For more Q & A, see my
Test your knowledge of ER terms by solving my ER crossword puzzle that was featured in the Prudential Securities Healthcare Group 2002 calendar. Or take the ER-MCAT to see if you have what it takes to be an ER physician.
Amy reviews ER computer games
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Why should you follow my advice on how to become a doctor? I explain why in this excerpt from the introduction to my book:
Want to be an ER Doctor?
Advice for a high school student looking far ahead
Q: Hi! My name is Latoya and I am 14 years old. I'm interested in becoming an emergency room physician when I am older. I know that being an ER physician is hard work. The shows on TV such as ER are not like real life in the ER. However, I do watch Trauma: Life in the ER on the Discovery Health Channel and I see what ER doctors face every day, and I am willing to do it.
I will be a freshman in high school in the fall, and I was wondering if you could give me any tips or advice on what classes I should take in high school. I will be taking all honors classes because I am an honors student. I don't really have a specific question, but I just wanted some advice.
A: Discovery Health's Life in the ER is not the complete story, either. Have you read any of the ER books that I reviewed on my web site? Some of them give a perspective you cannot get from a TV show. Television producers are not willing to reveal everything that occurs in real emergency rooms; their depictions are very whitewashed. Furthermore, doctors (and sometimes patients, politicians, nannies, and probably just about everyone else) behave differently when cameras are around.
As far as general tips, I think you should read The Memory Book by Jerry Lucas and Harry Lorayne. I read it in 1976 and I believe it is still in print (if not, it would be easy to find a used copy since there are so many millions of copies of that book in print). The Memory Book has fantastic tips for improving memory. Even if you don't think you need it now, you will in medical school. After you read it, do everything you can to challenge your memory by memorizing what might seem to be an impossible number of facts (what you get in high school classes won't be enough). It's been proven that people can improve their skills in one area by exercising that part of the brain. I never thought that I had a particularly good memory, but I ended up graduating in the top 1% of my class in medical school—so I must have been doing something right!
Good luck in your studies!
More advice for another prospective ER physician
Q: Hi. I'm a 13-year-old girl in the 7th grade. My goal is to become a pediatric ER doctor. I am interested in all those ER shows and I'm always watching the show Children's Hospital on the Discovery Health Channel. I know just watching medical shows doesn't mean I have what it takes to become a doctor, but my father is a doctor and my mother was a nurse. I am ready to work hard at Duke University—that's where I want to go to college—and succeed in medical school. My high subjects in school are science, math, and social studies. Do you have any tips for my future so I can succeed? If so, please notify me. Thank you so much for you time. Sincerely, Laura
A: Yes, I have several tips on how to succeed in medicine (in general) and ER medicine (in particular). You sound like you are an intelligent young lady, so getting into college should not be a problem for you. Obviously, once you're in college you must obtain very good grades to gain admission into medical school, and once you're in medical school you will have to perform exceptionally to be accepted into an ER residency program (it's very competitive). In a nutshell, that's what you will have to do, but it doesn't address your main question of how to facilitate success, so I'll now delve into that.
First, I highly recommend that you read The Memory Book by Jerry Lucas and Harry Lorayne. It was written in the 1970s but I think it is still in print (let me know if you cannot find it; I'll see that you get a copy). Unless you naturally have a photographic memory, reading this book will be one of the most important things you can do. I used the techniques in that book whenever I had to in medical school. I did not have much of a need for it in college since college was comparatively easy. In medical school, however, there is a phenomenal amount of information to be memorized and retained. By the way, I am not being redundant by saying “memorized and retained.” I chose those words because many people memorize things, but forget those facts months later. If you become a doctor, you will need to recall information that you memorized years or even decades ago. Memorization isn’t enough; you must also have retention. The memorization process that most people use is passably acceptable for most high school and college exams, but not for situations in which you must memorize a bewildering number of similar (and easily confused) facts, such as in medical school.
Second, take care of yourself. Get plenty of sleep, avoid junk food, don't smoke, and get plenty of exercise. Research has shown that exercise—especially aerobic exercise, such as jogging—increases brainpower (I discuss this more in depth in my book Fascinating Health Secrets). Also, I strongly believe that people should avoid any caffeine until they really need it—which for you will be in medical school. Once you become tolerant to it, you will never be able to derive its maximum potential to facilitate learning and academic performance.
Third, learn how to take tests. Your success in achieving your goals will primarily hinge on your ability to demonstrate your knowledge and intelligence on tests. My brother used to claim that I could absorb the correct answers on tests from the paper (he was kidding, of course) because I could usually deduce the correct answer even if I didn't know it. Being able to think logically and rapidly will certainly help you.
Next, learn about nutrition. Food fuels your mind as well as your body, and most people (even doctors) don't know enough about what to eat—and when to eat it—to enable your brain to function optimally. Certain supplements (such as lecithin or choline) can help you think better, but I think such adjuncts are best reserved for major tests. Eat most of your protein at breakfast and lunch, not dinner. I have a hundred other tips in Fascinating Health Secrets, but I think it would be premature for someone your age to do anything at this time except eat well, so I won't discuss this further.
I hope this helps. If you want, write to me in the future and I'll give you more tips that are relevant to your academic stage. What I've said here is just scratching the surface and I could say a lot more, but I am a very slow typist!
The most important preparation for anyone who aspires
to become a doctor
Q: I want to be a doctor. What can I do, besides reading The Memory Book, to prepare? Elizabeth
A: While reading The Memory Book is important, I think that the primary focus of anyone who aspires to become a physician (or other intellectually demanding career) should be to read the dictionary and read as much as you can about a variety of subjects to expand your vocabulary. Philosophers have long debated about the extent to which language is essential for the formation of thought. Without delving into the intricacies of this debate, most learned people think that it is difficult if not impossible to think most complex thoughts without framing those thoughts in words. Clearly, an expansive vocabulary enables one to generate more complex thoughts, just as a palette of more colors enables a painter to produce a more dazzling spectrum of paintings.
I believe that expanding your vocabulary will expand your brainpower. I wasn't a particularly outstanding student until I began reading the dictionary, and after that my academic performance skyrocketed. A coincidence? I doubt it. It's important to realize that my performance did not just increase in subjects like English in which vocabulary is an essential tool; my performance increased in every academic and non-academic subject. Thus, I believe that augmenting vocabulary does more than enhance linguistic skills; it literally increases IQ.
The English language is a rich language with a myriad number of words that express subtle but distinct nuances in meaning. People with limited vocabularies often think of these words as being highfaluting or as synonyms with identical meanings. Not true. Our language has many synonyms, but little redundancy. Once you grasp the exact meaning of various synonyms, you will appreciate that they are tools with which to express different thoughts. As you master more of them, the range of your thought will commensurately increase. You won't just be more knowledgeable, you will be smarter and better equipped to succeed in medical school or other challenges in your future.
It is also advisable to read a medical dictionary such as Dorland's Illustrated Medical Dictionary. The current edition is 2190 pages long, and those are large pages with content equivalent to that in 4000 to 6000 pages of more typical books. Hence, reading this dictionary will take more than a rainy weekend, but it is definitely worth your time. When you read it, you will learn about things you thought you knew everything about. You will also see how some of the zillion and one isolated facts that you learn in medical school "fit together," so to speak. Putting two and two together in this manner will enhance your grasp of medicine so that you truly understand it in a more comprehensive and integrated way. Primarily because of time constraints and a lack of awareness of what others covered, medical school professors usually do not do a good job of helping you integrate the material in their lectures with information that was previously presented by other lecturers. This can leave students drowning in a fog of information and wondering about the significance of some of the facts they learned. For example, I recall a medical school lecture in which I learned every fact presented, yet I hadn't the slightest idea of where that information fit into the big picture. This is analogous to someone telling you details about every home on every street of a remote town, but not telling you where that town was or why it was important.
This brings up one of the central problems in medical education: most medical school lectures are given by people who are accomplished in their fields but yet have no training in education. Knowing their stuff (and they do) is no guarantee that they can explain it in the best possible manner. Unfortunately, some medical school professors are brilliant people but abysmal educators, which decimates their ability to teach the next generation of physicians.
Today's students have a powerful tool that was not available when I attended medical school: the Internet. If a given lecture leaves you puzzled, you can search on the Net for similar lectures at other schools. The only problem with this is that it can be time-consuming. I've spent years online researching information for The Science of Sex, and found that while it is easy to find information, it can be excruciatingly arduous to find good quality information written by people who put it all together. One of my pet peeves is that it is often difficult to find a truly comprehensive source. For example, I sometimes spend a week reading about one topic from hundreds of sources. At the end of that week, I am often still learning facts that were not presented in the first 200 sources. So were the earlier ones comprehensive? Obviously not. If someone could "bring it all together" for you, it would save you a lot of time hunting down facts.
Most medical students think they're doing well if they can memorize everything presented in their curricula, but those sketchy lectures are just an introduction to the topic and by no means are a comprehensive presentation. Medical schools often believe they are doing you a favor by giving pared-down presentations. I disagree. I suppose most schools fear that presenting more information will overwhelm their students. Here is how my medical school (Wayne State) handled this. They claimed that they presented more information than anyone could feasibly learn because they did not wish to thwart the ability of better students to learn more by not challenging them sufficiently. They said that by presenting more information, the more capable students would learn more, and the other students would learn whatever they could. I agree with this, but I don't think they went nearly far enough. I cannot recall even one lecture that was what I'd term comprehensive. So what do medical students do? They take the sketchy lecture material and try to integrate it with facts they learn in the months and years to come. On countless occasions I recall learning additional material later on and thinking how it could have benefitted my understanding and mastery of a subject if it had been presented before in one integrated "just about everything you need to know about this subject" lecture. The medical education process is very fragmented and piecemeal. Consider this: do you think you could learn more about a subject if you were given a comprehensive lecture, or just a sketchy lecture followed by a hit-or-miss presentation of additional tidbits scattered amongst thousands of other discussions at indeterminate times in the future? Obviously, you'd do better with the comprehensive approach. If you wished to learn painting, you would be better off if someone told you at once everything you should know instead of initially giving you half of what you needed to know and then scattering the remaining facts in the future . . . maybe. Medical education is too important to be haphazard, but that is what prevails.
I think that medical school lecture notes should always be comprehensive, or nearly so. It shouldn't be the way it currently is where students might learn a fraction of what they should know and then hope that future sleuthing or some random source will fill in the factual gaps. Why not color-code the notes? Put the core material in black, and the additional material in purple. It is sometimes paradoxically easier to learn when you're given more material to learn because that additional information can help fill in knowledge gaps that otherwise may leave you perplexed. If someone gave you a jigsaw puzzle, it would be easier to grasp what the picture looked like if you were given every piece of the puzzle instead of half of them.
I've spent years filling in the gaps of my medical education (and given that I did so well in medical school, I obviously had fewer holes to fill in). Medical school deans may counter that education is a lifelong process for physicians. I wholeheartedly agree with this, but the process of filling in gaps is a very inefficient process. Let's consider the example of The Science of Sex: Enhancing Sexual Pleasure, Performance, Attraction, and Desire. Conservatively, I spent two to three years writing that book not because the actual process of writing took so long, but because it took years to pull all that information together from over 100,000 sources. You could read that book in a couple days and learn what it took me years to acquire bit by bit (and remember, I began with a better medical knowledge base than most people have). It would have been far easier for me to spend $20 to purchase that book, if only someone had written an equally informative book, but none existed. (You might think that I am obviously inclined to be partial to one of my books, but no one who read that book has evidently found a more informative one because I offer a 100% refund to anyone who can tell me the title of a book with a more comprehensive and detailed presentation of sexual pleasure, performance, attraction, and desire. If there is a better book, I'd love to read it because I want to learn more. However, I am routinely disappointed by how competitive books are often laughably simplistic and just a rehash of tired old facts.)
The problem is obvious: doctors do not have enough time to fill in the gaps (as I did in The Science of Sex) on every subject. A doctor or layperson could read the book and reap the benefit of the exhaustive work I did, but they could not replicate that effort because it is too time-consuming. (If there is a more comprehensive book, where is it?) Note the difficulty of filling in gaps on just one subject, then imagine the impossibility of filling in knowledge gaps on every possible topic. Let's say that medical educators decided to really earn their keep by giving students comprehensive presentations. If every expert did what I did, it would be feasible for a doctor to spend two days reading a book such as mine and learning facts that would otherwise require years to track down, but doctors cannot do that legwork on their own. Hence, they depend on authors to tell them what they need to know. Even supposedly comprehensive sources (such as Rosen's Emergency Medicine) are far from complete. For example, in another discussion I mentioned one of the alarming gaps in that book which conceivably may have contributed to a child losing his eye. Unfortunately, this is not an isolated event. Doctors routinely must make do with incomplete presentations because the authors were too lazy to do the work it takes to tell you just about everything you should know. These experts get away with this superficial treatment and expect thousands of people in their audience to fill in the gaps (as I've mentioned elsewhere, this is risky because if you don't know something, you may not know that you don't know it). It makes much more sense to me if one person took the time to cover a subject well instead of taking it easy and putting the onus of completeness on each and every member in the audience. Incidentally, this chaotic educational system is a boon to malpractice attorneys. Considering this helter-skelter system, it is easy to understand how a doctor might miss learning some vital information. With the benefit of his 20/20 hindsight, an attorney can backtrack and easily discover some source presenting this material. There it is, written down as plain as day, making the doc look like a moron. However, the problem is often not the doctor, but the medical education system. Realistically, the system will not change before you become a doctor. This is why I advocate doing things, like reading a medical dictionary, that will help fill in knowledge gaps. Try to do this within the first two years of medical school, if not before. It isn't a solution, but reading it is so much better than not reading it. If you follow the other advice I give for ways to fill in your knowledge gaps, your knowledge will still be far from complete, but you will be better informed than doctors who believe that they can get by with what they learned in medical school, residency, and CME (continuing medical education, which is notorious for being sketchy).
A parenthetical note to the Michigan Board of
Medicine and the eternally misguided American Medical Association: I
resent the hundreds of dollars I must pay for sketchy CME even though I try to
select the best available material. This is akin to forcing someone to pay
through the nose for a small meal consisting of food that cannot sustain life
just to obtain an "I have eaten" certificate that fulfills some bureaucratic
need, after which that person must forage on his own for a truly
sustaining meal. Get the metaphor?
Questions about the MCAT
Q: I know that MCATs are unbelievably important on getting into med school, so I have a few questions about them. Can you retake them like SAT's until you are satisfied with your grade?
A: I know people who did that, and I know people who changed colleges and concealed their prior academic records to give themselves a clean start. However, I think the best approach is to treat college or the MCAT exam as something worthy of your best efforts. If you've given your best effort, there is little reason to repeat it unless your performance was hampered by illness or some other transient problem.
Q: When do you take MCATS?
A: Generally, sometime during the year before you apply to medical school.
Q: And, is there a way to study for them, or do you simply have to be a genius to do well on them? I certainly am no genius, nor valedictorian of my high school class, but I am not stupid. Thanks for your time. Katie
A: It is a good idea to read at least one of the MCAT books to see what the test is like. However, reading a MCAT book without preparing in more basic ways is analogous to brushing your teeth before a date but neglecting to exercise or eat correctly in the preceding years. So what is this basic development to which I am alluding? Developing your brainpower. No MCAT study book will boost your IQ. If you want to do that, you must vigorously exercise your mind for years. Just as you cannot develop a fantastic physique by working out a few times, you can't significantly improve your IQ by reading a book or two. However, it is important to realize that you can become a genius by exercising your mind in the correct way. I know, because I did. Judging from my academic record and every other indicator of IQ, until the age of 16 I was certainly no genius. In fact, in sixth grade my teacher chided me for being “slow.” My college GPA was exceptional (3.94 on a 4.0 scale) and could have been better had I not had to work two jobs to support myself (and had I not been bored out of my mind by some classes!). I aced the MCAT and graduated in the top 1% of my class in medical school. Since the average medical student IQ is 130 (borderline genius), beating 99% of those folks was not easy. I had only three years of college, and many of my classmates had Ph.D.'s in biochemistry or pharmacology, yet on exam after exam I beat them in every subject, including the ones in which they held doctorate degrees. One of my old ER bosses told me that my IQ was 160, and he said that I was the smartest person he'd ever known. Many others expressed the same opinion. If you're familiar with the distribution of IQ scores, you know that an IQ of 140 is a genius level but an IQ of 160 is about 15 times as rare—sort of a super genius. I'm not saying this to boast about my IQ; I'm saying this to underscore the fact that IQ is malleable and if you hammer your brain in the correct way you can shape it into the mind of a genius. When I was young I doubted that I had the brains to be accepted into an American medical school, but I didn't just squeak through, I was a shoo-in. The member of the Admissions Committee who interviewed me didn't ask any challenging questions. Instead, he told me that I was going to be accepted. Being so readily welcomed into medical school was a surprising experience for someone who was once lambasted for being “slow.” My point is this: if I can do it, there is an excellent chance that you can do as well or even better than I did.
So what is my recipe for boosting brainpower? Here is a synopsis of it:
1. Expand your vocabulary as I discussed in the preceding topic. Don't kid yourself that memorizing 20 new words per week (as is typical for many high school English classes) is enough. It's not. I'd sometimes learn more than 100 new words per day.
2. Read voraciously on a wide variety of subjects. In addition to reading the prescribed course books in high school and college, I read many other books about physics, chemistry, history, anatomy, medicine, firearms (I'm a gun nut), nutrition, electronics, engineering, and the dictionary, of course. I also subscribed to a number of magazines. At my peak, I received over 200 per month. Magazines are often denigrated as being fluff, but some (e.g., Scientific American) are not. Even less cerebral magazines such as Time and Newsweek are beneficial if you know how to use them. Some of their writers are exceptionally bright, and by seeing how those people express themselves, I can distill how they think. Over the years, I've culled thousands of these “how they think” pearls. Thus, I read not just to acquire information or for entertainment, but also to learn how to think from people who do that quite well. I term this process cognitive mirroring. Professors are often great fodder for mirroring, so don't just listen to the facts they're saying, tune into how they think. However, at best you will have only a few professors per month. By reading an extensive number of magazines and books, you can monthly expose yourself to the minds of thousands of people. Just ignore the drivel and soak up the pearls of thinking from people who are good at thinking.
3. Challenge your mind. In my opinion, one of the best ways to do this is to invent. By definition, inventing means “To conceive of something previously unknown by the use of ingenuity or imagination.” Given that billions of people preceded you, thinking of something that they have not isn't easy. However, once you acquire a sufficient stockpile of facts that are the raw material for inventing, it isn't terribly difficult to associate those facts in a “connect the dots” manner to create something new. I think that most people could invent if they made inventing a part of their lives rather than relying on engineers in Japan to do their inventing for them. If I want a gizmo that doesn't exist, I make it, whether it's a new electronic circuit, a new tool or toy, a new kitchen gadget, a robot, a medical device, a part for my snowmobile—or even an entire new snowmobile!
You can also challenge your mind by writing. I kicked off my writing career in high school by penning long love letters (sometimes 65 pages long!) and a complaint letter about my gym teacher to my principal which he deciphered over two weeks using a dictionary (I thought my complaints would be less likely to be given short shrift if they were expressed in words that were not quotidian). Whether you're writing a love letter, a complaint letter, an e-mail to a friend, or a book, strive to write well. Especially in the case of e-mail generation, people often neglect proper grammar, spelling, and punctuation not to mention failing to expend much effort in phrasing their thoughts in the most cogent possible manner. That makes about as much sense to me as exercising with one-pound weights. If you want to exercise your body or your mind, you must challenge it. You won't do that by using one-pound weights, and you won't do that by expressing yourself in a lackadaisical manner. I'm not saying that you must always express yourself in a rigidly precise manner, because you can sometimes achieve a better effect by selectively using slang and other elements of non-standard English—just don't write that way all the time!
You can stimulate your creativity in other ways, too. Write a song, parody, a new and better advertisement, or design a house that makes the most efficient use of space. Make a present for someone instead of buying it, or create a new recipe. The more you exercise your creativity, the more creative you'll become.
4. Eat well. Your brain needs many nutrients to function optimally, and there is a good chance you have a marginal or overt deficiency of at least one of them. As a doctor, I know that most people do not have a good diet. Even if you follow the tenets of eating from the four basic food groups or the latest dietary pyramid, it is difficult to ensure that all of your nutritional needs are met. I've always been amazed that people take better care of their cars than they do of themselves. I see what others buy in grocery stores, and judging from their purchases they eat far too much junk food and processed food. If they abused their cars in a similar manner, they'd fill them with kerosene instead of gasoline and put Crisco® in the crankcase instead of motor oil. Nutrition is critically important for everyone, not just those with aspirations of a medical career. In Fascinating Health Secrets, I discuss nutrition in general and how it applies to increasing brainpower.
5. Exercise. Certain forms of exercise, as I discuss in Fascinating Health Secrets, help build your mind, not just your body.
6. Get plenty of good quality sleep. Shortchanging your sleep needs has both short-term and long-term consequences. You're probably familiar with the short-term consequences: poor concentration, slow thinking, foggy memory, and diminished creativity. What about the long-term consequences? Most people think that there are no long-term consequences, but they're wrong. As I mentioned above, every day you're alive is a day that you can do things to improve your brainpower. If you're sleepy, your ability to do the things that augment your brainpower is impaired. Would an Olympic athlete train when he was drunk? Of course not.
Notice that I said to get “plenty of good quality sleep,” not just some arbitrary number of hours per night, such as the oft-recommended eight hours. Light from any source (filtering past your blinds, or even from an alarm clock) can degrade sleep quality. So can noise and non-optimal levels of temperature and humidity. Sleep is also affected by what you eat and the ambient light to which you're exposed in the hours preceding sleep. I devote a chapter to sleep in Fascinating Health Secrets. You will spend about one-third of your life sleeping, so doesn't it make sense to spend an hour or so reading about how to make the best use of that time?
7. Don't smoke. Smoking destroys your body, but over time it can impair your mind, too.
8. For obvious reasons, don't abuse drugs. I won’t insult your intelligence with simplistic sayings such as “Just say no.” I don’t think it does much good when adults lecture you on what you shouldn’t do, unless they give you a viable alternative. I’ve heard Dr. Dean Edell (an author and host of a perennially popular nationally syndicated radio program on health) say that humans seem to have an innate need to use mood-altering drugs, just as they have innate needs for other things (food, water, comfort, sex, etc.). I think this is a bit of an overstatement because this need does not manifest in everyone, and when it does, it isn’t always as powerful as the other drives. While the desire to use mood-altering substances is not universal, it is very common. So what can you do if it affects you? If willpower and other common avoidance strategies aren’t working, try to satisfy your cravings with healthier alternatives. In Fascinating Health Secrets, I described the buzz I can get from ginger and garlic. Strenuous, prolonged exercise of any sort can also produce a natural high; somewhat misleadingly, this is called the “runner’s high.” I’ve obtained a far more intense and persistent buzz from shoveling snow than I have from running, lifting weights, or other traditional exercises. Other than the fact that this buzz doesn’t always occur, there is no downside to it. Alcohol and some drugs can induce a state of rebound dysphoria, a state of feeling anxious and gloomy—essentially the opposite of euphoria. Ginger, garlic, and exercise do not induce dysphoria.
You might think that the euphoria induced by these natural agents would be so much less pleasurable than the buzz induced by some drugs that they could not effectively satisfy a craving for a mind-altering agent. Based on my experience, I don’t agree. I used cocaine once in college, and for fifteen minutes I felt very self-confident, euphoric, and on top of the world. While I could easily understand why it hooks many people, I never used it again because I feared its side effects. If nothing else, that experience gave me at least a rudimentary idea of drug euphoria, and hence a baseline to judge the euphoric effect of other agents. In general, the euphoria I experience from ginger, garlic, or exercise is not as intense as the cocaine buzz, but it lasts longer (sometimes several hours). In Fascinating Health Secrets, I discuss how other factors (such as diet) affect the euphoric response.
9. Postpone your sex life. This is certain to be the most controversial of my recommendations, but you'd be wise to follow my advice. Once you begin having sex, you risk unintended pregnancy, the acquisition of sexually transmitted diseases, and romantic entanglements that are sure to divert your attention away from learning. Don't overlook the power of sublimation, which can channel your sexual energy into more productive uses. I am not a Puritanical prude who rails against sex—anyone who read my book The Science of Sex knows that. There is a time for sex, and that time is not when you're striving to maximally develop your mind.
I will incorporate my tips for enhancing brainpower into a book series entitled So You Want to be an ER Doctor?. If you wish to be notified when that is published, check the appropriate box in the form on this page: www.myspamsponge.com/doctor.php
A different point of view: Sex Between Adolescents in Romantic Relationships Is Often Harmless to Their Academics, Study Suggests
But here's some research that corroborates the benefits of postponing romance: Dating in Middle School Leads to Higher Dropout, Drug-Use Rates, Study Suggests based on Dating Trajectories From Middle to High School: Association With Academic Performance and Drug Use
Q: I am taking your advice on reading the dictionary, but I don't know how to go about it. Now that may seem silly, but it's true. Did you read it throughout the course of a month, year?
A: There is no compelling reason to read it from A to Z. Therefore, I selected words at random that struck me as being interesting. Perhaps a more logical way to select words is to use a thesaurus to select words of similar meaning, then contrast those definitions to highlight the nuances. A good time to do this is while you're writing. Select some of the words you've written, and use your dictionary/thesaurus to determine if there is a better word that more accurately conveys what you are trying to express. By the way, use a comprehensive dictionary, not one that is notable for being succinct.
In answer to your question, “Did you read it throughout the course of a month, year?” I haven't stopped reading it. Learning is a lifelong process, not just something you do when you're young, after which you exclaim, “Whew! I'm glad that's over!” Even people for whom the language is particularly important, such as authors, journalists, and talk show hosts, sometimes use it imperfectly. I know I am a better writer now than I was five years ago, and in five years I'm sure I will be better than I am now. An error I've seen made even by journalists writing for prestigious newspapers is to use the phrase “try and [something].” By analyzing the context in which those statements were made, in every instance it was more appropriate to say “try TO [something].” For example, rather than saying, “The police chief indicated he would try and find the culprit,” it makes more sense to say, “The police chief indicated he would try to find the culprit.” Sean Hannity, co-host of Hannity & Colmes on the FOX network and host of his own nationally syndicated radio show, is an intelligent man but judging from his misuse of the phrase “I could care less” does not know that the phrase he should use is “I couldn't care less.” Big deal, you say? Well, the meanings are antithetical. My point in mentioning these errors is that even adults with a better-than-average mastery of the English language could benefit from additional learning. So could I, for that matter. That is why I am always hungry for more information.
Before you even crack open a dictionary, you should read Word Parts Dictionary: Standard and Reverse Listings of Prefixes, Suffixes, and Combining Forms by Michael J. Sheehan. This book will make subsequent learning of the English language much easier by making it “make sense” rather than seeming like a hodgepodge of a million words. I am very fortunate to live in the Traverse City, Michigan area that is home to Professor Sheehan, who hosts a weekly radio program on WTCM (AM 580) called Words for the Wise. Professor Sheehan is a brilliant man with a quick mind and a knack for teaching, and he is eminently worth listening to. If I didn't live in his area, I'd build a directional antenna to pick up WTCM's signal or I'd implore them to simulcast on the Web.
Q: And do you have any good ways to remember what the words mean? I can remember their meanings for a few days or weeks, but I don't think I would ever be able to recall them a few months from now.
A: If you read Professor Sheehan's book you will have a much easier time retaining word definitions. Also, using the techniques presented in The Memory Book will help, and so will extensive reading, which will reinforce your prior knowledge. Memory is rarely a one-step process in which some fact immediately clicks in your mind and you retain a perfect knowledge of it forever. Because of the way our brains are wired, memories often fade in time if they aren't periodically reinforced. When you read, you'll unconsciously reinforce word definitions that are getting a bit shaky, and words you've forgotten or never knew will stand out like red flags—that's the time to grab your dictionary.
Q: Also, what other books will help raise my IQ?
A: I've read so many hundreds of thousands of sources that I can't begin to list them all. In general, try to read books by intelligent authors, and read books on challenging subjects such as physics rather than something like The Wit & Wisdom of Britney Spears. Peter Huber, Dr. Thomas Sowell, George Will, and the late Meg Greenfield are some of my favorite columnists. Even if you don't agree with their politics, you can't help but be impressed by their minds.
Q: I tried to get my hands on The Memory Book, but couldn't find it at Waldenbooks. Do you know where I can get it?
A: Any bookstore can order it for you. Or order it from Amazon.com.
Q: Oh yes, I struggle in math. I am taking geometry now, and I am just not good at it. Is math a key factor in medicine?
A: No. I've used only basic math (multiplication, division, addition, subtraction) to calculate pediatric doses. In fact, I usually used my trusty Casio calculator watch to do the math.
In conclusion, I'd like to comment on my suggestion to read Word Parts Dictionary, the dictionary, and a myriad number of books and magazines. While that advice may seem arduous, if it is truly overwhelming for you, you're in for a rude awakening your first day in medical school. I'll never forget the sense of shock I felt after that day. I was used to three lectures per day in college, and sitting through eight hours of intense lectures that first day in medical school left me numb and reeling. Rather than getting easier, it initially got harder. A month later, I concluded that the professors had crazy, unrealistic expectations of how much we could learn. Surely, someone should know those facts, but should I? Then it hit me: I was going to be a doctor, and if I didn't know those facts, then who would? After that, I put my nose to the grindstone and memorized everything. Was it easy? No. But the important point is that it became much easier in time. If you tax your memory, it will improve. If you really tax it, it will really improve. The reason why so many people think they have poor memories is because they have no pressing need to memorize millions of facts, and there are usually no harsh consequences for forgetting something. Doctors don't have that luxury. If you want to be a doctor, you must realize that your ability to memorize and think will affect the lives of thousands of people. Therefore, it behooves you to do everything you can to expand your brainpower as much as possible.
If any medical school deans or
faculty read this, I'd like to suggest that you offer a seminar on memorization
and enhancing brainpower to your students, perhaps in the summer preceding their
first year. You might not appreciate the need for this since medical students
are already gifted in those areas, but all medical students are not equally
capable. Since I graduated in the top 1% of my class, isn't it reasonable to
assume that the students in the bottom half of the class could benefit from
hearing what I have to say? Don't assume that this performance difference was a
result of the fact that I was born with a higher IQ. As I mentioned before, I
wasn't born a genius. I taught myself to think like one, and hence became one.
Thinking and memorization are malleable skills that can be taught, just as a
specific skill such as swinging a golf club can be taught. I believe that I am
especially qualified to teach such a seminar not because I'm a brilliant person
who aced medical school, but because I wasn't always so bright. My sixth grade
teacher opined that I was “slow.” If being slow is Point A, and graduating at
the top of the class in medical school is Point B, I know how to get from Point
A to Point B. Most likely, there are members of your faculty who are smarter
than I am, so why shouldn't they teach this seminar? Because their innate IQ
was probably higher than mine, so they may not possess such a keen perception of
how to augment intelligence. I have many more tips for enhancing brainpower
than I've mentioned in this book (which is just the first in a series), and many
of these tips are suitable for a more advanced audience.
Q: I got a book out about medical colleges, and looked at the acceptance rate, most of which were 3%. I knew it was hard to get into med school, but I didn't know it was that hard! Some were even 1%. Now I am having doubts on whether I should even try.
A: Don't be discouraged by the low acceptance rate. Keep in mind that those acceptance rates reflect the fact that students apply to more than one school. Hence, the acceptance rate by medical schools of applicants is NOT the same thing as the acceptance rate of applicants by medical schools. If this seems like mumbo jumbo, let's think about this mathematically to make it easily understood. Consider a hypothetical situation in which there are 200 applicants applying to 100 medical schools. Each school accepts just one person per year, and every applicant applies to every school. Therefore, from the standpoint of an applicant, he or she has a 50% chance of acceptance. From the standpoint of a medical school, it accepts only one out of every 200 applicants, so its acceptance rate is just 0.5%. Obviously, in real life these numbers are different, but this simplified example illustrates why the acceptance rate reported by medical schools is not the same acceptance rate experienced by medical school applicants. Come to think of it, wouldn't this make for a good MCAT question?
Q: Here is another question. Okay, I know that everyone who applies to med school is intelligent and has fairly good MCAT's and grades, so how do med schools choose?
A: Ever hear of a Ouija board? Just kidding! The primary determinant of acceptance is brainpower as reflected by college grades and MCAT scores.
Q: Are there certain extracurricular activities that med schools like to see? Perhaps if I studied abroad, would that give me an extra boost.
A: I would not recommend studying abroad. People who want a first-rate education come to America, not Europe. Europe has some good schools, too, but overall the consensus is that American universities are nonpareil.
Q: I guess I am asking what sort of things besides good grades/MCATs will make me stand out from the crowd.
A: Extracurricular activities generally make a difference only when the Admissions Committee chooses between applicants with approximately equal grades and MCAT scores. Yes, grades/MCAT scores are the foremost criteria for selection, but bear in mind that even if you're a qualified applicant you're competing with scads of other qualified applicants. Your best bet for getting into medical school is to have truly exceptional grades and MCAT scores; if you're in that category, your extracurricular activities could consist of winning pie eating contests and you'd still be accepted.
If you're like most medical students applicants, you have very good but not stellar grades and MCAT scores. Thanks in part to Gaussian distributions, there are a lot more of those folks than there are the brainiacs with sky-high grades and MCAT scores. So how do Admissions Committees select from this pack? Extracurricular activities are one factor. I discuss this later on in an answer to another person (Amy), and I recommended to her that she conduct some original research such as building a new medical device.
Admissions Committee members are often medical school faculty members involved in research, so you shouldn't overlook the tendency of humans to especially value things that they do. Just as Hollywood actors and actresses seem to think that the world revolves around them, medical researchers think that they are the elite of the world. If you demonstrate that you have the mental capacity to be part of their world, they'll value you more than someone who'll likely just be cut out for treating diaper rashes and handing out penicillin to people with sore throats.
I realize that it will take a substantial effort to conceive of some new medical gizmo and then develop the skills to make it, but if you think the possible reward is worth it, you'll be willing to expend the effort. I am willing to serve as a mentor to students to help them along, but only if they demonstrate that they are willing to do the work. I can (and have, many times) conceived of new devices, prototyped them, then produced a custom printed circuit board and case. In short, I've developed so many things from start to finish that it's easy for me. I could make the device and ship it to you by FedEx (and that seems to be what some students would like me to do), but what good would that do? You can't honestly present that as your work. If you want the reward, you must do the work.
Q: I am not sure I understand what you think I should invent? A new medicine, a machine?
A: Inventing new drugs is a challenge even for multi-billion dollar pharmaceutical corporations stuffed with Ph.D.'s, so I wouldn't turn my attention to that area. I developed a new application for an existing drug, and my dealings with the Food and Drug Administration (FDA) left me with the impression that they do not have an ounce of common sense. I don't know if I could have greased their wheels of bureaucracy by giving them a payoff, or if they're just pertinacious and obtuse nincompoops. In any case, it was a frustrating experience, and I highly recommend that anyone who doesn't wish to become more cynical steer clear of the FDA. My blood still boils when I think of how they effectively kneecapped a drug that was obviously safe and effective and a blessing for millions of people with a certain disease. I wondered, “Whose side are they on, anyway?”
Q: Where could I find the knowledge to do something like that? I am 15 . . . books? Thanks so much. You're an extremely helpful person. Katie
A: I don't know of any books that'd help. You could ask me (as Amy did), because I have far more ideas than time to develop them. However, a better approach would be to query a number of doctors, asking them about their “wish list” for gizmos they'd like to have but don't yet exist. They'll probably scratch their heads at first, but a few of them will undoubtedly get back to you with some novel ideas.
Once you have the idea (that's the hard part), all that remains is to build it. Most medical gizmos are electronic these days, so there is a good chance you will need to learn electronics. Most people think that designing electronic devices is some mysterious and arcane science that can be done only by Japanese engineers with thick glasses, but it's really quite easy. It took me a few years to start producing complex devices, but most of that time was attributable to the fact that I got into electronics when Radio Shack was still entrenched in the transistor era, not the era of integrated circuits (ICs, or chips). Linking chips together with a few passive external components (such as resistors, diodes, inductors, and capacitors) isn't rocket science. Heck, I have a much harder time getting a date than I do developing a new medical device—no kidding!
Q: I read about how you advocated that students postpone their sex lives so they would not get sidetracked by STDs or pregnancy, etc. However, I think you're overlooking a benefit of premarital sex. Most of my friends (both male and female) in college are horny, and they would climb the walls unless they had a sexual outlet. Hence, by relieving sexual tension, this makes it easier to focus on schoolwork. Lauri
A: You have a point, but . . . . Before I discuss why I still advocate abstinence, I agree that many people cannot satiate their sexual desires unless they have sex with another person. From my personal experience, I know that it is very difficult to study when testosterone has the upper hand. However, even if you know that your partner has no venereal diseases, there is no foolproof means of contraception. The real-world effectiveness of contraceptives is invariably less than what is quoted in sources that consider their effectiveness in ideal circumstances. Beyond this, women sometimes stop taking the Pill because they hope to get pregnant. As I learned in the ER, and in my own life, women don't always alert their partners to this decision, hoping to trap them in marriage. I had a girlfriend (note the past tense) who tried this, and she told me about discontinuing the Pill only after she became pregnant. Oh, now you tell me . . . thanks. She miscarried, but before that, I was sweating bullets. Needless to say, studying was next to impossible.
It is currently popular to engage in "buddysex" in which people assuage their libidos by engaging in casual sex with friends instead of with long-term romantic partners. The goal is sexual pleasure, not a committed multifaceted relationship. If people in long-term relationships can be unwittingly lured into an unintended pregnancy (as I was), it is also possible that this could happen with sex buddies. Some people circumvent this problem by engaging in oral sex only. From a disease standpoint, that is safer, but not totally safe because some diseases can be transmitted by oral-genital contact. These include herpes and the human papilloma virus (HPV). The latter causes genital warts and increases the risk of cervical cancer and oral cancer. If you are one of the many women whose Pap smears reveal cervical dysplasia, there is a good chance that you developed that pre-cancerous change as a consequence of HPV infection. In Fascinating Health Secrets, I discuss an effective method to reduce the transmission of various STDs besides the ways that everyone knows about, such as abstinence and condoms. (Now do you see why I entitled it Fascinating Health Secrets?) In The Science of Sex, I presented another easy way to minimize the risk of pregnancy and STD transmission while preserving sexual pleasure. Those books are worth their weight in gold for other reasons, but if you knew how frequently HPV and other STDs are transmitted, you would be a fool not to read those books.
Perhaps I possess an overly negative opinion of casual sex because, as an ER doctor, I've seen so many cases in which it had a disastrous outcome. Besides the obvious (pregnancy and STDs), there was anxiety, depression, suicide, and even murder (yup, that story is in my ER stories book). Obviously, I never saw the cases with happy endings.
Many parents, educators, and religious leaders would like to curb premarital sex, but their approach is often ineffective. Scare tactics, appeals to morality, and pragmatic advice are often no match for the human libido. When these exhortations fail, the admonishers often respond by becoming more vehement. Being shrill is not the answer; that makes as much sense as raising your voice to facilitate communication with someone who does not speak your language. In effect, libidinous young people do not speak the same language as the ones who are counseling them. Logic and persuasion are often not a match for raging hormones that fuel one of the most basic human drives. Nevertheless, the admonishers keep using the same tactics, year after year. They influence a few people, and are ignored by the rest.
Is there a better way? I think there is, and I opine that the admonishers are amiss for not occasionally trying a new tactic every century or so. Let me backtrack for a minute. When I was a kid in the 1960's, I read my Dad's army manual, Army Life, War Department Pamphlet 21-13, published 10 August 1944 (you can read the sex section by clicking on the picture at the left). During World War II, and likely centuries before, governments admonished soldiers to refrain from fornication, tacitly admitting that soldiers would not heed prior exhortations from their parents, teachers, religious leaders, girlfriends, and wives back home. If I wanted to rein in sexual intercourse or oral sex, I know that the "just say no" approach is not a sufficient deterrent. To be effective, I think people need an alternative. In searching for this alternative, it helps to understand why sexual relations are so much more desirable than masturbation. The reason for this is obviously not a mystery; people prefer sex because it feels better. Kissing, hugging, and caressing are undeniably pleasurable but can be done without genital contact. Thus, there is one paramount reason why people are so eager for sex: because sex provides more pleasure. For this increment of pleasure, people are willing to risk their health, finances, reputation, freedom, and principles.
People would not be so hell-bent to have sex if they could achieve comparable pleasure elsewhere. Just one problem: how? For all the lip service we give to being sexually enlightened, our culture is still highly repressive about sex. When Surgeon General Dr. Joycelyn Elders mentioned masturbation, President Clinton fired her. The prestigious journal The Lancet referred to this incident as "a bizarre example of the triumph of politics and prejudice over common sense." I think it is time to stop childishly sweeping this discussion under the rug. Millions of people have died because masturbation wasn't good enough, and countless others have suffered less severe penalties. Hence, the need for this discussion is obvious. However, it does no good to just mention masturbation and present that as an alternative to sexual relations. Everyone knows about it. Babies have been observed to masturbate in the womb. Consequently, it is pointless to mention masturbation and leave it at that. If it is to effectively suppress the urge for intercourse or oral sex, it must replicate the pleasure those activities provide. That is not easy to accomplish. As I discussed in The Science of Sex, sexual pleasure is potentiated by some very specific things that typically do not accompany masturbation. Thus, it is not surprising that masturbation is less gratifying. If our leaders truly cared about people, they'd get off their moral high horse and stop stigmatizing or ignoring masturbation. As I alluded to above, people don't need a primer on masturbation; they need Masturbation 499, not Masturbation 101. In other words, they don't need a Mickey Mouse discussion of it, they need an advanced coverage that is illuminating, not repetitive. They need to know how to make it feel better. That is one reason why I discuss how sexual pleasure can be enhanced in The Science of Sex. Some of these methods are applicable to sexual intercourse and oral sex, while others are suited for masturbation. I don't moralize; I merely instruct.
Q: But aren't you moralizing by telling students to postpone sex?
A: No. I am advising, not moralizing. They don't mean the same thing. The point of this forum is to foster academic success in every way possible. I mention things I think you should do, and things you should not do. Sex is not the most common reason why students fail to achieve their goals, but it trips up enough people that it is worth mentioning. Hence, I discussed it. It has been said that hope is a good breakfast but a poor supper. Hope isn't working. It's time for Plan B.
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You will have sex about 10,000 times during your life.
Doesn't it make sense to read a book that can maximize your enjoyment, and the enjoyment you give to your partner?
Cast away your preconceptions of sex books as being a rehash of things you already know and hence a waste of time. By reading this book, you will learn many things that Dr. Ruth and other sexologists have never considered.
The Science of Sex
by Kevin Pezzi, MD
Available in printed and Adobe Acrobat e-book versions (will display on any computer)
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Years of schooling and college advice
Q: I am very interested in becoming an ER doctor. I am really obsessed. How much school do you have to take? What age are you when you usually start if you start college at the age of 17 or 18? I would really appreciate it if you could answer me. Also, do you know any really good colleges?
A: How much school? Typically 4 years for college, 4 for medical school, and 3 for residency. What age do most ER docs begin working? About 29.
In regard to recommending a specific college, I'm not a big proponent of advocating one college over another. I think the main thing that counts is the student and his dedication—not the professors, not the textbooks, and not the college.
More on selecting a college
Q: Hello, my name is Lisa-Marie and I would love to be a doctor when I'm older. What college do you recommend I attend? Thank you.
A: There are a number of good colleges. Deciding which one is best for you depends on several factors, such as proximity to your home, tuition and boarding fees, college reputation and its specialization, your high school record, and so on. In general, though, I am not a fan of the supposedly top-tier colleges; I think they are exorbitantly overpriced. I went to a good, but certainly not illustrious, university (Michigan State). On the MCAT exam, I creamed the folks from Harvard, Yale, and other Ivy League schools that are purportedly so much better than the plebeian universities that commoners attend. I know one fellow who loves to brag about his Harvard degree, but he makes so many spelling and punctuation errors that I wonder what they do at Harvard—teach finger painting?
However, I'd advise you not to attend a community college for the first two years, as some people do in an attempt to save money or because they can't get into a university. Medical school Admissions Committee members look down on anyone who attended a community college. Might you still be accepted? Yes, and you might win the multi-state lottery, too. OK, the odds aren’t that bad, but look at it this way: it is tough enough to get into medical school even if you do everything right. Why shoot yourself in the foot and start out with one strike against you?
What was my undergraduate major?
Q: I would like to know what course of study you pursued in college? I am currently majoring in biomedical engineering, but am considering transferring to another major which would allow me to fulfill the entrance requirements for medical school without having to take all the extra engineering courses. Patricia
A: I majored in zoology, but I never finished college since the medical school I attended accepted one person per year without a degree if they had sufficiently high grades and MCAT scores. While I do not have a degree in zoology, I think I know enough about it to say that it is not, in my opinion, the best premedical major. It is certainly one of the more popular majors and it fulfills the requirements for most medical schools, but I would not choose it again.
In deciding on a major, you should consider several factors. First, what truly interests you? Second, choose a major that will not make the Admissions Committee think that you wished to take the easy road. Hint: forget about psychology! Some psychology courses are fine (and even desirable), but that major has a reputation for being fluff. Third, unless you have rich parents, choose a major that will allow you to support yourself if you don’t become a physician. Statistically, most people who have that goal do not achieve their dream, so it is important to choose a marketable major. In my life, I spent a lot of time reading the employment want ads, and I never saw a job listing for someone with a zoology degree. Fourth, choose a major that will best prepare you for medical school and the subsequent practice of medicine. Here is an example: a degree in biochemistry or physics is acceptable, but knowledge of physics has far less to do with patient care than knowledge of biochemistry. The prerequisites demanded by medical schools ensure that you will take some physics (generally, one year), and in that year you’ll learn far more physics than you will ever use in the practice of medicine. The same cannot be said about biochemistry. Most docs have a shaky knowledge of biochemistry, and they would benefit from knowing more. Ergo, doesn’t it make sense to focus more on that?
Why did I specialize in ER medicine?
Q: Dear Dr. Pezzi: Hi, my name is Danielle. Even though I am only 13 and in the eighth grade, I know I want my career to be the one you have. I was just wondering why you wanted to become an ER doctor? I also want to know what medical school you went to? Thanks for listening, hopefully I'll be hearing from you?
A: I had several reasons for going into ER medicine. In no particular order, they were:
· I wanted a specialty in which I could see immediate results. Some physicians (internists, for example) give people drugs to control high blood pressure and then wait days or weeks to see a result. How exciting.
· Some residencies are longer than the three years it takes to complete an ER residency. I was drawn to plastic surgery, but the extra four years that required was something I could not put myself through at that time.
· I did not want my own practice—which can be a veritable nightmare.
I attended Wayne State University School of Medicine.
Now available as a free e-book download
What really goes on in emergency rooms? If you're a fan
of the television show ER, you might think that you know. Not so,
asserts Kevin Pezzi, M.D., an ER doctor and author of True Emergency Room Stories. Pezzi says the show ER only
scratches the surface; the truth is far more interesting — and bizarre.
So bizarre, in fact, that the cases could shock even an experienced ER
physician. "I'm now a firm believer in the saying that truth is stranger
than fiction," he says. "I don't think that anyone could dream up such
Questions about being an ER doctor
Q: Dear Dr. Pezzi: Hi, my name is Nicole. I am a senior in high school who is interested in the medical field. For my English class I'm writing a report on being a doctor in the ER. While searching the Internet I came across your site, which is exactly what I wanted! But, I still have some questions about this profession. If you have time, would you please answer the following questions? First of all, what do you like most about this job?
A: Making a diagnosis that another ER physician would likely have missed, or doing a procedure (I love doing surgery in the ER) in which one's ability is readily apparent—such as suturing facial lacerations. I am usually not a competitive person, but those areas are a couple exceptions.
Q: What do you like least about this job?
A: Frivolous malpractice suits.
Q: Do you have any tips regarding getting into this field of work?
A: Do extremely well in medical school, since the competition to get into an ER residency is fierce.
Q: What abilities help you do your work?
A: The ability to think rapidly and deeply but accurately, lots of natural energy, the ability to do ten things at once, and the ability to get along with most people. Oh, I could go on: a large bladder, the ability to work for many hours without eating or breaks, the ability to tolerate abuse, and a good immune system so you won’t get sick when people cough and sneeze on you.
Q: What is the salary range for this job?
A: Usually $140,000 to $200,000. That may seem like a fortune if you are accustomed to making the minimum wage, but put it into perspective. I know a pharmaceutical representative who makes twice what I made at my peak ($173,000), and that isn’t counting his stock options and benefits. When I made $173K, I received no benefits, but the drug rep received health insurance, dental insurance, optical insurance, sick pay, personal days, retirement, unemployment insurance, life insurance, a company car, and who knows what else. Oh, he didn’t work nights or holidays, either!
If your motivation is money, don’t go into medicine because every time you turn around you will see someone who makes more than you do, but has an easier job. Eventually, this will gnaw at your sense of economic propriety. Last night, I saw a television interview of the parents of Elizabeth Smart, the 14-year-old kidnap victim. According to the show, her mother is a “stay at home mom” and her father is a mortgage broker. Judging by their mansion (which dwarfed the largest home I ever owned), being a mortgage broker is much more lucrative than being an ER doctor. ABC News reported that their home is worth $1,200,000. That is over four times what my most expensive home cost. Let's think about this for a minute. Ultimately, who pays mortgage brokers? People who obtain mortgages. If mortgage brokers weren't paid so handsomely, people would pay less for their mortgages. Evidently, society thinks that when mortgage brokers overcharge people for mortgages, they deserve to live in small palaces. However, ER doctors do not, even though they save lives and undergo many years of tortuous preparation for a demanding, stressful career. Becoming a mortgage broker is inestimably easier than becoming an ER doctor. But it's the mortgage broker, not the ER doc, who lives in the mansion. Is this equitable? While I am generally a proponent of a free market economy, I think that free markets can produce startling overvaluations and undervaluations of the work performed by some people. I could go on and on, mentioning rich salesmen, a former neighbor of mine who owned an auto parts store but lived like a king, and even women who sell cosmetics and make more than ER docs.
Q: What is the competition like regarding getting a job in this field?
She is determined to become an ER physician, despite my exhortations
Q: (I paraphrased this first part of her questions since I deleted the original message.) I want to become an ER physician, and I think I can increase my chance for acceptance into an ER residency program by attending one of the uppity New England medical schools such as Harvard, etc. What's your opinion? Thank you, Hannah
A: I don't think there is any compelling reason to believe that the medical schools on your list will offer you a better foundation for your prospective career. I think you have fallen prey to the human tendency to be enamored by schools with more illustrious names. What really counts is you, not the school.
I also think you would be wise to reconsider your career choice. The level of discontent among physicians today is alarming, and emergency medicine remains the medical career with the highest burnout rate. You may choose to ignore this fact in your youthful zeal, as I once did. I graduated in the top 1% of my class in medical school and my ER residency director said I was the smartest resident to ever go through their program, yet I think that going into ER was the worst mistake of my life.
The job of being an ER physician has been glorified in ER and similar television shows, which impart a deceptive glow to that career choice.
Q: Thanks for your thoughts. At the moment, I still hope to go into EM (not due to watching ER, but after much reading, research, and a bunch of internships). However, it's important for me to get both sides of the issue. I'd be interested to know more about specifically why you regret going into EM, if you feel like sharing more information. In any case, thanks for your thoughts. I will definitely consider the burnout rate more carefully as I continue on in my education.
A: There are so many drawbacks to ER medicine it is difficult to list them all. My books of ER stories give numerous examples (I will also present more examples later in this book). I think you would be wise to learn everything you can before you devote your life to ER medicine. Most ER docs I know hate their jobs but feel pressured to keep working because they are married and have children. Also, I think most people (whether or not they are doctors) fail to understand how the business principle of “sunk costs” applies to living a good life. Consequently, they keep going along the same path so they do not waste their earlier investment of time and money. It's a recipe for perpetuating misery. PS: How did you do on the MCAT?
Q: Hey, funny you should mention the MCAT actually—I'm in the process of studying for it now. If you have any suggestions about it, I'd love to hear them.
A: For a test like the MCAT (on which your entire career hinges), it is important to do everything possible to ace it. I had a poor idea of how to prepare for the exam (I just read a book on physics), but I can't complain too much since I scored in the top 1% overall. Nevertheless, I was disappointed that my test-taking strategy was so poor. After taking the exam, I finally realized how the test should have been approached. Here is one tip: go fast. Don’t double-check everything as I did. By double-checking your answers, you might get a couple more correct, but never finish each section (I didn’t). Also, read some of the MCAT study books to obtain a feel for the test. I did not do that, and consequently had no idea what was on the test, or how rapidly I was expected to work. By the time I figured this out, the test was over. Considering all these preparatory flubs, it’s a miracle I scored so well. Also, use caffeine! That may seem awfully basic, but caffeine didn’t touch my lips until my second year of medical school. Since caffeine increases rapidity of thought, and the MCAT stresses that, caffeine is a vital adjunct.
Q: My grades are good (3.83 GPA) and I have a lot of clinical and research experience, but I know a lot hinges on that one little score—well, hopefully, it won't be too little! :-)
A: Your grades are very good, and you seem to be a diligent person. My gut feeling is that you will be readily accepted into medical school.
Q: I have a lot of clinical experience, so I know a lot about what goes on in an ER.
A: Until you walk in the shoes of an ER doctor, you have very little idea of what it is like to be an ER doctor. Being a spectator will only show you the things that an ER doctor does—not the million and one things that he must think about. That is the tough part. If you watch a chess tournament, it just appears as if two people are pushing little pieces of wood around a board. Easy, huh?
Q: Do I really think I can do it for 40 years without burning out? I don't know. Here's a question for you, though: would you have been happier in another specialty or do you think you'd have been happier only if you were in a completely different career? If you would have been happier in another specialty, which one would you have chosen and why?
A: I am certain that I would have been happier in another specialty. If I had to do it all over again, I would have become a plastic surgeon even though the training period was longer. I enjoyed all the plastic repairs I did in the ER, and surgeons complimented me on my skill.
Before I go on, I want to emphasize that while there are many stresses and negative aspects of emergency medicine, there also are some priceless rewards. Here are a few of my favorite memories from the ER.
Lots of questions about a career in ER medicine
Q: Dear Dr. Pezzi: Hello, my name is Aline and I am writing because I am a junior in high school who is doing a report on what science has to do with the field you wish to enter later in life. Well, I hope to become an ER physician. Part of the report consists of an interview with someone in that field. I am extremely busy, as I imagine you are, but I really would appreciate it if you would answer some of the following questions and e-mail them back to me, please. First, what are the educational requirements?
A: Generally four years of medical school preceded by four years of college. A few med schools accept students with three years of college if their grades and MCAT scores are high enough; this saved me a year of undergraduate tuition!
Q: What are the training requirements, internships, licenses, continuing medical education (CME), membership in professional societies, etc?
A: Generally three years of ER residency, passing the medical boards (a breeze if you can weather med school), CME of 150 hours every three years (in Michigan, anyway). Membership in professional societies is optional, and expensive.
Q: What are the costs of education/training for this position?
A: When I went to medical school, the tuition was $5280 per year (indelibly etched in my mind), but I was told it is now over $15,000 per year. It varies from school to school.
Q: What are the opportunities for advancement in the industry?
A: If you want to be the ER director (which amounts to answering patient complaints, sucking up to hospital administrators, and making out the monthly schedule), you can earn an extra $100,000 per year if you work in a relatively major hospital. Count on an extra $20,000 per year, if that, for the minor league hospitals.
Q: What are the typical occupational perks for this job?
A: Dating cute nurses (I’m not kidding!) and relative immunity from speeding tickets. Hey, police aren't dumb—if a cop catches a bullet, he doesn’t want the person saving his life to be harboring a grudge. Besides, we're on the same side: us versus the dregs in society.
Q: What high school classes might help prepare someone for this career?
A: Psychology. If you become an ER doc, you'll work with more nuts than Planters, I guarantee you. Science (chemistry, electronics, and physics are my favorites—I'm still reading about them 20+ years out of high school) classes are helpful for understanding the wacko professors in college. I think the only reason I understood what some of them said is because I knew what they said before they said it. However, if I did not have the same background, I probably would have been lost—there are some extremely inept teachers in college (high school teachers are usually much better at teaching). This isn't sour grapes, either (my college GPA was 3.94).
Q: What are the general interests/talents of persons in this career?
A: You must enjoy chaos and have a high tolerance for people who could test the patience of God.
Q: What are the other careers that someone educated/trained for this career might move into?
A: Writing books of ER stories is one possibility. Believe it or not, but this question is a hot topic amongst ER doctors because many are eager to find a more tolerable career. The easiest switch is to work in an Urgent Care center. The pay is less, but the pace is generally more tolerable, the patients are generally nicer and less seriously ill or injured, and the hours are better since most Urgent Care centers are open only during the day.
Q: How are science and/or math used in this career? Thank you for your time and consideration. Thanks in advance for your cooperation. Sincerely, future M.D. Aline
A: Science is useful for understanding just about anything related to medicine. Math is not used much in clinical medicine (primarily basic math for calculating pediatric drug dosages). In medical school, I once had to do a negative logarithm to calculate the answer to a pharmacokinetics problem. Math just isn't used much in most medical specialties.
Preparatory classes for ER
Q: My name is Mallorie and I am 15 years old. I want to be a doctor, either Ob-Gyn or ER. What classes do I need to take in college and med school to work in ER? Thanks!
A: You can major in anything in college as long as you meet the basic requirements of the medical schools that you apply to. Generally, those requirements include at least one year of inorganic chemistry, one year of organic chemistry, one year of physics, one year of biology, one year of math, and so on. Many medical schools have specific additional requirements. For example, the medical school I attended required a class in genetics.
In an effort to meet those medical school entrance requirements and to not prolong the undergraduate time beyond four years, most premedical students choose a major in one of the basic sciences. Traditionally, the most common major is zoology (animal biology). I strongly advise you to avoid that, though. If you are not accepted into medical school, an undergraduate degree in zoology is not very valuable. If you want proof of that, scan the want ads and see how many employers are requesting such a degree: virtually none. Therefore, it is a good idea to meet the medical school prerequisites while simultaneously obtaining a more saleable degree.
If you want to become an ER doctor, in medical school you should take a “class” (actually, this is more properly termed a “rotation”) working in the ER. If you apply to an emergency medicine residency program without having had such a rotation, the residency director would be as surprised if someone she had never dated asked her to get married.
Specializing too early?
Q: My name is Frannie and I am in the 8th grade. I really want to become a doctor in the ER. I know that it takes a lot of school and you have to get good grades, but what can I do now that will help me in the future? I will be scheduling my classes for high school soon and I'm not sure what classes to take. What do you suggest?
A: Other than taking several science classes, I would not worry about taking specific classes in high school just yet—there's plenty of time for that in college and medical school. My only specific recommendation for someone your age is to do lots of reading on a wide variety of subjects, and read The Memory Book by Jerry Lucas and Harry Lorayne. I read it over 20 years ago and it is still in print, which is a testament to its success. I highly recommend it to anyone who needs to memorize a lot of information. The primary attribute of this book is that its techniques allow you to indelibly stamp information into your mind. With more traditional means of memorization, you may think you know the material, but three months later the memory fades. That will not happen if you use the techniques in The Memory Book.
Schedule? What's it like?
Q: My name is Kristy, and I would like some information on ER doctors because I want to become one myself. What is the schedule like?
A: The best word I can think of is “inhuman.” Working weekends, holidays, and nights is very taxing. In general, ER docs constantly change their shifts from day to afternoon to night. It is impossible to acclimate to such a constantly changing schedule, and that is why most ER docs quit working in the ER long before they retire, in spite of the supposed advantages of being an ER doctor. From what I’ve heard, the average longevity of an ER physician was seven years when I began, and nine years when I left the ER after working over a decade.
Q: What must I do to become an ER doctor?
A: College: four years, medical school, four years, and residency, usually three years. Also, you need to excel at every stage because the competition is so strong. It is tough to get into medical school, and it is even tougher to be accepted into an ER residency position; only the cream of the crop in med school stands a chance to be an ER doc. Having gone through all that, I really wonder why people aspire so fervently to be an ER doc, but that selectivity is just a consequence of the laws of supply and demand.
Cutthroat premed competitiveness
Q: Hi, I just looked over your site and it was very interesting. I wonder if you could give me some tips about getting into medical school and some other things related to that. I was one of those super students in high school. I am now in UC Berkeley in the biology department, and I'm just an OK student (about a 3.4 GPA— probably less in chemistry). A few years ago, I thought it would be no problem if I wanted to go to medical school, but here the premeds are all so competitive and anal about every little thing that I don't seem to have a chance. In some ways it has really turned me off of doctors to see the kinds of people who make it into medical school. The cheating is so bad that they don't even give grades for lab sections in classes because it leads to sabotage! Is this something new, or was it always like that?
A: There was talk of that when I was an undergraduate, but I never personally witnessed any of it. The worst example of rivalry I observed was when a woman at my Organic Chem lab table would not speak with me because she thought I would somehow use that information against her in a competitive way. I was stunned! That had never crossed my mind. I never thought of competing against others. I assumed there was an absolute standard that I had to measure up to if I wanted to be a doctor, and I was either good enough or I wasn't. It was incomprehensible to me that I would be “good enough” just because I performed better than someone standing next to me.
Q: Are my perceptions correct about this or is it just a Berkeley thing?
A: It must be a Berkeley thing, since I cannot imagine that all schools are that way.
Q: Also, I am a dual citizen: Israel and the US. I am now in Israel scoping out the possibilities of doing medical school here. It's harder to get into, but it seems more fair, and I think I might enjoy practicing here more. Most of the cases are related to military or auto accidents, and being a smaller country you just don't get as wide a selection of nuts as in the US (I'm in the paramedic corps here).
A: That would be a strong plus, since dealing with the wacko patients in the US is a real pain in the butt (as you know if you've read my book). How is the malpractice situation there? It must be a lot better than in the United States, where you can be sued even if you give perfect care—not just substandard care. It's happened to me, and it made me very cynical. Perhaps it is better in other states, but Michigan (where I live) is the land of frivolous lawsuits, and for most of my career I worked in the most litigious county in Michigan. From what I've heard, some other states (such as Illinois) are reasonable in that you can be held accountable for malpractice if you screw up, but cases without merit never get off the ground there.
Q: I've read all the papers about when foreign-educated docs want to work in the US, they say getting residency is no problem because of the shortage, but that doesn't show me what it is actually like. Are foreign-educated doctors looked down upon in day-to-day functioning? Any advice you give me would be greatly appreciated. I am glad someone still cares enough about people who are in the first stages. Thank you, Sara
A: It depends on the country in which they trained. If it was Israel, it wouldn't be a problem. It is generally the Caribbean schools whose graduates are looked upon with askance.
Q: Hi, I wrote to you a while back asking about medical school in Israel. Well, I'm now to the interview stage (next week) and wonder if you have any tips for that? What is a good type of answer to “Why do you want to study medicine?” Thanks for answering—if you have time. Sara
A: There are many different ways to answer that question, but in general your response should reflect your interest in and commitment to medicine and your desire to deliver compassionate, topnotch medical care. As the old Toyota commercials used to say, “Who could ask for anything more?” Well, medical school admissions committee members could ask for more, even though the foregoing response should be enough to satisfy any reasonable person. Some interviewers harbor antiquated stereotypes, such as the notion that pretty young ladies should marry and have children instead of spending the best years of their lives (from a childbearing perspective, if nothing else) cloistered in medical school and hospitals. The most logical response is that you would postpone marriage and childbirth until you're older even if you had not planned on going into medicine.
People warned her to not work in the ER
Q: Hi. I am 14 and in 7th grade. I know you're probably thinking that I am too young to be seriously thinking about a career, but I better start early, I guess. People told me that I shouldn't work in the ER because it's too depressing and there are too many life-and-death decisions, but I want to, anyway. Thanks for your time! Marissa
A: You seem to be an intelligent young lady, so I think you are smart enough to work in the ER if you want to. However, the life-and-death decisions you mentioned are the easy part of working in the ER—your training prepares you for that. What isn't easy to deal with is the constantly changing shifts (working nights, afternoons, days, weekends, and holidays). In addition, there are a number of other drawbacks, many of which I discuss in my books. That explains why the burnout rate in ER is very high. My old boss once confided in me that he grew up dreaming of being an ER doctor, but he found it so stressful that he would become sick to his stomach hours before each shift. Incidentally, he was an excellent ER doctor, which goes to show that the stress of ER can get to anyone.
Q: OK, thanks for replying to my message. I think you are right, but . . . Would the stress be as bad in the Intensive Care Unit? I’ve considered that, too.
A: No. Since the ICU has a fixed number of beds, any overflow simply stays in the ER. In contrast, there is no limit to how busy the ER can get.
Q: I also wonder where I can obtain money for college. My family is not poor, but college is so expensive. Where did you get your money? THANKS SO MUCH, Marissa
A: I mowed lawns (a lot of them!), did all sorts of odd jobs, worked in two different factories (making large industrial transformers and building trusses for homes), worked for the department of Pontiac that put on car shows, worked in a bottle recycling plant, delivered newspapers, worked as a security guard, built decks, painted houses, and I tutored several subjects in college. The most challenging job was probably when I was hired to carry lumber up a hill to a building site. The man building the home chose to build on a hill so steep that no truck could climb it, so he hired me — a human mule — to carry the building materials up the hill. The guy was a slave driver, too: for example, he insisted that I carry two thick sheets of plywood at a time, not one. That was the toughest $45 I've ever earned. The easiest job I had was when a builder hired me to pretend to be an electrician . . . don’t ask why—it’s a long story. That was easy for me since I'd just finished painting the home of an electrician. I adopted his mannerisms (down to the piece of straw jauntily hanging out the side of his mouth), his muted atavistic speech, and his overstuffed tool belt.
Now that I am discussing minor points in my résumé, I suppose I should mention that I helped a student cheat in college after he paid me $100 to take his physics final exam for him. I did, and “he” scored a 4.0 on the test. Before any of you highly principled people chastise me for this, I should mention that he was a premed student with as much chance of getting into medical school as I have of dating Brittany Daniel or Miss America. Had he been in the running, I would not have given him a boost that might have helped him displace some more qualified candidate from medical school. I also would not have done it had I not been starving. There were times in college when I had no money to eat, so I staved off hunger by eating the freebie packets of sugar and coffee creamer in the college cafeteria. However, there is a limit as to how long a person can subsist on that. Yes, I worked during college, but one of my jobs was a three-hour round trip from campus, and my car was a gas hog. If you think gas is expensive now, when you factor in interim inflation, it’s cheap compared to what it was at that time.
Q: Didn’t you receive financial aid?
A: Yes, but far less than some other students who received free room, board, tuition, books, and even spending money. They received a free ride; I received assistance, but not much. The financial aid department insanely believed that my mother, a single parent who worked in a grocery store and had two kids in college and one at home, could help support me. Yeah, right. My Mom is exceptionally frugal, perhaps because she grew up during the Depression, but in spite of her penny-pinching ways, she had no money to give me.
However, the iniquity with which Michigan State doled out financial aid was nothing compared to the scandalous way that they gave some students an academic free ride, and hence a sham degree. I can best illustrate this by including a response that I gave to another person:
A foray into
Considering the above, when I helped that person cheat on his physics exam, it was just a drop in the bucket compared to what the university did.
It’s no secret that affirmative action exists, but I was shocked by the degree to which it is sometimes so blatantly offensive. This isn’t just offensive to hard-working non-minorities who are displaced by minorities given an unfair boost, it is also a slap in the face to hard-working minorities who achieve success on their own. In fact, those latter people should be particularly incensed, because the existence of these scandals undermines public confidence in the legitimacy of their achievements.
Links to other pages in the More Q&A section:
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