The television show "Scrubs" premiered on NBC in the fall of 2001. By the time the show was canceled last May, viewers had been treated to a lot of laughs — and some new vocabulary as well. One of the new words — an acronym really — was GOMER, which stood for "Get Out of My Emergency Room." The origin of the term is believed to have been the Samuel Shem medical novel "The House of God."
Although most medical professionals find the term distasteful and disrespectful, the terminology persists. GOMERs are ER frequent fliers. They often have complicated and intractable conditions — problems that do not lend themselves to successful ER treatments.
I may have heard the term for the first time during the epic run of another TV medical drama, the long-running "ER." I hadn't thought about it in years, but the May cover story of HealthLeaders magazine brought the term to mind. ER (for Emergency Room) has now become ED (Emergency Department), but the headline said it all: "The New ED: Keep Patients Out (but Happy)."
As we noted last week, emergency room visits in Massachusetts are up 9%, and the Bay State is not alone in seeing an increase in ED traffic. According to the Agency for Healthcare Research and Quality and the CDC, in 2008 alone, 124.9 million people visited an emergency room in the United States. Of most concern to all is that, according to the American College of Emergency Physicians, ED visits increased by nearly 22 million between 1997 and 2007 — this is 23% faster than the U.S. population.
The HealthLeaders article takes a positive position, suggesting that the ED may have a new role to play in reducing the 50% to 60% of visits that result in hospital admissions. That's a great goal and would represent an amazing achievement — as patients make U-turns out of the ED to receive care in a more appropriate setting.
Yet as insurance costs increase and employers — especially small businesses — decide to opt out of providing comprehensive medical insurance, the numbers seeking care in the ED are expected to rise exponentially, and they won't just be GOMERs.
