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Interview with Dr. Kevin Pezzi

I receive so many requests for interviews from students that I cannot possibly accommodate all of them, although I've answered many of their questions in my various Q&A pages in this web site.  I posted this interview to help students who can't coax me into a full interview, although I'll always answer any questions you pose that I have not yet covered.

Note to radio, television, newspaper, and other publishing professionals:  I am always willing to do media interviews, and I will gladly assist you in providing information for stories you're developing.  If you send me an e-mail and you don't hear from me, please contact me again.  I've had a few computer crashes (thanks, Bill Gates) that wiped out my e-mail inbox.

Some of the topics in this wide-ranging interview:  Why I chose ER • Different shifts, different patients • The fate of most ER doctors • The pros and cons of ER medicine • Misuse of the ER • How ER doctors cope with impossible circumstances • The unappreciated collateral damage of wacky patients • Reactions to his first two books • HMO's:  bloodsuckers in disguise? • Ways to control healthcare costs • The exorbitant price we pay for FDA bureaucracy • Frivolous medical malpractice suits • Low-cost cosmetic surgery • Physician's Assistants and Nurse Practitioners • A doctor who videotaped himself having sex with a patient in the hospital chapel • McDonald's best customer • Doctors as patients • Drunk doctors as patients • The idiocy of prescription drug commercials • The myth of preventive medicine • Losing weight without dieting, drugs, exercise, or surgery • Hospital food that'd rival any 5-star restaurant • Pezzi's surprising next book • Esoteric medical knowledge and politics • The unfairness of fairness • What's Pezzi really like? • Dating requisites • A date from hell • The rationale for postponing caffeine use • Other drugs to enhance brainpower • Thomas Edison and cocaine • Being tempted with money and sex in exchange for prescribing narcotics • Politics • Compensating families of the 9-11 tragedy • Lisa Beamer • What not to say during your medical school interview • Toxic sock syndrome • Big Mac Attack:  Massacre at a McDonald's • Why I'd prefer medical school applicants who've been poor, and who've had a serious health problem • How being rich and coddled can put your patients in danger • A guy with a long glass tube up his rear who almost died because what his doc needed to know wasn't taught in medical school •

Today's interviewer is Ingrid, an 11th grade student who is considering a career in emergency medicine.

Ingrid: Thank you for agreeing to do this interview, Dr. Pezzi.  My first question concerns why you chose this profession.  What factors entered into your decision?

Dr. Pezzi:  I began medical school with the implicit expectation that I'd specialize in internal medicine.  I read The Merck Manual twice in high school, and that—being my first real exposure to a medical textbook—pushed me toward internal medicine since that book has a decidedly medical bent to it.  It does cover some surgical topics, but just superficially.  Also, I was drawn to the notion of developing close relationships with my patients, much in the same way as I'd witnessed watching Marcus Welby, M.D. on television as a youngster.  I know that must sound as if it's an impossibly naive goal, but that was the idealistic notion with which I began my medical career.

Ingrid:  What changed your mind?

Dr. Pezzi:  Internal medicine is often denigrated by medical students as "eternal medicine" since it frequently involves treating lifelong diseases for which there is no cure, such as diabetes or idiopathic hypertension (high blood pressure without an identifiable cause).  Maintaining the status quo is the treatment goal in those conditions, and that lacks the emotional satisfaction of being able to effect a cure or to do a procedure and see an immediate result.  In contrast, emergency medicine offers many opportunities for producing an immediate change.

Ingrid: Were you also drawn to the glamour of that specialty?

Dr. Pezzi: What glamour?  That notion is largely attributable to the flood of ER and other medical shows that are so popular on television these days.  However, when I began my ER residency those shows hadn't yet appeared, so us ER residents didn't know that what we were doing would be dramatized so favorably by Hollywood.  In fact, many of us possessed an antithetical viewpoint based upon the reality of working in an ER.  I'll never forget what my ER residency director said to me at the beginning of my first year as we walked together in the hospital.  Out of the blue she turned to me and said, "Kevin, you know that ER medicine is scumbag medicine, don't you?"  At that time I wasn't yet very familiar with the term "scumbag" but I quickly got the gist of what she said.

Ingrid:  Which was?

Dr. Pezzi:  Which was that the practice of ER medicine predominantly involves treating people you'd rather not have as a next-door neighbor:  drug addicts, alcoholics, criminals, and psychotic people in addition to people who are bizarre but fall below the threshold for a major psychiatric diagnosis.  Naturally, some perfectly normal people end up as patients in the ER through no fault of their own, but those people are often in the minority, especially on the night shift.

Ingrid:  Are there differences in the patients you see during different shifts?

Dr. Pezzi:  Most definitely.  During my ER career I usually worked the night shift, primarily because I was enticed by the extra money my partners offered me to shoulder that shift.  However, I'd occasionally work day or afternoon shifts, too.  When I worked those shifts I was amazed by how normal most of the patients were.  During the night shift I saw things I previously thought were unimaginable.

Ingrid:  How did that affect you?

Dr. Pezzi:  At first I thought it was interesting, but it can be very wearisome catering to people who often create a ruckus in the ER with their unruly behavior.  For example, taking care of someone with a given problem, such as chest pain, is much more difficult if that person is stoned on drugs or alcohol and is constantly screaming profanities, pulling out his IV, throwing things, hitting people, urinating on people . . .

Ingrid:  You're exaggerating, aren't you?

Dr. Pezzi:  Oh, no.  I haven't yet mentioned throwing feces, pulling out a knife or gun, escaping from the ER, threatening to sue us, threatening to come back with a gun and kill us . . . do you want me to go on?

Ingrid:  I get the picture.  OK, going back to what your ER director said to you about how ER medicine was scumbag medicine—how did you respond?

Dr. Pezzi:  I told her I didn't care.  And at that point, I didn't.  I had not yet had enough exposure to that element to know how difficult an ER career can be.  The burnout rate in this specialty is shocking, and many ER docs chuck their careers and do something else.

Ingrid:  Like what?

Dr. Pezzi:  Some stay in medicine but choose another specialty, while others leave medicine altogether.  Some go into law, perhaps figuring "If you can't beat 'em, join 'em" while others do anything to make a buck, such as being financial advisers, real estate salesmen, police officers, bartenders, and Amway reps.

Ingrid:  Amway reps?

Dr. Pezzi:  Yes.  I suppose that underscores what I've said before about how the reality of being a doctor is markedly different than the public perception of what it is like to be a doctor.

Ingrid:  But there must be some good things about being a doctor.  What do you like most?

Dr. Pezzi:  I enjoy doing things better than other doctors—I suppose that's my competitive nature in operation.  There aren't many opportunities for an ER doc to excel, since much of what we do is so routine and formulaic.  However, during meticulous surgery, such as repair of facial lacerations, there is clearly a difference in outcome that depends on the physician's skill.

I also enjoy taking care of decent, normal people with genuine problems.  I'm not fond of oddballs who concoct imaginary problems.

Ingrid:  Such as what?

Dr. Pezzi:  Such as some patients I had who lied and told me they'd been vomiting, or paralyzed, or having chest pain, or just about anything under the sun.  I've heard just about everything.

Ingrid:  Why would someone lie about having chest pain?

Dr. Pezzi:  In the most outrageous case I saw, that lie was intended to get the fellow a free ride in an ambulance to the hospital.  He called 911 and told the operator he was having chest pain, and when he arrived in the ER he continued his charade.  After I did the usual EKG, multiple blood tests, chest x-ray, and cardiac monitoring he told me he'd never had any chest pain.

Ingrid:  Why did he want a ride to the hospital?

Dr. Pezzi:  To visit his girlfriend, who was an inpatient.  He told me his car was broken down, and he couldn't afford a cab.  Pretty expensive way to get a cab ride.

Ingrid:  What was the cost?

Dr. Pezzi:  With the ambulance and ER charge, it must have been at least $2000.

Ingrid:  Did he ever pay the bill?

Dr. Pezzi:  Are you kidding?  In this country, people who are that financially irresponsible are bright enough to elect politicians who force the taxpayers to shoulder such charges.  People often wonder why medical care is so expensive.  Well, here is a good example.  I could give you a few hundred more, but that would take too long.  However, if any politicians would like me to testify so you can obtain a better insight into how medical insurance premiums and the taxpayers' money is wasted, I'd be happy to oblige.  Just prepare yourself for an eye-opening experience.

Ingrid:  What percentage of ER patients don't need emergency treatment?

Dr. Pezzi:  I kept score one fairly intense night, and by my estimation two-thirds of the patients did not require ER treatment.

Ingrid:  So why did they go to the ER?

Dr. Pezzi:  Many reasons.  Sometimes it is because their insurance covers ER visits but not scheduled office visits.  Other times it is because the ER is so convenient, since we're open 24 hours a day, 365 days a year.  Sometimes people are lonely and unfulfilled in their personal lives, and their relationships with the ER staff are an important aspect of their lives.  Sad, but true.

Ingrid:  Going back to the topic of whether or not it's desirable to be an ER doctor:  if that profession has so many drawbacks, why is there such competition to be accepted into an ER residency program?

Dr. Pezzi:  For the same reason that men compete so intensely for the limited number of beautiful, intelligent women with great personalities—because there is a limited supply of them.  It's the old law of supply and demand.  There are a limited number of ER residency positions, and there is no shortage of medical students who, in their youthful zeal and suffused with idealism, find it easy to overlook the drawbacks of being an ER doctor.

Ingrid:  What's the worst aspect, in your opinion?

Dr. Pezzi:  I can't give you any one answer to that question, but here are a few things that immediately come to mind:  after months of inadequate sleep, being so incredibly tired even before my shift began that I had no idea how I'd make it through a 12+ hour night shift.  Another thing:  spending my holidays in the ER, instead of with my family.  Another thing:  having to routinely rush to take care of patients.  To some degree that is an inescapable aspect of ER work since there is no way to know in advance how busy the ER will be during any given day and time.  Hence, it is difficult to schedule for unexpected surges in ER volume.  However, I used to work in an ER in which almost every day was a busy day, and many days were so busy that it was humanly impossible to keep up with the pace and do a thorough job.

Ingrid:  So how do ER doctors cope when it is that busy?

Dr. Pezzi:  By cutting corners.  I was once assigned to review the charts of my ER colleagues—a task that I performed only because it was one of my medical staff duties—and I was amazed by how even board-certified ER doctors frequently omit essential elements of the history and physical.  I'm talking about very basic things, such as performing a rectal exam on someone with abdominal pain, or checking leg pulses in an elderly patient with abdominal pain.

Ingrid:  What was the worst thing you've ever seen an ER doctor do?

Dr. Pezzi:  I've seen ER docs make all kinds of errors, some of which were partially excusable since they were a one-time aberration.  What I find impossible to excuse are repeated mistakes that are obviously intentional.  For example, one doc with whom I worked would give patients with abdominal pain an injection of morphine.  Not surprisingly, they'd feel better, and he'd discharge them without doing any tests or arriving at a definite diagnosis.  What he did was akin to giving an anxious patient a bottle of booze to calm him down.  No, on second thought it's even worse, since anxiety is rarely life-threatening and abdominal pain may herald a serious problem that should be addressed, not just temporarily suppressed with a narcotic shot.

Ingrid:  Why do you think he did that?

Dr. Pezzi:  I think he was sick of seeing patients, and just wanted to get them out of the ER.

Ingrid:  Is that why you wrote your book—to expose such practices?

Dr. Pezzi:  That's certainly one thing that riles me, but I'm not going to get on my high horse and say that I'm perfect in that regard.  The only thing I can say with a lot of justification is that, on average, I'm more thorough than an average ER doc and less likely to give patients short shrift.  During my ER residency one of my teachers faulted me for trying to deal with all the patients' complaints . . . and in Detroit, that's often a long laundry list!  Since they'd often never see a doctor except in the emergency room, I figured if I didn't address their problems, who would?  However, my teacher told me to pick just one problem that seemed the most serious, and blow the others off.  So if I had a patient with an asthma attack and a toe that was falling off, I was supposed to ignore the toe problem.

Ingrid:  Did you?

Dr. Pezzi:  That's very hard for me to do.

Ingrid:  In your ER book you don't seem very sympathetic to people with silly problems.

Dr. Pezzi:  I'm not.  I've never complained about a patient with a legitimate medical emergency, but it's an entirely different matter to kowtow to the quirks of patients who have nothing that resembles an emergency.  Many ER docs complain about such cases (pejoratively terming them "bullshit" or "crock" cases in the lingo of the ER), but never do anything about them, perhaps figuring that they're still being paid to see them, or perhaps figuring that such visits are benign.  In regard to the latter, I'm not in agreement.  Such patients are wasting limited healthcare dollars that could be put to much better use, and they're also frittering away the time of the ER doctor and staff.  Patients who come to the ER for legitimate reasons should not have their care delayed because the ER is busy attending to "bullshit" problems.

Ingrid:  So why don't the doctors just ignore the BS problems and go on to the real ones?

Dr. Pezzi:  I've yet to see a patient come into the ER carrying a sign saying, "I have a bullshit problem."  Oftentimes even the BS problems seem legitimate at first glance, such as the guy I discussed above who presented with chest pain but who really just wanted a free ride to the hospital so he could flirt with his girlfriend.  By the time the BS is discovered, time has already been wasted, so the damage has been done.  That's unfortunate, because at this very moment thousands of ER doctors are rushing to get on to the next patient who may or may not have a real emergency.  It's indisputable that some valid patients are not given all the time and attention they deserve, and this is one of the factors behind it.  Some people think I'm a cold and insensitive doctor for criticizing any patient, but I think people are cold and insensitive if they opine that we should ignore the ancillary consequences of the wacko element in this society.  Even if all the medical needs of a patient are met, patients often have emotional needs that should be addressed, too.  What about a man with a myocardial infarction (heart attack) who is scared out of his wits about dying?  We're not going to automatically assuage his fears just by pumping him full of clot-busting TPA, and his anxiety can in fact contribute to his medical problem and, for example, promote arrhythmias (abnormal heart rhythms).  Thus we should allay his fears, but if time is short—as it so often is these days—the emotional support is the first thing to go.  Hence, I don't think that wacky patients are just a benign annoyance.  Another reason that wacky patients provoke my ire is because they're wasting the limited number of healthcare dollars, as I said before.  Any dollar spent on a wacky patient cannot be spent on a legitimate patient.

Ingrid:  When you refer to wacky patients, are you referring to patients with mental illness?

Dr. Pezzi:  Not at all.  I firmly believe in the legitimacy of mental illness.  While it's often fruitless to assign culpability for various diseases, if anything I think that people with mental illness have less responsibility for inducing their illness than many patients with physical problems that are often induced or exacerbated by overeating, smoking, lack of exercise, eating junk foods, imbibing too much booze, using drugs, or failing to exercise discretion in the choice of a sexual partner.  However, many people think that mentally ill people are just weak.  Those folks obviously aren't cognizant of research over the past several years that revealed a link between mental illness and various prior, or longstanding but smoldering, CNS (central nervous system) infections.  So would I ever take a whack at such a patient?  Never.  What grinds me are the people who act like oddballs but possess the mental wherewithal to know that his or her actions are wrong.

Ingrid:  Such as that guy who used an ambulance as a cab to get to the ER?

Dr. Pezzi:  Exactly.

Ingrid:  But how do you know that he knew what he did was wrong?

Dr. Pezzi:  That's easy.  If he wasn't cognizant of the fact that what he was doing was ludicrous, he never would have concocted his duplicitous chest pain story.  The fact that he dreamed that up is proof that he sought to give a socially acceptable excuse for calling an ambulance.  If he were truly incapable of recognizing the wrongfulness of his cockamamie request, as might be the case with a mentally ill person, he would not have attempted to give it a socially acceptable veneer.

Ingrid:  Interesting . . . I see your point.  Going back to your residency in Detroit, what surprised you most about that?  Did you see many crock cases?

Dr. Pezzi:  Surprisingly few.  We saw an occasional patient feigning back pain or a kidney stone in an attempt to obtain narcotics, but for the most part the majority of the patients had genuine problems—lots of them, in fact.  One thing that astounded me was the prevalence of heart disease in that population, perhaps triggered by untreated hypertension.  Another thing that surprised me was the lack of sophistication of the patients.  In all my years in Detroit, I had a grand total of one patient who knew the names and doses of her medications and why she took them.  The most common response of the others was something along the lines of, "I'm on the blue pill."  Why?  "I'm taking the little blue pill 'cause I be sick."  And how are you sick?  "I'm sick all over."  And how long have you been sick?  "A long time, doctor."  And how long is a long time?  "A long time—I just done told you that, doctor."  I'm here to tell you that after a doc hears such an unhelpful history a few hundred times he's ready to pull his hair out.  After all, malpractice attorneys presume that adult patients can give better medical histories than what veterinarians obtain.

Another thing that surprised me was how violent Detroiters were to one another.  Vicious, merciless, sickening, and pointless violence that goes on and on.  Many kids were murdered simply because they wouldn't hand over their leather jacket, T-shirt, or shoes.  Ironically, those items were invariably destroyed in the murder, and the assailant never got what he sought.  It was just wanton vindictiveness.

Ingrid:  What reactions surprised you most about the publication of your books?

Dr. Pezzi:  What surprised me was the degree to which those books elicited either strong praise or condemnation.  For example, I never expected those books would result in me being offered my own television show or that my words could elicit such an ardent following in some circles.  On the other hand, I never imagined that others would become so embittered that they'd make up lies just to slander the ER book.

Ingrid:  Can you give me an example?

Dr. Pezzi:  One reviewer claimed that my stories "are all the same."  Clearly, that's patent BS.  There are hundreds of ER stories, and dozens of different story types.  If you read a brief listing of those story types that I posted on my ER book page (see below), you'll know that the stories are anything but "all the same."

You will meet healthcare personnel whose thirst for revenge is chilling. You will read about people who look for love in the ER — of all places! You will hold your breath as I tiptoe through a case in which the patient was at risk of being murdered — by her father. You will meet a beautiful teenager who tried killing herself after having an affair with her psychiatrist. You will watch me fight to keep a patient from endangering the lives of dozens of hospital visitors. You will encounter people with very unusual habits. You will hear about a child who was shot in the head with a bullet, but didn’t know it. You will find out if I can resist the temptation of a gorgeous woman who offered me her body in exchange for a prescription for narcotics. You will witness a shocking end to a friendship. You will read about how an uppity nurse refused to ease the suffering of a dying man. You will understand how a homeless man gave me an unexpected insight into why some homeless people are homeless. You will observe a patient eat a sandwich that was soaked with the blood of his mother. You will discover how a man used a gun to seek revenge against a pit bull that had savagely mauled his young daughter. You will see your tax dollars and insurance premiums go up in smoke as the price of maintaining the status quo, and you’ll understand why the shenanigans of lawyers are more than an economic drain. You will discover why ER docs have the highest burnout rate of any medical specialty, and you’ll begin to see the Hollywood depictions of the ER for just what they are:  fiction. These stories, and several dozen more, are in TRUE Emergency Room Stories.

So those stories are all the same?  Hardly.  However, it's reassuring when people are so desperate to find fault that they're forced to pick at something so absurd and imaginary.  Another reviewer berated me for mentioning the amount of free medical care I gave in one year, which was over $70,000.  That reviewer conveniently neglected to mention that figure but wailed about how it was "not much."  Not much?  Is that person tuned into reality?  Gee, if I'd included my other donations for the year, they would have been over $100,000.  That may be pocket change for Bill Gates, but for an ER doc that is a huge sum of money.  I'll bet that that's more money than that complainer gave in his entire lifetime.

I'm of the opinion that many people hate doctors and they're looking for a reason to stick a knife into them.  One of my grandfathers possessed such a burning hatred of doctors that I never told him that I was one.  Countless people idolize actors who play doctors on television, but despise real-life doctors.  Oftentimes her personal physician is kindly regarded, but other doctors are frequently chided as being moneygrubbers who ineptly leave a trail of dead bodies in their wake and who ignore the needs of their patients, such as their need for adequate analgesia.  Have you watched the news these pasts few years?  There were a slew of stories about deaths caused by medical errors, and then there was a lot of bellyaching about how docs don't give their patients enough pain meds.  After a few months the nitwit news anchors then babbled about how we're giving patients too many narcotics and turning patients into addicts!  OK, Tom, Peter, and Dan, what is it?  Are we giving too few narcotic prescriptions or too many?  Sheesh!

Another absurd criticism of the book came from a person who didn't like that I praised the intelligence of Dr. Laura Schlessinger, host of the popular Dr. Laura radio talk show.  I presented a case in the book about a pregnant teenager who was in extreme danger of being killed by her father.  Without retelling the entire story here, the situation was such that calling the police to protect her was utterly useless.  What the problem boiled down to was a sticky dilemma for which there was no good solution.  In the end, the teenager's mother chose a plan that saved her daughter's life, but it was a decision that would have caused Dr. Laura to go ballistic.  Since Dr. Laura would never choose Plan A, she was faced with a couple other not-very-appealing options.  Superficially, one of them might seem like the obvious alternative, but choosing them would undoubtedly carry some attendant risk that the daughter would be killed by her father—hence, we're back to the original problem.  Dr. Laura fancies herself as a person who can moralize her way out of any dilemma, and one of my reasons for mentioning her was as a friendly challenge to see if she could solve a dilemma that I thought was beyond even her powers.

Ingrid:  So why on Earth would someone criticize you for what you said about her?

Dr. Pezzi:  That person was obviously a liberal whose hatred for the conservative viewpoints of Dr. Laura was so extreme that he'd take a whack at anyone who had something nice to say about her.  I certainly don't agree with all of Dr. Laura's viewpoints, but one undeniable fact is that she's very bright.  The left-wing thought police evidently won't tolerate any statement unless it harmonizes with their viewpoints.  However, facts are facts, and Dr. Laura is intelligent.  Trying to claim otherwise is like saying that Bill Gates isn't rich.  Now there's a fact that I don't like, but I'll never waste my breath slamming someone who mentions that fact.

Ingrid:  This is getting off track, but why don't you like the fact that Bill Gates is rich?

Dr. Pezzi:  If Bill Gates were even half as smart as he and his sycophantic troops claim that he is, years ago he could have given us stable, relatively bug-free software that was easy to use and didn't require endless tinkering that's masqueraded as "upgrades."  I used non-IBM compatible computers for years before I began using IBM-compatible computers powered by Microsoft software.  In those pre-Microsoft days, I often heard Microsoft customers lamenting their frequent computer crashes and other Microsoft maladies.  That made me wonder what was a computer crash.  In all my years of using those other computers I'd never experienced a crash, so I had no idea what one was.  Professor Bill Gates taught me that lesson in a hurry after I was, like so many other people, sucked into the Microsoft fold.  All told, I estimate that I've wasted at least six months of my life fixing one problem after another with my computer that was attributable to the ineptitude of Gates and his Microsoft minions.

Ingrid:  I've also wasted a lot of time with crashes and bugs fixes, so I can sympathize.  Getting back to medicine, what do you think of HMO's?

Dr. Pezzi:  I think that's one of the great frauds perpetrated in the last century.  In a nutshell, here's how the HMO scam was accomplished:  businessmen convinced politicians that they could reduce healthcare costs by offering lower premiums.  Here's the catch:  that price reduction was temporary.  After those businessmen were firmly entrenched, they began raising their premiums at the same rate as traditional insurance companies, or even at a higher rate of increase.  If you factor in the money HMO's siphon off as profits and operating expenses, it is amazing how much blood is being sucked by those leeches.  Of course, that doesn't even take into consideration the human misery inflicted by HMO's and other managed care organizations.  Their layers of bureaucracy and red tape can be utterly frustrating.  I've canceled the bills of some patients just to save them months of frustration dealing with bureaucrats who don't know a thing about medicine.  Also, another factor that shouldn't be overlooked is the amount of time some physicians spend every week —sometimes 20 hours or more — interfacing with the bureaucrats and filling out forms, and so forth.

Ingrid:  How do you think healthcare costs could be controlled?

Dr. Pezzi:  Forget control; if I were the healthcare czar, I could slash healthcare costs in half.  I'd begin by requiring schools to educate people in the basics of health.  That would allow most people to care for trivial problems on their own, thus minimizing the number of BS cases such as the young woman I saw in the ER after she scratched her back and popped a pimple.  If such a person came in anyway, I'd require that person to pay for her care—not the taxpayers.  Whenever "you're got to be kidding" could be part of the diagnosis, the financial responsibility for the bill shouldn't be given to anyone but the person with the zany problem.

Next, I'd stipulate that pharmaceutical companies cannot charge more for their drugs in the United States than they do in other developed nations such as Canada.  Canadians pay considerably less for the same drugs we have.  The end result is that Americans are disproportionately shouldering the burden for drug costs.  I can appreciate the money that it takes to develop and market a new drug, but this burden should be equally shared by the users of that drug if they're reasonably able to pay.  Canadians are hardly paupers, and Americans are essentially giving them welfare by subsidizing their drug costs.  Ditto for the other developed countries, such as those in Europe.

I'd also revamp the policies of the FDA that are instrumental in increasing healthcare costs.  Let's consider the example of an EKG machine that is, like other medical devices, heavily regulated by the FDA.  If EKG machines of comparable quality were sold at Wal-Mart, they'd be priced somewhere in the neighborhood of a hundred dollars.  Years ago, I made an EKG circuit for one dollar.  The cost for an FDA-approved machine is several thousand dollars.  Furthermore, EKG machines are inexpensive compared to other medical gizmos, all of which could be far more affordable if the manufacturers didn't need to kowtow to the insane requirements of the FDA.

Ingrid:  How do you know that the requirements of the FDA are insane and not merely intended to protect patients?

Dr. Pezzi:  I'll give you a real-life example.  Years ago, I thought of using an existing drug to camouflage acne by fading the redness of individual acne lesions to a normal skin tone.  I discussed this with the two FDA officials who had regulatory authority for acne products and both verbally agreed there was no reason why this couldn't be safely used.  After all, that drug had been used for years in another application in which it would inevitably be inadvertently slopped onto the skin in a far greater amount than the miniscule amount I used to camouflage acne.  There had never been any adverse reactions from that inadvertent skin contact, so it is obvious that there wouldn't be any problem if it contacted skin in a far lower dose.  To make a long story short, an investor thought I had a great idea and he intended to advertise it on radio and in the Sunday newsmagazines .  However, he said that radio stations would require a letter from the FDA giving the OK to this product.  As soon as I requested the FDA officials, who'd previously agreed that my product was unquestionably safe, to vet this in writing, those officials then insisted that I perform clinical trials.  The cost for a clinical trial might be a quarter of a billion dollars, or more.  I countered that it was pointless to waste that money since that drug had a long, safe history of skin application in amounts hundreds or thousands of times more than were used in my application.  What the FDA officials insisted upon made as much sense as insisting that a flamethrower is safe, but a match is not.  Apart from wasting money, ridiculous and untenable positions such as this are one reason that people resent and feel contempt for government bureaucrats who have far more power than brainpower and common sense.

Ingrid:  What else would you do to control healthcare costs?

Dr. Pezzi:  Curtail frivolous medical malpractice suits.

Ingrid:  How would you do that?

Dr. Pezzi:  There are a number of ways.  A good start would be to copy the laws in other technologically advanced countries that offer medical care comparable to that in the United States yet aren't plagued by frivolous lawsuits.

Ingrid:  Can you give me an example of what you consider to be a frivolous lawsuit?

Dr. Pezzi:  Yes.  First, it's helpful to know the legal definition of malpractice.  Malpractice exists when a doctor does something that an average physician of his same specialty would not do, and this error resulted in harm to his patient.  If that were the reality of how alleged malpractice was litigated in our courts, I wouldn't have any reason to complain about it.  However, that definition has been so twisted that doctors can be sued for malpractice even when their performance is flawless.  I wrote about such a case in one of my ER books.  (If you'd like, you can read about it here.)  In that case, it's clear to anyone with a knowledge of emergency medicine that I was very cautious and didn't just do an adequate job, I did a perfect job.  Yet I, and other physicians, were sued because that guy had a heart attack almost a year later.  Ingrid, imagine that you're married and you made your husband not just an ordinary dinner, but you carefully prepared an extraordinary dinner.  Now imagine that almost a year later your husband began complaining about it, and blamed that meal for causing his current heartburn even though he'd eaten 1000 meals in the interim, the last 999 of which weren't prepared by you.  How would you feel?

Ingrid:  I'd be furious!

Dr. Pezzi:  And so was I.  I managed that patient impeccably, and there was obviously no connection between that treatment and his mild heart attack several months later.  When even perfect care is no guarantee that a doctor won't be sued, it is clear that doctors can never feel safe from frivolous lawsuits.

I don't think that most people have a good conception of how American lawyers are on such a rampage.  I heard on the radio this morning that 33% of all doctors and business owners are sued every year.  One of my old bosses, who was very much attuned to the legal aspects of emergency medicine, told me that an average ER doc is sued once every two years.  How is this litigation benefiting our country?  Lawyers would like people to believe that the fear of being sued makes doctors more careful, but I don't buy that argument.  Think back a few decades when malpractice suits were only initiated in cases of genuine malpractice; were doctors any less careful or attentive then?  If anything, a very good case could be made for the fact that doctors were then definitely more attentive and no less careful than they are today.  The fear of being sued forces doctors to engage in defensive medicine, such as ordering CYA tests to "cover your _ss" and increasing the referrals to specialists, all of which drives up the cost of healthcare.  As every economist knows, as the price of healthcare increases, it is priced out of the reach of more and more people.  I dropped my own medical insurance a few years ago after the monthly premium rose to more than my food bill.  If more people were forced to pay for their own insurance rather than receiving it as a free job benefit, I think more people would be outraged by the cost of healthcare and many people would look at reasons why it's so costly.  Lawyers are a big part of the problem.  I've heard some estimates that lawyers increase medical costs by 20%, but I think that's a gross underestimation.  I think the true figure is closer to 50%, since the fear of malpractice litigation permeates almost every physician-patient encounter to some degree.

Ingrid:  Do you have any other suggestions to control healthcare costs?

Dr. Pezzi:  Yes.  I think one of the ways to make healthcare more affordable is to increase competition by removing artificial constraints.

Ingrid:  What do you mean by that?

Dr. Pezzi:  Let's say that you want some cosmetic surgery performed.  If you could afford the steep fees charged by plastic surgeons, you'd see one.  If you could not afford their fee, you wouldn't have the surgery performed.  This is analogous to transportation in a country in which the only cars available are Mercedes-Benz, Rolls-Royce, or Jaguar; if you want to drive, you must buy one of them. If you can't afford them, you're going to walk. Is this fair? Obviously not. However, this is essentially the dilemma faced by many people who desire cosmetic surgery—if you can't afford the best, you get nothing at all.  Furthermore, that presumes that a plastic surgeon will deliver a superior result in exchange for the mega-bucks he charges.  That may not be a valid assumption.  Here is a story I wrote years ago:

When I was a teenager, I had severe acne which left me with a pockmarked, bumpy face. I wanted to have dermabrasion performed, but I could not afford the fee—equivalent to $1800 today. (Dermabrasion is a process of sanding the outer layer of the skin off so that new, smoother skin grows to replace the flawed skin.  This procedure is intended to mitigate the appearance of acne scars or wrinkles.) Determined to improve my appearance, I read about the procedure, took a 19¢ sheet of sandpaper off the garage shelf, and went to work. Thirty minutes later, I'd saved myself what was for me at that time a year's income. I had dermabrasion performed twice more until I was satisfied with the result. The second time it was performed by a plastic surgeon, who was less skilled in this procedure than myself. He sanded too deeply in a couple of areas, leaving me with gouges that took years to fill in. The last time I opted to do it again by myself.

So if a teenager can read a paragraph or two about dermabrasion and use a 19¢ sheet of sandpaper to produce a better result than a plastic surgeon with years of training and experience and all the latest equipment, then why should I or anyone else pay the exorbitant fees demanded by plastic surgeons?  Patients should be willing to pay for one thing, and that one thing is a good result.  Patients should not have to pay for a doctor's supposedly impressive credentials when a good result isn't obtained.  However, in many cases patients are paying for the credentials, not the result.  If results were what mattered, I should have been able to quit high school, open my own dermabrasion clinic, and make a lot of money while giving people new faces free of acne scars or wrinkles.

However, in this country there is essentially a doctor cartel, and patients oftentimes end up paying for the paper credentials that doctors offer instead of a superior result that may or may not materialize.  However, I am realistic enough to know that the government would never allow unlicensed medical practitioners to do surgery on people to see if they had "the right stuff" or not.  So here is one cost-saving approach that I can suggest:  have physicians who possess a full and unrestricted medical license, such as myself, offer cosmetic procedures to patients for substantially less money than is charged by plastic surgeons.  While physicians customarily restrict their practice to areas in which they've been trained, many physicians possess aptitudes and skills that are outside of the domains of their specialties.  While I did a lot of surgery in the ER, my aptitude for surgery was evident years before I attended medical school.  If someone has good hand coordination and can read and follow basic directions, surgery is fairly easy.

Ingrid:  Do you do such cosmetic surgery?

Dr. Pezzi:  Yes.  Anyone interested in having a procedure performed can contact me.

Ingrid:  OK, what about the other areas of medicine besides cosmetic surgery?

Dr. Pezzi:  If anything, areas of medicine other than surgery are even more suited to my concept of patients paying for results rather than credentials.  For example, many nonsurgical areas of medicine could be filled by anyone who possesses sufficient knowledge.  I am not a fan of glorifying education obtained in a university while denigrating self-education.  No patient should care how a practitioner acquired his knowledge; the only thing that matters is whether or not that knowledge is present.  An MD degree and a medical license offer reasonable assurance that a practitioner is competent, but why can't anyone who passes those same exams be deemed equally competent and allowed to practice medicine?

Ingrid:  Like PA's (Physician's Assistants) or NP's (Nurse Practitioners)?

Dr. Pezzi:  No.  I think that anyone who wishes to practice medicine should take the same exams that doctors take, not watered-down exams that supposedly qualify them to do the easier things in medicine.  That's absurd.  As I've said before, I would strongly support how some NP's and PA's are playing doctor these days, except for one problem:  many, if not most, diseases present with common signs and symptoms, even when those diseases are uncommon.  So how can an NP or PA who purports to be an expert in common maladies know when the mélange of signs and symptoms now facing him or her add up to something other than a garden-variety problem?  They can't.  In short, they're playing Russian roulette:  hoping for the right outcome, but having no way of really knowing it.  This is not to say that some of these alternative practitioners aren't reasonably qualified to fill the shoes of a doctor.  I worked with one PA in the ER who did a better job than some board-certified ER docs I know, and that PA should welcome the opportunity to take the exams given to doctors so he could demonstrate his skills.  On the other hand, I worked with another PA whose lack of knowledge shocked me, and she was lazy and apparently incapable of following simple instructions.  Figuratively speaking, I kept knocking on her head to see if she'd ever wake up, but she never did.  I wouldn't trust her to put a Band-Aid on correctly.

Ingrid:  So why was she hired to work in the ER?

Dr. Pezzi:  Reason # 1 was because she possessed the paper credentials for a PA.  How she obtained them is beyond me.  Reason # 2 was because she had a cute face, and the person who hired her was a man.

Ingrid:  Does that really matter?

Dr. Pezzi:  Of course it does.  That reminds me of another ER doc I used to work with.  He wasn't much to look at and his competence was highly questionable, but his wife was mouth-wateringly gorgeous.  Hence, that couple was a great addition to the hospital clique so the hospital brass had someone pleasing to gawk at during the official and unofficial hospital gatherings.

Ingrid:  I'm amazed by how such social factors influence hospital operations.

Dr. Pezzi:  You think that is something?  How about this?  I used to work with a fellow who was notorious for shenanigans such as taking a patient into the hospital chapel and rigging up his video camera to tape him having sex with her in that hallowed area.  My boss told me about that years before the state prosecutor got wind of it, but my boss didn't fire the guy when he learned of that unethical affair.

Ingrid:  Why not?

Dr. Pezzi:  Who knows?  One explanation I heard was because the philandering doc's sons were high school football stars.  I found that difficult to believe, but the application of justice is often very uneven in hick towns.  What I think is a more accurate answer is that the doc in question was part of the social fabric of that town, even if the fabric were, ahem, stained.

Ingrid:  In my government class in high school we discussed the rule of law, and how laws should be uniformly applied regardless of the social status of the offender.

Dr. Pezzi:  The rule of law is often a joke.  If a police officer pulls over a person for speeding and then discovers that the speeder is his wife, do you think she'll receive a ticket?  Almost certainly not.  If that speeder were a teenage boy with a nose ring and a bad attitude, a ticket is a virtual certainty.  One of my friends has a real lead foot, but she's never received a ticket in her life.  Why?  She's exceptionally attractive.  Surprised?

Ingrid:  Not really.  Maybe that's why I've never received a ticket.

Dr. Pezzi:  That just goes to show that law, rules, and regulations mean different things for different people.  Some people are effectively above the law.

Ingrid:  But the doctor who had sex with a patient in the hospital chapel was eventually prosecuted, wasn't he?

Dr. Pezzi:  Yes, but only because he had an overblown sense of his immunity.  Had he played it a bit safer, the local yokels wouldn't have turned him in.  Actually, from what I know of this case, they never did.  I think the state prosecutors learned about it from the newspapers.  It certainly wasn't my boss saying "Tisk, tisk, if you have sex with a patient in the hospital chapel, you can't work in this ER!"

Ingrid:  The real world is a lot different than I thought it would be.

Dr. Pezzi:  It surprised me, too.

Ingrid:  Anything else surprise you?

Dr. Pezzi:  Yes.  Let's switch gears for a minute.  I once had a patient in the ER who spent about $35 per day to feed himself at McDonald's.

Ingrid:  How could one person eat so much?

Dr. Pezzi:  That's what I asked him.  When he first told me that, I assumed it was a one-time fluke, but he assured me it was his daily routine.  He said he just loved to eat at McDonald's.

Ingrid:  What did he come to the ER with?  A heart attack?

Dr. Pezzi:  I can't recall what his problem was, but it wasn't a heart problem.

Ingrid:  Have you ever had a doctor as a patient?  If so, what kind of patient was the doctor?

Dr. Pezzi:  I've had several doctors as patients, usually for heart attacks.  One person that comes to mind was an obese 40-year-old female physician with an MI who came to the Urgent Care center at which I worked.  I couldn't understand why a physician with an obvious MI would go to an Urgent Care center instead of an emergency room.  She told me she used to work there.  Perhaps she wanted to see the old gang.

Another doctor I recall as a patient also presented with a cardiac problem, but what stuck in my mind about that encounter was the strong smell of booze on his breath.  Eventually, he drank himself to death, but not before losing his medical license and all of his money.  And not before inflicting a lot of collateral damage.

Ingrid:  Like what?

Dr. Pezzi:  I admitted a patient to his service, and shortly thereafter he went on a drinking binge and "forgot" to see the patient for three days.  She died on the third day of her hospitalization, and he'd never come to see her.

Ingrid:  Why didn't that patient's nurse inform the hospital's Chief of Staff or someone who could have done something sooner?

Dr. Pezzi:  I'd like to know, too.  To me that seems like simple common sense.

Ingrid:  Do you have any other "doctor as patient" stories?

Dr. Pezzi:  Here's one with a twist:  a pediatrician brought his kids to the ER so that I could figure out what was wrong with them.

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Ingrid:  Wouldn't a pediatrician know more about diagnosing diseases in children than an ER doc?

Dr. Pezzi:  I certainly hope so.  Otherwise, his professional raison d'être is pretty much kaput.  My guess is that he wanted a second opinion so as to relieve himself of any culpability or guilt if his diagnosis weren't correct.  I suppose that underscores the fact that in medicine we often don't always know with absolute certainty if a diagnosis is correct or not.

Ingrid:  Doesn't one of the drug commercials now on television include the phrase, "doctors know"?

Dr. Pezzi:  Yes, but that's just blatant pandering to those doctors whose egos can be stroked by fawning.

Ingrid:  Now that we're on the subject, what do you think of drug commercials, in general?

Dr. Pezzi:  They drive me nuts.  They're obviously targeted to the consumer, not the people who decide what drug is best for a patient.  Of course, any good physician knows that oftentimes the best treatment is no drug at all.  However, drug companies want to inculcate the message that a pill is the solution to every problem, and those companies want consumers to pressure doctors into giving them the drug they saw advertised on television.

If you listen closely to those commercials, pharmaceutical companies are doing a lot more than just hyping their drugs.  They're revealing what they think—or more accurately, how little they think—of the American consumer.  They're also giving us some mini-health lessons, some of which are wrong.

Ingrid:  Can you give me an example?

Dr. Pezzi:  Yes.  There is a commercial during which an airline passenger with heartburn is casually given a pill to combat stomach acid by the guy sitting next to him.  The "patient" then wonders aloud if he should see a doctor for his problem, and the guy who gave him the pill—now revealing his professional identity—said, "You just have."  Heck, who needs EKG's, stress tests, blood tests, cardiac monitoring, and other such tests when our diagnosis can be hammered out in a heartbeat by some guy sitting next to you on an airplane?  I'm just waiting for the day when some chap will sue that drug company after experiencing an MI because he was taught by their commercial that a cursory exam is sufficient to differentiate heartburn from a heart attack.

Ingrid:  Are there any more commercials that give you heartburn?

Dr. Pezzi:  That's very witty, Ingrid.  Yes, there are.  Another goofy commercial in the "heartburn pill wars" between the drug companies shows a person light up with joy after realizing he can indulge in the spicy food that gives him heartburn if he precedes his gluttony with their antacid pill.  There are two implicit messages in that commercial, both of which are patently wrong.  The first goofy message is that there is no need to do the common sense thing and avoid the troublesome food; heck no, a pill is the answer for what ails you.  The second idiotic message is that a pill intended to reduce gastric acid secretion is a logical choice for combating heartburn triggered by spicy foods.  Spicy foods may seem hot, and the burning sensation they induce may make some people think that acid is the cause of their problem, but it's not.  But what the heck, if it increases their sales, that commercial did its job.  Let the truth be damned.

I'm also bothered by commercials in which they pronounce the phrase sugar pill as if it were a single word, thus making those commercials more insulting than they already are.  Whoever wrote those ads obviously thinks that the typical viewer doesn't know the correct term, placebo.  If they insist upon using sugar pill, they could at least use it in its more correct plural form instead of the dumbed-down singular form.

The latest commercial that provoked my ire is the Lipitor commercial in which a mid-fifties man in great shape struts by some beautiful women in bathing suits sitting near a pool.  The women are young enough to be his daughters, but from their admiring looks, they appear to be very interested in him.  The tacit message is that Lipitor does more than just lower your cholesterol, it'll make gorgeous women a generation younger than you practically go into heat as you walk by.

Ingrid:  I read your first book of ER stories and I must admit that besides liking it, I enjoyed your candor.  You just come right out and say some things that other people might think, but never express.

Dr. Pezzi:  I think that any author who dances around the truth is doing his readers a disservice.  Being namby-pamby is not my style.

Ingrid:  Another thing I liked about your book is that it's more than just a collection of ER stories; it's also something of a personal journal.  You tell the readers what you're thinking and feeling, and why.  Thus your book gives great insight on what being an ER doctor is like.

Dr. Pezzi:  Let me switch roles for a minute and ask you a question.  Now that you've read my book and are cognizant of the many drawbacks of emergency medicine, why are you still planning on choosing that profession?

Ingrid:  Because in your book and web site you give many hints, both direct and indirect, on ways of minimizing what you term the noxious aspects of emergency medicine.  You're a good teacher and your lessons really "come alive."  I'm sure I'll benefit from what I've learned from you.

Dr. Pezzi:  Thank you.

Ingrid:  Do you think that doctors are doing a good job of teaching their patients ways of avoiding illnesses and injuries that might cause them to go to an ER?

Dr. Pezzi:  No.  It's trendy for doctors to boast about their efforts in preventing disease, but the results obtained by most physicians are abysmal.  Let's consider the example of obesity, since that disease is increasing at a rate that is literally epidemic, and obesity is an important risk factor for a number of other diseases, including the biggest killers in America.  Have physicians had any luck in combating obesity?  Evidently not, given the increasing prevalence and severity of this problem.

Ingrid:  What more can doctors do to fight obesity?

Dr. Pezzi:  Doctors and sundry other people who fancy themselves as weight-loss experts have totally neglected one method of weight loss that is very effective but doesn't require dieting, drugs, herbs, exercise, or surgery.  On the day I discovered this technique, I saw a definite change in my physique in less than 12 hours.

Ingrid:  From the pictures I've seen of you on your web site, it doesn't look like you have a weight problem.

Dr. Pezzi:  I don't have one now, but after I got out of my residency program I was fat enough so that I couldn't see my feet when I stood up.  One of the benefits I received as a resident was free food.  In addition to the hospital cafeteria, we had a doctor's dining room which served food so delicious it'd probably equal or outclass any restaurant in the world.  The refrigerator in the residents' lounge was stocked with a variety of foods, and every nursing station had a supply of snack foods and supplement foods.  I knew the location of every morsel of food in that place, and I ate whenever I could.

Ingrid:  Why?

Dr. Pezzi:  For a variety of reasons.  First, eating was just about the only pleasure I had in my life at that time.  Second, I usually didn't know when my next meal would be.  We'd often get so busy that stopping to eat was utterly out of the question, so I'd routinely stuff myself in preparation for what might be a 14-hour fast.  Third, the food was excellent.

Ingrid:  Excellent food?  I thought hospital food was supposed to be horrible.

Dr. Pezzi:  No, that's the crap they serve to patients.  Most larger hospitals serve different food to employees than to patients.  Furthermore, the food in the doctor's dining room was unbelievably delicious.  Where they obtained such flavorful food is beyond me.  For example, I've had mashed potatoes thousands of times in my life, and I used to think that all mashed potatoes are pretty much the same—that is, blah.  The second I forked into my mouth some mashed potatoes from the doctor's dining room, I thought, "Oh my God, this is delicious!  How can potatoes taste so good?"  I still don't know, but the potatoes and everything else in that place were bursting with flavor.  It's difficult to quantitate any pleasurable experience, including taste, so I can't give you any precise quantification of how much more flavorful those foods were, but I'd guess they were at least five times more flavorful than ordinary food.  And then there was the pecan pie problem.

Ingrid:  The pecan pie problem?  Care to elaborate?

Dr. Pezzi:  The regular hospital cafeteria, which I'd often eat in just to avoid the incessant medical prattle in the doctor's dining room, served pecan pie at almost every meal, including breakfast, for some odd reason.  Pecan pie is something I can't resist, and I'd often eat two pieces per meal along with two entrees.

Ingrid:  No wonder you got fat!

Dr. Pezzi:  Yes, and I didn't even tell you about the pizza parties thrown by drug reps, who wished to brainwash us—um, educate us.  In any case, I packed on the pounds.

Ingrid:  Let's get back to the topic of your weight loss method that doesn't require dieting, drugs, herbs, exercise, or surgery.  It seems to me that the world would be clamoring for such a breakthrough and talk show hosts would be eager to interview you.  Why hasn't your tip obtained such publicity?

Dr. Pezzi:  Probably because I presented it on page 42 of my health book, Fascinating Health Secrets, with no ostentation.  I just came right out and presented it in a very matter-of-fact way, then moved on to my next tip.  I thought people would recognize it as a breakthrough even if I didn't hype it.  I suppose I should have ballyhooed it a bit more.  I just completed writing another book in which I mentioned this tip, and in that book I tried to convey the message that this is a powerful tip you shouldn't overlook.  I also explained the tip in greater detail to make it easier to understand why it is so effective, and why weight loss achieved in that manner is so easy to do—even fun.

Ingrid:  What is the subject of your new book?

Dr. Pezzi:  It's entitled Enhancing Sexual Pleasure:  A Scientific Approach.

Ingrid:  Why would a weight-loss tip be germane in a book about sex?

Dr. Pezzi:  First, most people prefer slim mates.  Second, there is a correlation between obesity and a number of diseases (such as heart disease, diabetes, and arthritis) that can negatively affect people's sex lives.  Third, obesity induces hormonal changes that can decrease libido and reduce sexual pleasure.  Fourth, some of the neurotransmitters regulating appetite and sex are intimately intertwined.  Every doctor should know these facts, but I think many doctors forget much of what they learned in medical school.

Ingrid:  How did you become interested in this topic?

Dr. Pezzi:  Everyone is interested in sex unless they're prepubescent or suffering from some serious disease or hormonal imbalance.  I think what triggered my desire to write this book is because I've heard a number of supposed sex experts blather about how "there are no aphrodisiacs."  That's ridiculous—there are a number of things that positively affect sexual interest, pleasure, and performance.  Anyone who claims otherwise is ignorant of basic neurochemistry, nutrition, pharmacology, medicine, and health in general.  Whenever I hear a reputed expert claim that something is impossible, I think, "Is it really impossible?"  It reminds me of when I read a book about radar and the author claimed it was impossible to make an airplane transparent to radar.  In a split-second I thought of a way to achieve true radar transparency.  Parenthetically, years later I accidentally discovered—oddly enough, while microwaving a food—another way of achieving this effect.  I didn't think that latter technique would have much utility since the Air Force took a different tack in making stealth aircraft with reduced radar signatures, but I recently read about how the new passive radar systems might obsolete our entire inventory of stealth aircraft.  Hence, my inadvertent discovery might be useful after all.  Anyway, to get back on track, whenever I hear someone claim that something is impossible and I know it isn't, I have the urge to show how such impossible things can be achieved.

Ingrid:  So sex can be made more pleasurable?

Dr. Pezzi:  Definitely.  Just as in the example I gave above about how the food in the doctor's dining room was so much more pleasurable to eat than ordinary food, there is sexual pleasure and there is extraordinary sexual pleasure.  I don't know of anyone who thinks that sex is always the same.  Sometimes it is so-so, and other times it gives mind-boggling pleasure.  As a scientist, I asked why and then explored the reasons for this variation.

Ingrid:  What did you find?

Dr. Pezzi:  I can't give you all the information here since it would fill a few hundred pages, but in regard to sexual pleasure variation there is both temporal variation and individual variation — that is, there is variation in pleasure from time-to-time with the same partner, and there is also a definite difference in the pleasure you can obtain from different partners.  My book explores all of the reasons underlying both types of variation, and it explores ways of enhancing libido, sexual performance, and sexual attraction.

Ingrid:  When will that book be available?

Dr. Pezzi:  I'm just now beginning the process of getting it published, and publishers work at a snail's pace.  The publication of most books takes about two to three years, so I decided to offer it as an e-book in the interim.  If you're like me and you can't stand to read a book on a computer screen, I can sell a laser-printed copy, either bound or unbound.

Ingrid:  On to my next question:  why would an ER doctor write a book about sex?

Dr. Pezzi:  In medicine, there really isn't any specialty that focuses upon enhancing libido and sexual attraction, pleasure, and performance.  At first glimpse, some people might say that either gynecologists or urologists would be the ones to turn to for advanced knowledge about this topic, but their focus is really upon the relatively boring plumbing of sexuality.  Oftentimes their understanding is rather limited about ways to augment sexual interest and pleasure.  Some of them seem to know just one fact:  that testosterone impacts libido and sexual pleasure.  Testosterone is important and I certainly don't ignore it in my book, but there is so much more besides testosterone.  It's just the tip of the iceberg.

Ingrid:  How did you learn so much about this subject?

Dr. Pezzi:  I'm a voracious reader, and I read about a number of different subjects.  That's key, because some of my sexual knowledge came from sources that superficially might seem unrelated to sex.  However, if a person  with a good foundation of medical knowledge reads these other informational resources, sometimes he can put 2 and 2 together and make a heretofore unknown connection.  Basically, that's just the process of integrating information, and it's vital to inventing as well as making full use of the information a person has memorized.  Some people can memorize reams of information but aren't able to integrate that knowledge in such a way that they can do anything novel with it.  As we used to say in school, they can regurgitate it, but that's it.

Ingrid:  Judging from the fact that you graduated in the top 1% of your class in medical school, you must have an exceptional memory, and judging from some of your inventions on your web site, your creativity is phenomenal, so I agree that you are very good at integrating information.  Do you think the skill of integrating information is adequately stressed in schools?

Dr. Pezzi:  Not at all.  The expectation in most classrooms is that teachers spew out information which the students are expected to return on the exams.  Memorization is an integral aspect of learning and performance, but it's overemphasized.  The ability to think for yourself is sadly neglected.  I can think of only one exam I've ever taken that stressed integration, and that was my final exam in genetics.  The professor didn't ask any question that could be answered simply by knowing the course material.  Each of the five options on each multiple-choice question required the students to integrate a number of pieces of information taught in the course and then extrapolate or deduce something from that to arrive at the correct answer.  People with a photographic memory but lacking the ability to integrate information would be totally lost on such an exam.  They could know everything in the course, yet not know the answer to a single question.  In our society some people can get along fine just by memorizing a circumscribed amount of information, but it's crucial that some people have the ability to "think outside the box," so to speak.

Ingrid:  What is the most unusual thing that happened to you as a result of the publicity you've achieved from your books?

Dr. Pezzi:  I became friends with a person who read my first ER book, and she offered to set me up on a date with a friend of hers, Katie Couric.  Then there was something really odd.  An official from India asked me to help design their telephone network.

Ingrid:  Why would they ask you?

Dr. Pezzi:  He'd seen one of my inventions on my web site and presumed — incorrectly — that if I could design such a device, I could help engineer a telephone network.  I did buy a book about that years ago, but it was so boring I couldn't complete it.

Ingrid:  Does your web site list all of your inventions?

Dr. Pezzi:  No, it describes less than 10% of them.  For obvious reasons, I left my most valuable ideas off the web site.

Ingrid:  What other books would you like to write?

Dr. Pezzi:  I included some discussion of politics in my first two books because medicine and politics are inseparably linked, but I'd like to write a book in which I  discuss other political topics.

Ingrid:  Such as?

Dr. Pezzi:  How politicians can use medical knowledge to increase their odds of being elected.  A few years ago I gave Al Gore a copy of my health book, Fascinating Health Secrets, because one of my friends, who is also a friend of Gore, told me that he's avidly interested in health.  I included one tip in the book that'd interest any politician, and from Gore's transformation during the election it was clear to me that he put that information to use.  Had I given him the other tips, he could have trounced George Bush.

Ingrid:  So you're a Gore supporter?

Dr. Pezzi:  No.  My only link to him is through our mutual friend.  I think Gore is a good man with good intentions, but I think he erred by adopting some ludicrous ideas to appeal to some of the wacko elements out there.  And his oft-repeated class warfare theme was an untenable stance for a Presidential candidate.  Most people aren't dumb enough to swallow that nonsense.  If an author sells a million books, is he hurting you?  If he sells two million books, is he hurting you more?  Obviously not.  No one is hurt in this country because someone else is more successful, but the class warfare idea is predicated upon this fallacy.  And why should any politician waste so much breath bashing people who pay the lion's share of the taxes?  Since politicians are so fond of spending money, if they were fair they'd demonstrate a shred of gratitude for the taxes that makes their profligate ways possible.

Ingrid:  If you wrote a book that presented medical ways of enhancing a politician's chances of being elected, wouldn't his opponents also read that book and hence neutralize the benefit of that information?

Dr. Pezzi:  That's very astute of you.  Yes, I'd like to write such a book, but I'm not going to offer it to the public.  I'll offer it to the highest bidder and, since I'm so convinced that the politician who reads it will win, it'll come with a 100% money-back guarantee.  You lose, you get your money back.  You win, I keep it.

Ingrid:  Yes, but don't most political contenders, barring the occasional landslide, have roughly a 50-50 chance of winning?  If so, there's a 50-50 chance they're paying for a win they might otherwise achieve.

Dr. Pezzi:  No political party or candidate is content with 50-50 odds.  The potential stakes are too high.  Presidential candidates spend millions of dollars on things that might, just might, marginally increase their chance of winning.  I'm offering something that virtually guarantees success.  That's worth something.

Ingrid:  Aren't you concerned by the fact that your knowledge could be used to thwart the will of the people?  I mean, shouldn't people be able to vote for whomever they choose?

Dr. Pezzi:  I'm not holding a gun to anyone's head and forcing him to vote for a certain politician.  I'm offering a number of ways to make people think that a given politician is their man.  Political parties attempt to sway public opinion all the time in a number of subtle and not-so-subtle ways.  I'm just making this into a 21st century process that's considerably less iffy.  The other side is free to try all their usual tactics; they just won't win.

Ingrid:  So you are thwarting the will of the people!

Dr. Pezzi:  If you're addressing the issue of fairness, I can't argue with that.  However, fairness has little to do with how the world really works.  Is it fair that some politicians are rich and can spend millions of dollars on their campaigns?  Or is it fair that some politicians are better looking than others?  Physical appearance obviously plays a role in political success, especially in elections for federal offices.  When was the last time you saw an ugly President?  Some ugly people are qualified to be President, but they'll never win.  People are just too enamored with appearance.

Ingrid:  I still don't think it's fair.

Dr. Pezzi:  You're correct, it's not.  But must everything be fair?

Ingrid:  I think we should do everything we can to make things as fair as possible.

Dr. Pezzi:  That's a noble idea, but I don't think you'd like the implications of true fairness.  In fact, I think you'd say that's downright unfair.

Ingrid:  Care to try me?

Dr. Pezzi:  Sure.  Judging from your picture, you're very attractive.  You're also very intelligent.  When it comes time for you to choose a spouse, you'll select a handsome, intelligent man.  Men who are intelligent but ugly will never have a chance with someone as gorgeous as you.  Is that fair?  You could, of course, decide to make it fair by giving the ugly, intelligent men an equal shot.  Or, if you want to be really fair, you'd give the ugly unintelligent men an equal shot.  But would you?  Well, the list of intelligent, attractive women who marry dumb, unattractive men is very short, not surprisingly.  Of course, your decision about whom to marry isn't based on fairness, it's based upon a perception of your value as a marital partner.  You want a partner who can offer an equal or greater value.  When you're deciding about who to date or marry, fairness is not part of the equation.

Ingrid:  I see your point.  I must admit that I've learned a lot more about you than I thought I would as this interview progressed.  I began it with the expectation that you're just an ER doc, and I didn't know that you're so diverse.  What are you like in real life?  Are you as intense as you seem?

Dr. Pezzi:  That's a misconception that many people form about me.  In real life I can be intense, but I'm usually very easygoing.  That surprises me because I used to be a dyed-in-the-wool Type A person.

Ingrid:  What do you do for fun?

Dr. Pezzi:  I love snowmobiling and riding my Sea-Doo, which most people refer to as a Jet-ski.  I love to invent and think, in general.  I also like dating, bicycling, camping, exercising, watching movies, traveling, working in my shop, shooting, hiking or just being outdoors, reading, and writing, naturally.  Unlike most guys, I truly enjoy shopping, baking, and some creative outlets that don't qualify as inventing.

Ingrid:  Like what?

Dr. Pezzi:  For example, earlier this year I made a hand-carved door and a cupola with copper shingles for my Mom's shed.

Ingrid:  I saw those pictures.  They were awesome.  OK, doc, I have a tough question for you:  why aren't you married?

Dr. Pezzi:  I dated two nice women in college and medical school, but at that time in my life marriage was the last thing on my mind.  By the time I began seriously thinking of marriage, just about all the good catches were taken.  I now live in what I term a dating hinterland that isn't exactly inundated with people I want to date.

Ingrid:  So you're stuck-up?  I suppose I can say that about you since you inferred a few minutes ago that I am.

Dr. Pezzi:  You bet I am.  When it comes to dating, I make no pretense of being an equal opportunity employer, so to speak.  Yes, I discriminate.  My first rule is:  no brain, no date,

Ingrid:  I can't argue with that.  What are your other requisites?

Dr. Pezzi:  I want someone who is down-to-earth and lacks ostentation.  Women who require more maintenance than the International Space Station don't stand a chance with me.  Plus, they'd probably break out in hives if they saw me dressed up in my fluorescent orange chainsaw clothing.

Ingrid:  Pardon me for my lack of chainsaw knowledge, but what's that?

Dr. Pezzi:  Protective clothing that's worn while operating a chainsaw.

Ingrid:  OK, what other requisites do you have?  So far you haven't ruled out enough women to solve the mystery of why you're not married.

Dr. Pezzi:  I want a woman who is genuinely nice, generally happy, an interesting conversationalist, slim, and at least reasonably attractive.  Oh, and no weird women; no one who makes me think that the date would be great fodder for a Dates From Hell book.

Ingrid:  You've been on such a date?

Dr. Pezzi:  Unfortunately, yes.

Ingrid:  Care to give me any details?

Dr. Pezzi:  Well, we ended up on a snowmobile trail.  She was driving.

Ingrid:  What's wrong with that?  I thought you enjoyed snowmobiling.

Dr. Pezzi:  I do, but it was summertime, and we were in her car.

Ingrid:  So why did she take you on the trail?

Dr. Pezzi:  She told me that she'd originally assumed we'd have sex.

Ingrid:  Did you?

Dr. Pezzi:  No.  Until she mentioned it, the thought never crossed my mind.  It was our first date.

Ingrid:  What then?

Dr. Pezzi:  Then her flakiness became very evident.

Ingrid:  How so?

Dr. Pezzi:  She told me that she couldn't get very sexually excited about me because I wasn't a biker in trouble with the law.

Ingrid:  You're pulling my leg, aren't you?

Dr. Pezzi:  Nope.  I learned that her husband was in prison, and then she told me about her other beaus.  All bikers, and all in prison.  No wonder she was lonely.

Ingrid:  Is that why she dated you—because she was lonely?

Dr. Pezzi:  She didn't have any reason to be lonely.  She'd just broken up with her fiancé, who was over 40 years older than she was.  Then she moved in with a guy her age who lived in a dilapidated cabin that was literally a shack a mile deep in the woods.  It didn't even have a driveway per se, just a narrow trail leading to it.  Thank God I had a Jeep.  Anyway, she claimed that she and her roommate were just friends.  I was skeptical.

Ingrid:  I would be, too.  Why did you date such a winner?

Dr. Pezzi:  Because she was energetic and very attractive.  She had a high-class, intelligent look.  Very deceptive.

Ingrid:  Strange date, indeed.  I can't think of any logical way to segue off that story, so how about giving me some tips on being successful in college and medical school?  I read the tips you gave in your web site's More Q&A section about advice on becoming an ER doctor, but I have some questions about that subject.

Dr. Pezzi:  Shoot.

Ingrid:  To begin with, why are you so opposed to people consuming caffeine until they're in medical school?

Dr. Pezzi:  Let me clarify what I said.  I wrote that people should avoid caffeine until they really need it—which for you will be in medical school.  For people who don't attend medical school or some other graduate school, the right time might be in college.  What's critical to appreciate is that caffeine does more than just stimulate alertness and concentration, it also enhances the integration of information, which I mentioned earlier in the interview.  One thing I learned in college and medical school is that professors spew out a lot of seemingly disconnected bits of information.  If you can put this information together, or integrate it, you'll have a number of "aha" revelations in which the facts fall into place and you can derive an understanding that transcends mere memorization of the facts.  There isn't much glory in pure memorization; computers can easily outclass us in that regard.  The strength of humans is our ability to make sense of billions of individual facts.

Ingrid:  So why the exhortation to postpone caffeine use?

Dr. Pezzi:  Because the effect of caffeine diminishes with continued use, just as the body becomes tolerant to so many other drugs.  Therefore, it's vital to postpone caffeine use until you can achieve its maximal benefit.  Why use it during high school when, frankly, your brain isn't yet programmed with enough information to make integration very useful?  It obviously makes sense to postpone its use until your brain is suffused with countless new facts, many of which seem to be floating around without much meaning or clear means of application.  Add caffeine to the equation at that point, and you'll make sense of seemingly disconnected information.  Figuratively speaking, you'll put 2 and 2 together.  You'll literally increase your brainpower.  I hate to denigrate what you're learning in high school, but don't squander the peak integration effect of caffeine on the material you're now studying.  It's like getting dressed up in a wedding gown just to answer the doorbell; it's overkill and it's a waste of time.

Ingrid:  What about using drugs besides caffeine?  In your chapter on enhancing intelligence and creativity in Fascinating Health Secrets you discuss a number of pharmaceuticals that are substantially more powerful than caffeine.

Dr. Pezzi:  I think their use should be reserved for situations in which there is a clear need for them and a well-defined benefit.  For example, let's say that you're a lawyer studying for the bar exam, and you've already flunked it a few times.  If you don't pass it this time, you'll never obtain a law license in that state since it limits the number of times an applicant can try to pass the bar exam.  In such a situation, there is both a clear need for enhanced brainpower and a well-defined benefit, namely that of obtaining a license to practice law.  However, for many people there isn't any definite need or benefit for such drugs.  If a man works on an assembly line and his most mentally challenging activity is playing Scrabble, what is the need or benefit?

Ingrid:  When you were in college or medical school, did you ever use any performance-enhancing drug besides caffeine?

Dr. Pezzi:  No.  I never perceived a need for it.

Ingrid:  In your preface to the section on drugs that enhance brainpower, you mentioned what I thought was an interesting historical tidbit, namely that Thomas Edison used cocaine and that his usage of it may have played a role in his prolific creativity.

Dr. Pezzi:  That's true.

Ingrid:  In your first ER book you presented a story in which a gorgeous woman offered you first money and then the chance to sleep with her in exchange for you giving her a narcotic prescription.

Dr. Pezzi:  Yes.  She claimed that she intended to sell them only to good people who'd presumably sit around their nice homes on Friday night and get a pleasant buzz without hurting anyone.

Ingrid:  Do you think that some drugs can be used safely?

Dr. Pezzi:  First, you must realize that to a scientist, nothing is totally safe.  Some things just have a higher lethal dose.  Take good old pure water.  Give it via an IV and it's possible to kill a person within minutes.  So can narcotics be safely used?  Of course they can, and intelligent, reasonably cautious people without any medical need for them could occasionally indulge themselves and obtain a euphoric respite from life without doing any permanent damage to themselves or society.  The problem is that many if not most of the people clamoring for drugs in this county are nitwits who cannot safely use drugs, guns, or even their own sexual organs.  Judging from their prevalence of venereal disease, many of them haven't yet figured out how to choose a sexual partner who isn't a modern-day Typhoid Mary.  These irresponsible people spoiled it for people who could responsibly use recreational drugs.

Ingrid:  So why didn't you give her the prescription if she'd only sell to responsible people?

Dr. Pezzi:  First, how did I know to whom she intended to sell the narcotics?  Second, it isn't my role as a physician to selectively decide which laws I will and will not follow.  Anyone who wishes to become a physician and stay a physician should be beyond reproach in all aspects of life, both professionally and personally.  I think that the government enacts a number of idiotic laws and regulations, but it's pointless trying to fight them.

Ingrid:  What do you consider to be an idiotic law?

Dr. Pezzi:  When I built my house I had to first obtain a number of permits, one of which was a driveway permit!  Given the topography of my land, there was only one logical choice for locating my driveway.  The government, arrogant as it is, assumes that it's a heck of a lot smarter than you and that you cannot choose a safe, reasonable location for your driveway without a bureaucrat giving you guidance.

Ingrid:  If she is as pretty as you said she was, I think that most male ER doctors would have succumbed to her offer for sex in exchange for the narcotic prescription.

Dr. Pezzi:  She was indeed quite beautiful, but I can't think of any ER docs I know who'd agree to such a quid pro quo.  We're frequently offered money in exchange for drugs, but my answer will always be "no."

I'd love to continue this interview, but I need to work on something else.

Ingrid:  May we continue this interview at a later date?

Dr. Pezzi:  Yes.

Ingrid:  By the way, what are you working on?

Dr. Pezzi:  I'm making a bandsaw powered by a gasoline engine that will cut logs into lumber.

Ingrid:  Why do you want to do that?

Dr. Pezzi:  I have some trees I need to cut down, and I thought I might as well make use of the lumber, some of which is maple.

Ingrid:  That's a beautiful wood.  Good luck on your project and thank you very much for your time.

Part 2 of the interview:

Ingrid:  Let's return to a topic we recently discussed — governmental intrusiveness.  I take it from some of the things you've said that you're exasperated by the government.  Are you?

Dr. Pezzi:  How could anyone not be?  Doctors have plenty of reasons for resenting the government, but so do all other taxpayers.  Have you ever seen "The Fleecing of America," a regular feature on the NBC Evening News?  This series has been going on for years, because there seems to be no end to how the government wastes our money.  The government demands that its taxpayers keep intricate records, yet the government regularly loses billions of dollars that it cannot account for.  Why do we put such nincompoops in power?

Ingrid:  Are you a Republican or Democrat?

Dr. Pezzi:  Neither.

Ingrid:  I thought you'd be a Republican.

Dr. Pezzi:  I'm more of a Republican than a Democrat, but I'm not a Republican.

Ingrid:  What don't you like about Republicans?

Dr. Pezzi:  They are pro-business, which is good.  In contrast to the preposterous insinuation repeatedly made by Democrats that business is bad, businesses are the backbone of America.  Without them, we'd have no jobs, or at least no jobs like the ones we have.  We'd be living in huts or caves, and when our children get sick, they'd often die in misery instead of being treated by the best healthcare system in the world.  So, I'm generally pro-business.  The only exception to this is that when an industry is dominated by too few competitors, the normal competitive pressures are lost that keep corporations on their toes in terms of price and quality.  One good thing I'll say about Democrats is that they are less tolerant of monopolistic corporations than are the Republicans.  Here's a good example.  While I generally like President Bush, I don't think it's a coincidence that summer gasoline prices, which had been skyrocketing, didn't come under control until the Democrats regained control of the Senate.  I have no doubt that part of that price was due to collusion, and the Democrats threatened to investigate.  Bingo, the prices fell.

Ingrid:  So what don't you like about the Democrats?

Dr. Pezzi:  By and large, they're demagogues.  They're divisive, and they pit one group of Americans against another.  They're experts at attacking the Republicans and scaring people, but they have almost no ideas of their own, except to "give" people more things.  Of course, the government doesn't have anything to give; it can only use its power to compel one citizen to give money to another citizen.  But what I really detest about the Democrats is how they usually prattle about how they're fighting for "hard-working Americans."  Hmmm, let me see . . . if a man gets a job and works, I suppose he'd warrant being called a "hard-working American" by a Democrat.  But what if this man gets another job, so he's REALLY hard working?  That might very well put him in a tax bracket that the Democrats attack with punitive taxes.  Or what if a man works 110 hours per week for 10 to 15 years to become a doctor?  Isn't that person a hard-working American?  Yes, he is, but from a tax standpoint he's clearly in the crosshairs of the Democrats.  Or what if a man works 16 hours per day, 7 days per week for years to build his business?  Isn't he a hard-working American?  The point I'm making is that Democratic policies are not consistent with their rhetoric.  They say they're for hard working Americans, but their policies punish Citizen A if he works harder than Citizen B.  If hard work is good, then more hard work is not bad.  However, that's the tacit message that spews from the Democrats during every election.  Anyone with half a brain would be incensed by how illogical and morally corrupt that Democratic message is, yet it plays well to the masses, or at least that segment of the population that can't think on its own.  They can swallow campaign platitudes hook, line, and sinker, but do they ask themselves if that pablum actually makes sense?  It's "the glove don't fit , so we must acquit" type of mentality.

Ingrid:  Speaking of  how the government can only give something by taking it from someone else, how do you feel about the compensation offered to the families of the 9-11 tragedy?

Dr. Pezzi:  I realize that criticizing that handout may seem callous and as un-American as criticizing baseball, hot dogs, and apple pie, but I'm adamantly opposed to those payments.  First, as you suggested, the government cannot give people that money without taking it from taxpayers who had nothing to do with the terrorism.  Why the heck should we pay for this?  That governmental largesse will make people instant millionaires, and in some cases multi-millionaires.  In theory, this is done to compensate them for lost future earnings.  However, that presupposes that the survivors lives won't go on.  Let's say a woman lost her husband on 9-11, and his estimated future income was $3,000,000.  The government writes her a huge check, and most likely she'll remarry in a few years.  Now that her new husband's income replaces that of the first, will she refund the lottery-sized payment the taxpayers gave her?  No way!  We will still be pinching pennies, clipping coupons, and working our butts off to pay the taxes that pay for such programs, and she will be shopping for a new Mercedes.  In fact, on the news last night one 9-11 widow was bitterly denouncing the government because they offered her $3,000,000 tax free.  She wanted two million more, because she said that's the amount her husband might have made in his lifetime before taxes.  The government said three million was enough, because that's what he would have made after taxes.  That seems logical to me, and more than generous . . . after all, the government could and should give her nothing.  Over 99% of the taxpayers who will make her a multi-millionaire don't have anywhere near that amount of money, but she's rabidly throwing a temper tantrum and denouncing American generosity because it doesn't meet her greedy pie in the sky visions of a mega windfall.  I'm tired of those brats spitting in the faces of other Americans who are funding this unprecedented compensation.  However, I shouldn't be surprised, because for those insatiable people, life seems to be just about money.  Even soon after the attack, I saw some of them smiling so much on television you'd think that instead of just losing a spouse, they'd won the lottery.  Maybe that's because they realized they just did.  How on Earth could they smile such a short time after the death of their partners? (UPDATE: In an appearance on The Big Idea show in October, 2007, Ann Coulter had a quip that capsulized how I feel about the glee exhibited by the 9-11 widows: "I've never seen people enjoying their husbands deaths so much.")

I'm not insensitive to their losses, but I don't think that giving them money was the best way to solve the problem.  Actually, it created a problem by fostering resentment from other Americans.  Were the families of the victims in the Oklahoma City bombing showered with money?  No.  The government evidently doesn't think it is fair to compensate victims of domestic terror, yet it gave so much money to the 9-11 families that they're set for life.  Is there moral justification for this?  I don't see it.

Many recipients of the Federal Government's September 11th Victim Compensation Fund are screaming that the payments aren't enough.  Time out.  My father was murdered by someone who was born and raised in the United States.  Therefore, if culpability is an issue, I could make a much better case that the United States is more responsible for the murder of my Dad than it is for murder perpetrated by foreigners, as was the case on 9-11.  However, the federal government put a price on life, and it valued my father's life, and my loss, as not worth a penny.  So when I see the 9-11 families bitching for another million or two, how does that make me feel?  Is their loss so worthy of millions, and my loss not worth anything?  Try explaining that.  Meanwhile, let's roll on to another topic . . . oops, I suppose I shouldn't have said that, because I heard that Lisa Beamer, wife of Todd Beamer (the person on Flight 93 who uttered "Let's roll" before they charged the cockpit), wanted to copyright that phrase.  Cha-ching!  I wonder why?  I don't know if she is pursuing that copyright, but I hope she does not.  First, it's preposterous to think that it is worthy of a copyright; Todd Beamer was not the first, or even the millionth, person to use that phrase.  Second, the 9-11 families have been given a ton of money.  I'm reminded of the colloquial phrase, enough already.  From what I know, Lisa is a good person with altruistic motives for the money — to benefit a foundation she started.  However, I think it sets a bad precedent when laws are twisted, even if for good causes.  If she can copyright "let's roll," then I want to copyright "code blue."  By the way, as far as I can tell, I was the first person to coin the term "toxic sock syndrome."  Should I try to collect royalties whenever that phrase is used?

I'm not unsympathetic to her loss.  I deeply feel the pain that she and others have suffered.  I've seen her on television looking sad and forlorn, and I wanted to give her a hug and comfort her.  Any caring person would feel likewise.  However, I don't think money is the cure for what ails her, and if she is as rich as I heard she is, I don't think she needs to fund her foundation by trying to expropriate ownership of an everyday phrase.

I have nothing against Lisa Beamer and the other 9-11 families.  In fact, I thought of forming a charity to help them, at least until I heard of how unnecessary that was.  Americans are naturally generous people, and we love to help others.  However, I think many of us don't like it when we're forced to give, or else.  I think this is one of the flaws of the welfare system; we're forced to hand over money (indirectly, of course, since it's funneled through the government) to people in need.  Actually, whether they're in need is another story.  As an ER doc, I've seen so much abuse of the welfare system, and I could tell you story after story about how the people I was forced to help via my taxes had a better car than I did, took more extravagant vacations than I did, or indulged in the luxury of eating in restaurants more often than I did.  That's a bitter pill to swallow, but let's overlook it and address a more central defect in the welfare system, which is how the anonymity of one's donations are why such donations fail to engender much in the way of positive emotions in either the donor or the recipient.  Let's say that instead of handing over "x" amount of money per year to the government, that potion of my tax bill would be satisfied if I gave it directly to a few needy families in my community.  Wouldn't that be much more satisfying?  With computer technology, it'd be easy to match up donors with local recipients, and this would, if anything, strengthen the sense of belonging to a community.  However, the government would never go for it, because too many politicians derive their power from determining how that money is doled out.  They want to keep their fingers in the pie, and they will.  I don't think it matters much if a Democrat or a Republican is elected, since Republicans usually co-opt Democratic handouts and water them down so as to make them seem palatable.  Some choice.  It's either "I'm going to hold a gun to your head and demand that you give a dollar," or it's "I'm going to hold a gun to your head and demand that you give 96 cents."  Some choice.  Don't expect me to jump for joy because the Republicans are fractionally less avaricious and insatiable.  The economic similarities between the Republicans and the Democrats are much greater than the differences.  Republicans often profess to be for limited government, but even when they control the Presidency and Congress, what do they do?  Expand the size of the government!  Republican rhetoric deludes a lot of people.  People shouldn't look at what they say, they should look at what they do.

Update: A woman whose husband was a 9/11 victim commissioned a painting to thank the law firm that "helped settle her affairs," according to a television report. Commission a painting? Isn't that what the ultra-rich do? Who ultimately paid for that extravagance? The American taxpayer? Or some insurance company, that will recoup its loss by increasing its rates? I bet that it's the same old story: that painting was likely paid for with money that came out of our pockets.

Lisa Beamer update: According to the Wikipedia, Lisa sought to trademark (not copyright) the phrase “Let's Roll.” The current Wikipedia page states that “she has been accused of trying to profit from her husband's death after it was learned that on December 4, 2001, she applied for a trademark” on that phrase. [...] “In addition to the controversy surrounding the trademark registration, the public financial records of the non-profit Todd M. Beamer Foundation (now known as Heroic Choices) have come under scrutiny for taking in more money than was delivered in services.” However, financial problems may explain that irregularity.

Ingrid:  Speaking of Lisa Beamer, why do you think she is the most frequently interviewed family member of a 9-11 victim?

Dr. Pezzi:  Have you seen her?  She isn't just attractive, she has a luminous beauty that is as rare as a 10-carat diamond (my apologies to Lisa if a 10-carat diamond isn't exceedingly rare, but I'm no diamond expert).  I think most of us are so accustomed to seeing gorgeous people in movies and the media that we often fail to notice them; they stick out as much as another pine cone on the ground in a forest.  But Lisa is another story.  Why do you think President Bush chose her to stand up during his speech to the nation?  Because she lost her husband?  Well, so did countless other women.  TV producers are enamored with beauty, even more than I am.  I'm sure there are more compelling stories than "let's roll," but we don't hear them because the family members aren't especially attractive.  I've read that many 9-11 families resent her stardom.  Even in the face of an unparalleled national tragedy, our media finds a way to glorify beauty and give a singular focus to those who possess it.  Instead of hearing Lisa say the same things over and over again, wouldn't it be more interesting to hear from some people who have yet to be in the spotlight?  Let's hear some other poignant stories, instead of an endless rehash of one experience.  But if there's something that TV producers love more than beauty, it's reruns!

Ingrid:  Just when I think you're getting serious, you get flip!

Dr. Pezzi:  I have some strongly held opinions, but I'm rarely as serious as I may seem.  I think the boring people are the ones without discernible opinions who are fond of saying, "whatever."  I may not agree with your opinions and you may not agree with mine, but it's certainly more interesting to have a spirited exchange of ideas than it is to utter that conversation-killing phrase "whatever."  Since many pre-medical students read my web site, it's germane to pass along a tip for their medical school interviews:  do not, under any circumstances, use "whatever" as the response to a question.  If you do, you won't be accepted.

Ingrid:  Why not?

Dr. Pezzi:  It's too punkish, immature, and vapid.  Admissions committees are seeking people with antithetical qualities.

Ingrid:  What do you think admissions committee members should look for, besides the obvious, such as high grades and MCAT scores?

Dr. Pezzi:  With everything else being equal, they should favor applicants who've had a serious illness or injury . . . and recovered from it, obviously.  Having endured such an event is very maturing; it alters the way you look at life, and it gives you a unique sense of empathy for patients with serious problems.  It's so easy to say you have empathy, or to think that you're empathic, but until you've been in their shoes, you have no idea what it is like.

I also think admissions committees should favor applicants who know the pain of poverty.  The reason for this is threefold.  First, in my experience, rich kids are so used to having things handed to them on a silver platter that they don't know what it means to really work.  If any rich kid objects to this stereotype, I challenge them to try to outwork me . . . go ahead, put your daddy's money where your mouth is.  I'm not poor now, but I used to be.  Rather than breaking me, it made me phenomenally resourceful and it inspired me to develop talents and skills that otherwise would have remained latent.  I think most people are considerably more intelligent and capable than they think they are, but they've never been put through a hot enough fire to bring out their hidden talents.  In many respects, I've had a hellacious life.  I suppose I could have written a "woe is me" book and had Oprah give me a pat on the back.  But having it rough can be a good thing, which I'll explain later.

Second, I think being poor is a great way to learn more about a wide variety of things.  The stereotype is that the "haves" learn more than the "have nots."  Perhaps their book smarts are greater, but what about their practical knowledge?  When not at work, many MD's and Ph.D.'s can't do anything more complex than screw in a light bulb.  Is such a person truly intelligent?  I don't think so.  They may be knowledgeable about one subject, and that knowledge may make them seem intelligent, but I contend that anyone possessing true intelligence will have a wide range of abilities.  Sheesh, if you're really intelligent, how can you not learn other things?  If a person is poor, that is an incentive to learn things to compensate for the lack of money.  For example, when I could not afford to buy a mower, I took a discarded one, read a book on how to repair them, and I fixed that thing so it ran better than new.  I took a dead TV set, and fixed that, too.  To fix my car, I made a tool that could thread a hole from the inside out.  That may sound impossible if you know anything about tapping threads, but I had to do it because I didn't have the money to fix my car the old-fashioned way.  I've made countless other machines, and in the process I've learned a lot.  My creativity skyrocketed.  It was once average, but it is now off-the-scale.  I know what you're thinking:  yeah, right, he's just exaggerating.  Well, take a look at some of the devices and inventions I've made that I described on my web site, and tell me who you know who is more creative.  Then tell me who is a hundred times more creative.

Ingrid:  Why a hundred times?

Dr. Pezzi:  Because my web site describes less than 1% of what I've done creatively.  I wasn't born that creative; it developed because I've had many challenges in my life, many of which were due to a lack of money.  Hence, I don't regret my prior privation.  I relish it, because it molded me into a more capable person.  As a result, I have an incredible "can do" attitude, and I sincerely believe there's almost nothing I can't do.  I think that having diverse capabilities is important for physicians, especially ER docs.  If you don't have common sense and a broad range of knowledge, you might kill a patient because textbooks cannot mention every possible problem.  Here's an example.  My brother used to work as a sales rep for a company (I’ll call them Acme®) which made power tools and other stuff for building contractors. During their sales meetings, they’d share unusual stories. This was one of them.

The rep, who I’ll call Steve, told about a call he’d received the prior week from a frantic ER doctor. He had a patient with an Acme® glass tube in his rectum, and he’d tried all sorts of ways to remove the tube—all to no avail. The doctor asked if it’d be OK if he were to break the end of the tube which was projecting an inch out of the anus. That, he figured, might make it easier for him to get a hold on the tube.

Steve implored, "No! Don’t break the tube!"

The ER doctor inquired why. Steve explained the technical details. The tube, which was 1¼ inches in diameter and 13 inches (!!) long, held two different chemicals. When the tube was broken, the chemicals would mix and form an adhesive. The tube was designed to be inserted into a hole in concrete, into which a chisel-pointed threaded rod would be inserted. The adhesive bonded the rod to the concrete, and 40,000 pounds of force were required to extract the rod once it bonded. That wasn’t the worst part, though. When the chemicals mixed, an exothermic (i.e., heat generating) reaction would result, which would reach a temperature of 500° F. Had the tube broken inside the man, he would have been cooked from the inside out.

The scary part of this story is that the doc said he'd almost broken the tube, but at the last second decided to call first.  Fortunately, the patient came to the ER during business hours.  What if he'd come at another time?  The doc would have gone back to Plan B, and broken the tube . . . and the patient would have been fried.

OK, I'll give the ER doc one gold star for making the call, but I'd still flunk him for not having the brains to think of any way to remove the tube other than to break it.  I bet there are 13-year-old kids reading this who could think of a better solution (if you're curious, send your ideas to me, and I'll tell you if they'd work or not).

Bottom line?  If you've had a truly diverse life, you would not be challenged by such a patient.  Solving that problem would be an absolute breeze.  Currently, there is no exam that tests for such practical knowledge, but as I've just demonstrated, the lack of that knowledge might kill or injure your patients some day.  I think this is so important that I am developing a test to assess whether medical school applicants are more than book smart.  Tentatively, I call this test the MCAST (Medical College Airhead Screening Test), in honor of Ellen, a doc who graduated from Harvard Medical School yet was such an airhead, she didn't know what styrofoam is.  This inspired me to take a good-natured poke at her frightening level of ignorance, and if you want to see what I came up with, you might get a chuckle out of it.  I'm sure that Ellen is a knowledgeable doctor, at least in terms of knowing what lies between the covers of medical books.  Unfortunately for Ellen, real people live real lives that involve things not defined in those hallowed medical books, and her ignorance might make her miss an important clue.  For example, do you think Ellen knows much about welding?  Given that welding knowledge is far more esoteric than a knowledge of what the heck styrofoam is, I doubt that she does.  The lack of welding knowledge may not seem like a big deal, but what if Ellen had a patient who developed symptoms after welding?  Since there are so many other concomitant variables (e.g., his food?  Meds?  Something he ate or drank?  Some infection?  Something he was exposed to at home?  Maybe some anthrax or another gift from a terrorist?), Ellen might easily overlook the significance of welding and not put two and two together.  Even if someone knocked on her head and told her the problem stemmed from the welding, would she have the slightest clue as to what caused the problem?  Highly unlikely.

Generally speaking, rich people are less likely than poor people to weld, fix a TV or mower or car, or do a zillion other things that increase general knowledge.  This general knowledge can make a difference in patient care, so I think applicants having it should be favored.

Finally, I'd pick a poor applicant over a rich applicant because doctors treat many poor people, and if a person has never been poor, he cannot understand the tough choices that poor people must make.  Food or medicine?  Fix the furnace, or the brakes on the car?  Should I take time off work to recuperate like the doc recommends?  If I do, the boss might fire me.  Or the kids might starve in the meantime.  Or I can't buy my daughter the new winter coat she needs.  And on and on.

I don't think there is any glory in being poor.  Having been poor and having had money, it's much better to have money . . . especially if you've been poor, so you can truly appreciate it.  Also, I don't think poverty is something that politicians should address with handouts; that's the surest way to disincentify the urge to learn and triumph on your own.  Let's say that some politician thought he was doing me a favor years ago by giving me a new mower, TV, or car.  Would I have learned to fix the mower or TV?  Would I have invented the tool I needed to fix my car?  No.  When you add up all the other things that would not have been, it is clear that my success and contributions to the world would have been a mere fraction of what they are.  So are such politicians the good guys they purport to be?  No.  They stymie the growth of individuals, our society, and our economy.  It is no different for parents.  Rich parents often think they're doing their children a favor by giving them so many things.  I don't agree, and neither would his patients if that kid becomes a doctor one day and kills some people because the tidbits of knowledge he needed to save them wasn't taught in their prep school.

Ingrid:  Back to the "toxic sock syndrome."  What made you think of that phrase?

Dr. Pezzi:  Years ago in Detroit, I was working on a patient in the Trauma Room, and I removed his shoes and socks.  As I removed his socks, his skin peeled off, too.  His skin had grown into the fabric of his socks, similar to how a tree will grow around barbed wire or some other object if it is wrapped around the tree long enough.  Anyway, the sight of rotten skin intermixed with fragmenting socks was disgusting, and the smell was atrocious.  All of a sudden, I thought of the phrase "toxic sock syndrome."  I also used the term "Big Mac Attack" to describe a massacre at a local McDonald's restaurant.  The reporters liked that usage, so they used it in their stories.

To be continued . . . .

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