A G.O.M.O.

In Emergency Room vernacular, a G.O.M.E.R. is someone whose frequent visits are unwelcome, often an elderly and noncommunicative patients who is sent or dropped off with vague complaints not easily remedied in the ER. The acronym stands for “Get Out of My ER”, and it comes from Samuel Shem’s novel “House of God”.

In my line of work, we have what I think of as G.O.M.O. patients. I don’t know if anybody else uses the term, but in my mind it means “Get Out of My Office”, specifically “and to the ER instead”.

The other day I was called to the lab to see an elderly looking main, who turned out to be my own age (that gave me pause, and maybe I need to do some introspection here…), who looked a little peaked as two phlebotomists were trying to coax him into the phlebotomy chair and off his feet.

“He feels lightheaded”, I was told.

“Are you fasting this morning?” I asked.

“Yes”, he answered after he landed in the chair.

“Are you a diabetic?” I continued.

“Yes”, he said.

“Let’s get a finger stick blood sugar”, I said. It was 188.

I grabbed a blood pressure cuff. His pulse was 80, and so was his blood pressure. His oxygen saturation was 96%.

“Are you having any chest pain?” I asked.


“Are you short of breath?”

“A little.”

“Did you eat okay yesterday?”


“Why not?”

“I didn’t feel good.”

I thought of my blog post “Twenty Questions” as I continued my interrogation.

“In what way did you not feel good?”

Finally, he uttered two dozen words at once:

“I did some yard work yesterday morning and when I came back inside I felt really weak and nauseous so I didn’t eat all day.”

“Did you have any chest pain then?”


“Did you have any diarrhea or vomiting?”


By that time it was clear this man was a G.O.M.O. that needed to go to the ER by ambulance. His EKG was normal, his blood pressure remained low at 80/60 and by the time the EMTs rolled him out of the lab on a stretcher, I had called the ER and we had faxed his medical history to Cityside.

Sometimes all we do is triage, I thought to myself as I sat down at my desk with the M*A*S*H* poster in front of me.

2 Responses to “A G.O.M.O.”

  1. 1 mary dunn January 15, 2018 at 5:09 am

    can we know “the rest of the story”?

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Osler said “Listen to your patient, he is telling you the diagnosis”. Duvefelt says “Listen to your patient, he is telling you what kind of doctor he needs you to be”.



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