Dr Phil Hammond, GP, lecturer and presenter of BBC2's Trust Me, I'm a Doctor

Is it possible to be a good doctor and have a sick sense of humour? Is it possible to work in the NHS without one?

Laughing at misfortune is a human trait, but in medicine we see more misfortune – in volume and severity – and often we don't have the time, training or emotional machinery to deal with it. So we laugh.

Medical science is all about diagnosis by reductionism, and patients may also be reduced to pejorative labels not just for diagnostic purposes but also for ease of emotional processing.

This tactic was first described in a book called The House of God, written by a pseudonymous American doctor called Samuel Shem in 1978.

Shem coined the acronym Gomer – Get Out Of My Emergency Room – to describe what you want to shout at 3am when faced with human beings who have lost what goes into being human beings.

They want to die, and we will not let them. We're cruel to the Gomers, by saving them, and they're cruel to us, by fighting tooth and nail against our trying to save them. They hurt us, we hurt them.

In Shem's experience, Gomers don't die so you have to try to 'turf' them. To turf is to get rid of, to get off your service… it's the main form of treatment in medicine.

Last year, I was sent The Official Definition Gomer Rating Scale that a junior doctor had found pinned up on the doctors' wall in a Liverpool casualty department.

According to the scale, Gomers are given point scores for signs or attributes. A score of 40–60 means a true Gomer – avoid all contact – and a score of over 60 means apply for special leave immediately. Examples are shown in the box above.

Most doctors believe that patients should be protected from this sort of humour, that it should stay in the sluice room or behind the closed doors of medical school. But in my (perhaps misguided) quest for openness, I think medical humour should be exposed.

If you want the public to understand doctors and nurses, the type of people we are and what our work does to us, they need to understand our humour. Whenever I've tried to get this debate out in the open, I've been shot down for exaggeration. They're only jokes after all.

But does this sort of humour allow doctors to face up to the stress of the job and the futility of human existence? Or does it lead to the dehumanisation and neglect of patients?

It's your decision. Vote now at Phil_Hammond@msn.com

The Official Definition Gomer Rating Scale – sample scores
Admitting letter from GP ends with sorry
10 points
Urinates on nurses
20 points
Toenails cannot be cut with nail clippers
3 points
Stool specimen (unrequested) found 10 feet from bed
5 points
Answers yes to all questions
4 points
Answers yes to all questions asked to other patients in the room
8 points
Refused by private hospital
8 points
Easier to understand without dentures
3 points
Room disinfectant causes conjunctivitis
2 points
Overlooked on three consecutive consultant ward rounds
4 points
Faecal impaction under fingernails
20 points

  • Dr Phil presents Trust Me, I'm a Doctor, Wednesdays, BBC2, 7.30 pm. The book of the same name is available for £8.99 on 01476 541080.

Guidelines in Practice, April 2000, Volume 3
© 2000 MGP Ltd
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