Hospitalist Wingman Response: GOMERology as a New Subspecialty.

I have been a practicing hospitalist now since 2003. In that ten years, hospitalist medicine has been the fasting growing medical specialty in America. Our tentacles run deep and they run far. We offer incredible value, directly and indirectly, in the delivery of hospital based medicine. We are maturing as a field and we shall continue to define our role in the constantly changing Medicare landscape.

Hospitalist medicine even has its own focused maintenance of certification board exam. I believe this vindicates the field as a stand alone specialty. However, just as it took a decade to divide internal medicine into an inpatient vs outpatient experience, a great divide is occurring within the field of hospitalist medicine that is spilling over into the field of emergency medicine too.

I present to you the fastest growing subspecialist in hospitalist and emergency medicine: The GOMERologist. That's right folks. You heard it here first on The Happy Hospitalist. Mark your calendars. In ten years, the fields of hospitalist medicine and emergency medicine are going to offer a combined subspecialty board in GOMERology. I sat for my internal medicine boards late last year and rocked them solidly. Ten years from now I am going kill my GOMERology boards without even lifting a finger.

Emergency Medicine News recently published an article by Dr Edwin Leap titled Second Opinion: The Hospitalist's Wingman. Dr Leap eloquently described the fraternal relationship hospitalists have with emergency medicine physicians. We are the last men and women standing in a rapidly collapsing health care financial tsunami coming our way. He feels our pain. We feel his pain. We are the poster children for it hurts all over.

The Baby Boomers are here and they aren't going away. They're getting older. They're getting weaker. They're getting too old to go home from the ER. As Dr Leap astutely points out, they see the GOMERs first. We are their wingman to get them out of the emergency room. Us hospitalists are not alone in our on the job training to become experts in managing suboptimal wound care orders and strange tube feed regimens that pepper the nursing home landscapes of America. Excuse me, I meant skilled nursing facilities (SNF).

We are in this together. The old are getting older and the younger generation is too busy sharing the latest cat picture on Facebook to jimmy rig their basement bathroom with handicap toilet bars for grandma and grandpa to live out their final decade of life with family. Nope, they have Medicare and the three midnight rule, which if played correctly, will provide decades of fraudulent nursing home care on the backs of half the tax paying American public who are stricken with such difficult life decisions about whether to pay the cable bill or the data plan on their smart phone that is 2 months overdue.

Every year that passes in my tenure as a hospitalist, I admit more and more GOMERs to the hospital. I work feverishly to maximize their intensity of service and create complexity where none exists, all in an effort to qualify this Medicare beneficiary for their three midnight stay and a 100 day ride on the Medicare National Banks' merry-go-round of life. You see, it's not good enough anymore to be a great doctor providing great care. What hospitals really need these days are experts in optimizing the game of Medicare 2.0.

What better way to process old people in the ER than to combine emergency medicine's expertise in initial point of care contact with the GOMExpertise of hospitalists who excel in this madness consuming inpatient medicine. In a few short years emergency medicine physicians and hospitalists will have the opportunity to combine forces as expert GOMERologists to provide care for Medicare patients that are too wrinkled to see or too crooked to stand. GOMER patrols promise to revolutionize the delivery of hospital based nursing home care forever.

Ten years from now I can see myself working full time from home as a GOMERologist, using our MARTI translation system to personally speak GOMER with my patients to complete my 10 point review of systems and physical exam. I'll even get to fill out my prepopulated level threehospital followup electronic progress note template while drinking a pot of coffee and watching cartoons with my kids.

Subjective: ROS and HPI unable. Patient is a GOMER
Objective: VSS--see EMR
Head: Looks normal
Eyes: closed: Exam unable
Mouth: Q-sign present
Neck: No JVD
CV: Chest wall motion means blood is flowing.
Lungs: Normal chest wall movement.
Abdomen: Constipated
MS and skin: Both are present
Neuro: Arms flailing
Psychiatric: Crazy
Assessment: GOMER: Too weak to go home with major complicating condition of too old to order telemetry.
Plan: Q 4 hour neurochecks, IVFs at 125 cc/hour. IV vancomycin in case there is infection. Blood cultures to verify presence of blood flow. Qualify for 3 midnight SNF stay and discharge when nursing home has a bed next month. Reviewed case details with RN.

Hey docs. Yeah you, the ones that mock hospitalists and ER physicians as beneath your skill set . Our day has arrived. Who's laughing now. If only you knew just how great a life you could have as a GOMERologist, submitting 100 E/M charges a day from the comforts of your own home. We're livin' the American dream! Someday you're going to be a GOMER too. When that day comes, you're going to thank us for our skills. This original Happy Hospitalist ecard helps explain.

"Let's just be honest, shall we? We aren't hospitalists. We are GOMERologists."

This post is for entertainment purposes only and likely contains humor only understood by those in a healthcare profession. Read at your own risk.

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source : http://thehappyhospitalist.blogspot.com, http://flickr.com, http://kompas.com

Posted by Tutik W