Official Gomer Rating Scale

Admitting letter from local MD ends with “Sorry.”10 points
Local MD.’s letter begins with “Than you for admitting…”10 points
Has untreated fractured N.O.F. for over 3 weeks prior to presentation7 points
Fractures hip

  • while in hospital
  • while restrained
  • while in traction for fracture to other hip
3 points
6 points
9 points
Spikes temperature night prior to discharge4 points
Decides “doesn’t like” nursing home that Social Worker has taken 6 weeks to locate5 points
Hemoccult positive stool night prior to discharge5 points
Sent back from X-Ray Department without having requested Barium Enema performed8 points
Removes own

  • IV line
  • NG tube
  • sump drain
  • peritoneal catheter
  • chest tube
  • ventriculo-peritoneal shunt
2 points
3 points
5 points
8 points
10 points
15 points
Removes own foley with 30mL balloon full

  • while restrained
5 points
10 points
Any one of the following

  • age < urea
  • hemoglobin < shoe size
  • years in N.H. > years not in N.H.
  • number of hospital presentations > age
5 points
5 points
5 points
5 points
Toenails cannot be cut with nail clippers3 points
Urinates on

  • roommate
  • visitor
  • resident physician
  • consultant
  • medical student
2 points
4 points
5 points
7 points
1 point
Fluid balance chart OUTPUT column reads “voided in bed”

  • on more than 4 occasions
  • while catheterised
4 points
8 points
Stool specimen (unrequested) found 10 feet from bed5 points
Aspirates dentures

  • requires tracheostomy for same
6 points
12 points
Femoral punture required for daily bloods3 points
Problem list 1 page long5 points
Falls out of bed despite bed rails and 4 point restraint4 points
Old notes

  • 2 volumes
  • 2 Kg
  • 2 feet high
3 points
3 points
3 points
Admitted by same Intern to more than 3 different teams6 points
Overlooked on attending rounds on three consecutive days4 points
Requests cigarette during spirometry5 points
Fecal impaction

  • despite ileostomy
  • if ileostomy originally for fecal impaction
  • under fingernails
6 points
12 points
20 points
Answers “yes” to all questions4 points
Answers “yes” to all questions asked to other patients in the room8 points
Found drinking from urine bottle (own) Found drinking from urine bottle (neighbor’s)

  • while on strict fluid balance chart
  • while NPO
3 points
6 points
9 points
12 points
Psychiatry consult suggests transfer but declines same3 points
Admission begins “Found unresponsive…”5 points
Patient breaks thermometer while in:

  • oral
  • rectal
3 points
6 points
Room disinfectant concentration causes conjunctivitis2 points
Refused by VA Hospital despite service in two World Wars8 points
Clings to resident physician.’s arm though grasp reflex is negative5 points
Easier to understand without dentures3 points
Welcomes Medical Students7 points
Daughter rings Social Worker more than 3 times per day6 points
Appreciates hospital food10 points
Requests bedpan immediately on arrival in hospital3 points
Sits in waiting room following discharge5 points
Knows catering staff by name5 points
File includes more than 3 Incident Report forms5 points
Squamous metaplasia of tongue due to prolonged exposure to air (Q sign)8 points
Successfully resuscitated by Paramedics20 points

  • request admission
  • demand admission
  • arrive with patient’s suitcase in hospital
3 points
6 points
9 points
M.R.S.A. discovered after admission

  • to ward
  • to theatre
  • to I.C.U.
2 points
3 points
4 points
Anointed by priest prior to presentation6 points
Presenting complaint reads only “Social Admission” and/or management plan reads only “For Placement”5 points
Bounces after turf to Neurosurgery20 points

Notes: All points doubled 0000-0700; 25% loading for non-English speaking patients; 37.5% loading for recognised dysphasias




0-20:Hardly a Gomer at all. Almost Human.
20-40:Borderline Gomertose. Reassess frequently.
40-60:A true Gomer. Avoid all contact. Placement a priority.
Over 60:Apply for Special Leave immediately, or consider Psychiatry Training.
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