., Canada (28 February 2004)
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Whose idea?
- Stephen R Workman (28 February 2004)
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The source of the brilliant idea
- Richard Smith (28 February 2004)
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Re: Etiology of 'gomer'
- Jonathan D S Kay (28 February 2004)
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Gomer comes from Samuel Shem's "House of God" and stands for "Get Out of My Emergency Room"
- Richard Smith (28 February 2004)
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Mr Blunkett: sue me now or never
- ralph wilhelm albert kruger (1 March 2004)
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No triumph at the Lancet
- Brian Deer (1 March 2004)
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Re: No triumph at the Lancet
- MC Feliciello (2 March 2004)
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Nothingness: The role of editors?
- Stephen R Workman (2 March 2004)
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Re: Etiology of 'gomer'
- Renee M Crichlow (5 March 2004)
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Re: Gomer comes from Samuel Shem's "House of God" and stands for "Get Out of My Emergency Room"
- Silke Brueggemann (5 March 2004)
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Friedrich Flachsbart, General Medicine Praxis 37085 Göttingen (Geismar)
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Dear Sir, Lao-Dse was the first medical author. The Tao-Te-King was the first medical book concerning the WU WEI - NO ACTION. Look, wait, do not act, think before You do. A little bit of penicillin, a little bit of anticoagulation, and that is all. Sincerely Yours Friedrich Flachsbart Competing interests: None declared |
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Judith Deutsch, Associate Professor Doctoral Program in Physical Therapy, UMDNJ-SHRP, Newark NJ 07101
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Dear Editor, I read with great delight your editorial and was reminded of what we tell our doctoral students of physical therapy "less is better." We speak to them often about over-treating by doing more for the patient than the patient really needs. A great therapist is one that can observe the patient, identify the limitations and work with the patient to solve them. The therapist creates the right environment and intervenes only when it is necessary, letting the patient take the lead and solve the problem required for their rehabilitation. Best, Judith Deutsch PhD PT Editor, Journal of Neurologic Physical Therapy Competing interests: None declared |
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Peter H.M Brooks, Next Tuesday Aucklakd
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I have not heard the expression 'gomer' for an elderly patient who never dies. What is its etymology? Competing interests: None declared |
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Robert A. McCollom BSc. Pharm, Pharmacy Practice Leader Richmond Hospital, Richmond B.C., Canada
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Was it not Voltaire who wrote " The efficient physician is the man who successfully amuses his patients while Nature effects a cure"? Competing interests: None declared |
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Stephen R Workman, Asistant Professor 1278 Tower Road Dalhousie University Halifax Nova Scotia B3H 2Y9
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Dear Dr Smith I responded to a call for ideas for theme issues posted on the BMJ website in September of 2000. It is stated on your website that the purpose of the venue for suggestions is to "break down the walls that divide us." I proposed 'What doesn't work and how to show it' as a theme issue. Voting results for this theme issue can subsequently be found on your website. (http://bmj.bmjjournals.com/cgi/content/full/321/7267/DC1) So, as you can imagine, I was disappointed to read that credit for this 'brilliant idea' is attributed by you to one of your editors. A review of your correspondence about suggestions for theme issues would undoubtedly substantiate my claim that I submitted the idea for this theme issue. Of course, such a review would not prove that the idea was not simultaneously or previously proposed by others. I completely agree with you however that it is a brilliant idea.
Yours Truly Stephen Workman Competing interests: None declared |
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Richard Smith, Editor BMJ
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I congratulate Dr Workman on his brilliant idea just as I congratulated Trish Groves. I've discovered that many brilliant ideas have multiple origins, which is why we are not keen on papers on who discovered something first. Trish, if I remember rightly, was given the idea several years ago from a French newspaper. What I also know about ideas is that having them is usually the easy part. Bringing them to fruition is the hard part-and I congratulate Trish again for her efforts on the theme issue. Richard Smith, editor, BMJ Competing interests: I'm the editor of the BMJ and acountable for al it contains. |
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Jonathan D S Kay, Consultant Chemical Pathologist Oxford OX3 9DU
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It is usually said to have originated as an acronym for "Get out of my
emergency room" and popularised in "The House of God", as mentioned in:
http://www.medfools.com/shopuk/product/ASIN/0385337388/
The_House_of_God_:
_The_Classic_Novel_of_Life_and_Death_in_an_American_Hospital.html
and
http://www.studentbmj.com/back_issues/1202/reviews/481.html
This is discussed at:
http://www.quinion.com/words/weirdwords/ww-gom1.htm
Competing interests: None declared |
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Richard Smith, Editor BMJ
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The word gomer comes from Samuel Shem's novel "The house of God," which tells the story of an intern's first year. Published in 1978 it has sold over two million copies. The novel came from the experiences of Shem (the pen name for Steve Bergman) as an intern at the Beth Israel Hospital in Boston in 1973-4, the Nixon Watergate year, and is stunningly politically incorrect viewed from 2004. It is, however, a wonderful book and is perhaps one of five that might merit the ultimate cliche of every medical book reviewer:"should be read by all doctors and medical students." What's more they will enjoy it- -even though it will bring back pains known to every doctor. Gomer stands for "Get Out of My Emergency Room; a human being who has lost--often through age--what goes into being a human being." (Interestingly a very similar phrase is used about two of the senior doctors: "neither..seemed to have a firm grasp on what went into being a human being.") I read the book for the first time recently and imagined that the word gomer--which is used extensively throughout the book--would have disappeared. But several doctors have told me that it's widely used today. Richard Smith, editor, BMJ Competing interests: I'm the editor of the BMJ and accountable for al it contains. |
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ralph wilhelm albert kruger, GP locum in Edinburgh eh7 5 lq
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...what doesn't work. An orgy of failure. Isn't this a mad idea? Don't our readers want to hear ... (from editors choice, nothingness: the role of journals) I am afraid to say, do not mention the war does not cut the mustard. being led by war criminals our noses tight in their believe, revelations of who did what when, public scrutiny obscure, evaporate to not important, non existant. Nuremburgh trials. War criminals. Me being of german origin. Sitting next to a 75 year old jewish woman is awkward. Now Britain has to face up to the most serious of legal quests (which I am prepared to present in court)(please Mr Blair/Blunkett, sue me, I cry out: YOU ARE A WAR CRIMINAL!!) that this country invaded against international law another country. That this administration is riddled with war criminals I find. Where is your reply? So I will leave these shores. Not without regret. A lot to be learned from Britain in Europe. People in general are good hearted, genuine, intelligent. But just right now a blind man leads prosecution, who knows, I might find myself in a dungeon for ventilating my views. Good bye Britain and good luck Competing interests: None declared |
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Brian Deer, journalist The Sunday Times
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In his editorial, BMJ editor Richard Smith concludes: "Journals (words on paper) are poor at changing behaviour but good at creating debate, stirring the pot. So a journal that creates debate around what doesn't work is a paradoxical triumph." The Lancet paper of six years ago, (Wakefield et al, Lancet, February 28 1998), for which the editor of that journal now says he is sorry, had a profound effect on behaviour, causing immunization rates to fall and infectious diseases to rise. Children died in measles outbreaks. Doubtless others may have been left brain-damaged by measles and rubella. The fertility of males may have been permanently compromised by mumps. Although nowadays "debate" often takes precedence over attempts to unearth fact in every area of media, I do not believe any "triumph" to be involved here, whether paradoxical or otherwise. Competing interests: Investigated the 1998 Lancet paper for The Sunday Times |
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MC Feliciello, n/a Leeds
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Mr Deer, I note your article for the Sunday Times of 22/02/04 contained a quote from Dr Richard Smith that refers to the published observations of Wakefield et al(1) as an example of a "very, very dodgy paper" I would appreciate Dr Smith expanding this critique (2) beyond the one adjective that per se tells me nothing of the papers's inherent scientific strengths and weaknesses. As to the attribution of all the ills of the world to one mans' doorstep,Mr Deer, I do not recall Dr Wakefield ever advising parents not to vaccinate their children and "do nothing" Merely to consider single vaccines as an alternative in the interim as more research was needed. Do you have references that would indicate otherwise? MCF (1)Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children. Wakefield et al '98 (2)Committee of Publication Ethics http://www.publicationethics.org.uk/cope2001/pages2001/about.phtml Competing interests: Parent of child diagnosed ASD, aetiology unknown. |
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Stephen R Workman, Assistant professor department of medicine Dalhousie University
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While I am pleased to find that Dr. Smith and I agree that the idea for this theme issue is 'brilliant' I find his postulated chronology, as best as I can follow it, unlikely. I believe he is stating that: 1. I (Stephen Workman) submitted the idea for a theme issue about non-efficacy in October 25 2000. 2. Subsequent to this, through two rounds of voting, the topic was ranked fourth by the journals readership. 3. At some point, BMJ editor, Trish Groves, unaware of this highly ranked suggestion suggests the idea to Dr. Smith in 2002 or 2003. 4. He then credits her for this brilliant idea for a theme issue that arose independent of my initial suggestion. I respectfully submit that the idea for publishing a theme issue about non efficacy originated from my suggestion. (Further, I did not merely have such an idea but actively conveyed it to the BMJ.) I find it difficult to believe that Trish Groves, an editor and contributor to BMJ for many years, remained completely unaware of highly ranked suggestions for theme issues made years before she suggested this theme issue to Dr. Smith. If credit is to be given it is worth ensuring that it is given to the right person. In his response to my query Dr Smith claims that the origin of an idea is unimportant to him (I cannot make the same claim) but by attributing the idea for this theme issue to a particular individual he clearly acts in a way that contradicts his position. The following is a copy of an email (and the corresponding website address) submitted, by me, to BMJ on October 25 2000. (Typing THe instead of The is an unfortunate habit of mine.)http://bmj.bmjjournals.com/cgi/eletters/328/7438/0-g#51917 Stephen Workman, assistant professor Dalhousie University Send response to journal: Re: THe Disproven Email Stephen Workman Invite articles demonstrating non efficacy. Talk about what it takes to prove something does not work. Competing interests: None declared |
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Renee M Crichlow, Assistant Clinical Professor MFPR 59101
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This is an unfortunate bit of dark humor which is the product of long hours and frustration experienced by Interns and Resident physicians in training. GOMER , Get Out of My ER, ER=emergency room=Casualty (in the British System) The idea was that this misfortunate ill patient with multiple chronic progressive illnesses, and often demented, was not going to be helped by the hospitalization, yet would add to the workload of the exhausted Resident physician. Hence the pejorative, “Gomer” came into existence. In my experience it is a word that fades the further one is from residency training, and the more one is caring for their own patients. The book “House of God” did not coin the phrase, but may have perpetuated its further dissemination. Competing interests: None declared |
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Silke Brueggemann, Doctor BfA, Berlin, Germany
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If Samuel Shem's "House of God" is one of the five books doctors should read, what are the other four? If they are equally good I wouldn't like to miss out on them! Yours Silke Brüggemann Competing interests: avid reader |
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