Nothingness: the role of journals
BMJ 2004; 328 doi: https://doi.org/10.1136/bmj.328.7438.0-g (Published 26 February 2004) Cite this as: BMJ 2004;328:0-gAll rapid responses
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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
Competing interests: No competing interests
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
Competing interests: No competing interests
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.
Competing interests: No competing interests
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
Competing interests: No competing interests
...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
Competing interests: No competing interests
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
Competing interests: No competing interests
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.
Competing interests: No competing interests
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.
Competing interests: No competing interests
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
Competing interests: No competing interests
Re: Gomer comes from Samuel Shem's "House of God" and stands for "Get Out of My Emergency Room"
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
Competing interests: No competing interests