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.
ER doc too busy to make love to the woman he's
Q: I started dating (if you can even call it that) an ER doc about a month
ago. He is always really tired or really busy works 14 shifts a month, but
what exactly is a "shift"? I know they're rotating shifts. I REALLY like this
guy and can't tell if he truly works a ton of hours or if he's just blowing me
off. I'm thinking "if you're too busy to f*ck me, you are TOO BUSY" but I'd like
to give him the benefit of the doubt. Should I continue to wait for his call or
A: An ER shift is typically anywhere from 8 to 12 hours. However, by the
time the doc completes his dictations, paperwork, and wraps up the care on his
patients, each shift may be prolonged a few hours or it may not, depending on
how busy the shift was. Working 14 shifts per month may not seem like much, but
ER work can really sap one's energy. I've worked many jobs in my life, and
nothing I mean NOTHING was even a tenth as exhausting as ER work. I used to
mow lawns, primarily using a push mower. Trust me, you've never seen anyone mow
a lawn as fast as me. I souped up my mowers so they could still do a good job of
mowing even when pushed at a breakneck speed. In the blink of an eye, I could
turn the mower around and accelerate to my mowing pace (which was faster than
most people run). I'd do this all day long, seven days per week. Tiring? Just a
pleasant stiffness in my muscles at night. Compared to ER, it was like being on
If you think I'm getting off-topic, just bear with me for a minute: I'm
giving you this background information so you can fully grasp what I'm about to
tell you. Physically, the most taxing job I had was when I worked for a guy
carrying building materials up a hill (he was building a home on a hill so steep
that no truck could ascend it, so he hired me to carry the boards from the base
of the hill, a few hundred feet to the top, stumbling on potholes after sunset. The man was really a slavedriver,
insisting that I carry two thick sheets of plywood at a time up the hill. An
average man couldn't even pick up two such sheets of plywood, let alone carry
them hundreds of feet up a hill, and do that over and over again building a
home requires umpteen tons of lumber. Was I tired afterward? A bit, but that job
was a walk in the park compared to being an ER doc.
I could regale you with tales of my other 18 jobs, but the take-home message is
the same: nothing is nearly as exhausting as being an ER doc. Obviously,
ER work isn't especially demanding from a physical standpoint: witness the
paunchy physiques of most ER docs. However, ER work is mentally taxing, and that
is far more onerous than physically demanding jobs. If you care to think about
this from an evolutionary perspective, humans evolved to tolerate prolonged
physical activity quite well, and also sporadic mental stress like being
chased by a saber-toothed tiger. Our "fight-or-flight" response is great for
dealing with such periodic stresses, but it does a miserable job of coping with
mental stress that goes on and on and on … such as what ER doctors face.
It's been scientifically proven that humans and animals have a more difficult
time coping with stress when the stressor(s) are not under one's control. You
may think the ER doc is in control of the ER, but he isn't. He can't control how
many patients flood the ER at any one time. If the patient volume is
overwhelming, he can't prevent another dozen people from walking in the door,
all screaming for attention NOW. He can't control what his patients are like,
some of whom are so out-of-control that one such patient could sap all his time.
There are hundreds of factors that are not under the control of ER doctors, and
these stressors malignantly affect the docs. After all, they're human.
Most ER docs love to feel that they're tough and can handle anything.
Unfortunately, they can't evade biological reality. Protracted, severe stress
induces biochemical changes within the body that produces noticeable changes:
muscles atrophy a bit, and there's a bit more fat, especially on the trunk.
There are a dozen other changes, but you didn't tune in for a lecture on
endocrinology, so I'll cut to the chase and discuss how chronic stress impacts
libido. Briefly, it reduces it, primarily mediated by a fall in the testosterone
Don't think that I'm writing all this to excuse the apparent sexual exhaustion
of your quasi-boyfriend. I'm not. I've worked full-time in one ER and part-time
in another ER while doing other jobs on the side, such as writing and inventing.
Even though I'm typically a high-energy person, sometimes I'd be so drained that
on my days off, all I'd want to do is sit in a chair and stare at the wall. I
had so much I wanted to do, but I was so pooped I couldn't muster the
energy … except when it came to sex. On those rare occasions when I had a
girlfriend, I was never "too tired," except for once when my girlfriend spent over an hour in the bathroom getting dolled up at 2:30 AM after a l-o-n-g day spent driving up north to snowmobile with me fighting gusty crosswinds to control the world's worst trailer towed by a sportscar clearly not designed for snow, let alone towing in it, all followed by stuffing myself on a smorgasbord of unbelievably delicious food at Canada Creek Ranch, then enough whiskey to make my nose numb—hey, I was young then!
My diagnosis? There's a problem here. Either the doc you're dating has a problem
with his libido, or he isn't attracted to you. Since he is dating you, I suspect
that he must be attracted. Ergo, there is likely a problem with his libido.
Working rotating shifts (in which the schedule changes from day to afternoon to
night shifts in a cyclic fashion) is a great way to wreak havoc on the body.
People who work the night shift typically live a few years less than average,
and those who work rotating shifts face even greater stress, because their body
never has a chance to adapt to the constantly changing schedules. Hence, it
isn't surprising that an ER doc working rotating shifts would manifest some
Other than the stress of ER, there are countless factors that may impair
sexuality. I won't try to offer a definitive diagnosis for him over the
Internet, but I'd like to help. I know more about sex than Dr. Ruth. That
may seem like bragging, but it's true, I assure you. She knows the basics, but
yawn what doctor doesn't? Compared to what I know, she is still in
kindergarten. Therefore, I have a lot to offer, so I will send you a
complimentary copy of my book, The Science of Sex: Enhancing Sexual Pleasure, Performance, Attraction, and
Desire, if you don't mind reading an e-book. Reading that book will give
you a lot to mull over, including some things you've certainly never considered.
If you think I'm just hyping the book (but why I'd do that to encourage someone
to accept a free copy is beyond me), I'm not. There isn't a doctor in the world
who knows more about sex than I do. I read every book I can get my hands on that
is even remotely similar to mine, because I believe in checking out my
competitors. Consequently, I've read countless books in this genre, and most are
laughably mickey-mouse and an utter waste of time. My book will have your head
spinning, and if the information in it can't turn your man into a sexual dynamo,
well, it's time to search for another man.
You know that writer's block you get when you sit down to write the essay
portion of your personal profile for online dating? And you know the
difficulty you have trying to think of a catchy headline? Well,
MyProfileWriter allows you
to create a profile essay and headline without typing, just by clicking!
A reader thinks I'm arrogant Note: The following message is unedited:
Q: Hi, I'm writing about your answer to the question of how to become an
ER tech (assistant.) in your answer you stated that the girl who asked the
question sounded very intelligent and that she should go for RN or MD. I believe
that that was great advise and that everyone should strive to be their best, but
I am an EMT seeking an ER Tech position. I take pride in my skills and the work
I put into getting my certificates. I am a very intelligent person and I do hope
to continue on to nursing. I'm also a 20 year old who is married and has a 3
year old diabetic son. Attaining my goals are going to take a little longer but
I'm confident that I will succeed. With all due respect, I think you sound a
A: What on Earth is wrong with complimenting someone? The justification for your comment is inscrutable.
“People who repeatedly attack your confidence and self-esteem are quite aware of your potential, even if you are not.”
— Wayne Gerard Trotman
“Whoever is trying to bring you down is already beneath you.”
— Habeeb Akande
Regarding your statement, "I think you sound a little arrogant." I
don't know what prompted that characterization, which strikes me as a non sequitur. I readily admit that I am very
proud of my accomplishments. I had a superb undergraduate GPA, aced the MCAT,
got into medical school after 3 years of college, graduated in the top 1% of my
class, and was such a shoo-in for an ER residency position (the most coveted
residency at that time) that I was offered an under-the-table deal because they
wanted to ensure that no other hospital lured me away. During and after medical school I took Accutane: an acne drug that can cause pseudotumor cerebri; it gave me excruciating chronic headaches that made it difficult to concentrate—but when you're young and foolish enough to value appearance over feeling good, I put up with pain that would send most people to an emergency room.
I've designed and built
hundreds of things from scratch, such as a pocket echophonocardiograph and the world's
best electronic stethoscope that gives the user the acoustic impression that
he is actually inside the patient's chest not the typical muffled, muddy
sounds that most stethoscopes give. I've written several books and developed
dozens of websites that are packed with information (like this one) or are
truly innovative. Once I discovered how to unleash my creativity, I did much more, such as inventing devices that cure certain infections much faster and more reliably than antibiotics. I sold that technology to a company founded by a friend of Bill Gates but leapfrogging the capabilities of all pharmaceutical companies was what I'd call a single (to use a baseball analogy); my best ideas are comparatively like a home run that wins the World Series. I can't yet talk about them, but they will change the world for the better, save countless lives, and put smiles on billions of faces.
So am I proud? You bet! You're proud of what
you have accomplished, and when you accomplish more, you'll be even more proud.
Pride is one thing, and arrogance is something altogether different. The two are not direct synonyms. According to my American Heritage dictionary, pride
means "pleasure or satisfaction taken in an achievement" or "a sense of one's
own proper dignity or value; self-respect." Arrogant means, "making or disposed
to make claims to unwarranted importance."
“If being an egomaniac means I believe in what I do and in my art or music, then in that respect you can call me that … I believe in what I do, and I'll say it.”
— John Lennon
The key difference is whether the sense of accomplishment is warranted. If you're going to call me arrogant, I wish you would explain why my pride is not justified. We live in a plastic world filled with people who truly are
arrogant because they've accomplished little or nothing on their own, but yet
think they're hot stuff because they were born beautiful, rich, or famous.
I think of arrogance, I think of Hollywood folks who believe they're America's
royalty. Their success is attributable to their good looks. Take away their
pulchritude, and what do you have? Not much. Their talent? Ha, I'm
laughing about that.
Take Ben Affleck, for example. I mentioned him only because
I saw him in a movie last night, and I was stunned by his performance … not
because it was good, but because it was so pathetic. As a doc with years of
experience in the ER, I can tell if someone is on drugs or has brain damage. I
don't know if laypeople key in on the speech patterns that alert docs to those
possibilities, but the cadence and intonation of his speech, and his glassy-eyed
countenance, made me wonder if he was drunk, on drugs, deficient in some
nutrient vital to mentation, or if his neurons had a third-rate wiring job. He
is treated like royalty just because he happens to be one bodaciously handsome
man. Let's say Affleck had twice the talent that he does, but he looked like the
Wal-Mart greeter I saw this morning, or he looked like me, you, or just another
face in the crowd. Would he still be a star? The answer to that rhetorical
question is obvious, so let's move on.
“Who would you impress if the world was blind?”
— Shannon L. Alder
Another group of people who are frequently arrogant are beautiful women, even
the ones not in Hollywood. Men are all too eager to shower such women with
things that less attractive women rarely get or have to earn on their own.
Eventually, some beauties come to possess an exalted opinion of themselves, just
because they're beautiful. Have they ever saved anyone's life, as I have
numerous times? Would they risk their lives to save the life of a poor black male, as I did? Have they ever spent hours making handmade gifts for sick
people, just because they wanted to see them smile? I have. Have they ever spent
hours removing the snow from the driveway and porch of a disabled veteran? I
have. Take away their God-given beauty, and what do you have? In many cases, not
much. I've dated some real beauties, and once I stopped drooling over them, I
realized that most coasted through life on their looks alone. (For more
information, see the
beautiful woman syndrome site.)
I wasn't born famous, beautiful, rich, or smart. My Dad abandoned us when I was young
(and was later murdered), and my Mom worked two jobs to support us. I'd
frequently awaken in the middle of the night to the sound of my Dad pounding my
Mom (breaking bones) or just a wall. I'd stay in bed, frozen in place with fear, staring in
the darkness at the ceiling, wondering if my brothers were awake and heard all
this shit. I was too scared to speak, so I spent those nights waiting for
the time I could get up, dab some more grease into my hair (hey, this was in the
1960s), and do my best to pretend that everything was hunky-dory. I
wondered how any father could look his children in the eye after hitting their
mother, then I'd go to school. How I kept awake without coffee is beyond
My vision was so poor that I'd run into walls and couldn't see what teachers wrote on the
chalkboard until I began wearing glasses at age 16. Before then, I used one finger to push on an eyeball to partially correct its astigmatism. It still mystifies me how I
could go through that many years of school without one teacher noticing I
was blind as a bat; aren't they trained to recognize such problems?
I lived in a
home with peeling lead paint that I dutifully removed with a paint scraper over
a period of months, never wearing any mask or gloves to protect me from the
neurotoxic lead. I simply didn't know better. Worse yet, when my Dad was still
around, we'd decorate our Christmas tree with icicles made of pure lead. As a
young child when the developing brain is especially vulnerable to lead I
would roll those icicles into balls, and then eat cookies, without washing my
hands. I was exposed to lead from other sources, such as helping my Dad cast
lead bullets and work with lead type. With so much lead exposure, it's a wonder
that I ever learned to tie my shoes. My sixth-grade teacher said I was “slow,” and I struggled my first two years of high school until I serendipitously stumbled upon a way to significantly increase brainpower. Before that, I was so tired of floundering academically I planned to drop out and get a job working in an auto assembly plant.
working when I was in junior high school, and I kept working up to three jobs at a time to support myself
in college and medical school. On my first morning delivering newspapers in college, a man amused by my appearance called me a “retarded boy” and told me to get out of there. I couldn't afford a winter coat, so I wore every shirt and jacket I had, trying to keep warm. I wasn't given any bag or advice on how to carry so many thick Sunday newspapers, so I improvised a solution by using my plastic laundry basket as a sled, which I pulled with a rope over the sidewalks covered with fresh snow.
I used to drive junkers that often broke down,
and had various mechanical problems that wasted my time (such as a car that
wouldn't budge until it was warmed up for 20 to 30 minutes—that's 40 to 60
minutes wasted per day). One car smoked so much I had to drive it to
college before sunrise and stay there until it was dark. If I didn't,
the plume of oil smoke trailing it would result in another ticket I
My poverty forced me to sometimes room with people who
were either exasperating or even downright nuts, and that wasted time, too. When my Mom's (and later my) money ran out I
sometimes starved and developed diseases stemming from nutritional deficiencies, but I was either too stupid or too hard-headed or too proud (that word again!) to ask for help. My acne was so bad I wasted thousands of hours popping pimples and trying to unclog my sebaceous glands—up to two hours per day!
I had a bleeding ulcer that bored a hole in my gut twice the size of a bullet. The only doc I could afford to see was such a quack he couldn't diagnose an ulcer, and instead opined that I had a back problem, for which he prescribed a 4-millimeter shoe lift! While my classmates were studying, I was writhing in pain and shitting out blood for years because I thought he must know what he was doing … he was a doctor, wasn't he?
I performed minor surgery (dermabrasion and excision of gangrenous tissue) without
anesthesia a few times on myself because I couldn't afford to see a surgeon. When I was younger and even poorer, one of my knees would swell internally so much that I couldn't begin to bend it. I had other joint pain so bad it was difficult to sleep, but I didn't get even an aspirin for it. I had untreated strep throat that led to rheumatic heart disease. I developed objective tinnitus so severe it'd awaken me as soon as I entered anything deeper than a light sleep. Did it last for weeks? No, many years. Without medical insurance, I had to put up with the tingling in my hands and feet after I broke my neck. So did I
lead a charmed life? Not quite. In a blog article, I mentioned more challenges I faced.
Thanks to ADD (attention deficit disorder) that likely arose from earlier lead exposure, I found it almost impossible to concentrate on schoolwork; my mind incessantly wandered until I found a temporary antidote for it. I was also poisoned by mercury that produced symptoms making restful sleep impossible for decades. Mercury produced diverse debilitating symptoms associated with erethism, the effects of which are so devastating they could not be inflicted on mass murderers because the Supreme Court would rule such punishment unconstitutional. Suffice it to say the toxic effects of mercury interfered with school and essentially robbed me of much of life's joys.
Many of my classmates in medical school had advanced degrees, such as Ph.D.s in
pharmacology and biochemistry. Many of them came from well-to-do, famous
families, and had all the advantages money can buy: the best prep
schools, the best colleges, the best medical care, the best food, the best
lodging, the best advisors, the best connections for those all-important letters
of recommendation, and even a reliable car. Most importantly, many of those
students were supported by their parents, eliminating their need to work. So, as I
was slaving away mowing thousands of lawns, baking in a couple of factories while getting ripped off by union bosses, and
performing countless odd jobs (some of which were brutal, dangerous, or just
plain God-awful), my cohorts could have been studying, doing research, prepping
for the MCAT or the boards, or doing something else that would have given them a
competitive edge over me. Frankly, I was intimidated by their achievements,
their money, their connections, and their other advantages. But guess what?
There were 255 people in my medical school class besides myself, and I beat 254 of them. If you
had overcome the difficulties I faced and accomplished what I did, you'd be
I sincerely doubt that you or anyone else is interested in my accomplishments.
That's why I never bothered to mention them for years. The only reason I've done
so in this venue is because I present myself to the public as someone who is
qualified to counsel people on how to succeed in college and medical school. Not
all doctors possess equal brainpower and qualifications; some graduated at the
bottom of their class, and some at the top. If I were a student listening to the
advice given by supposed experts, I'd give more credence to the topnotch docs.
Or would you prefer to follow the guidance of someone who graduated at the
bottom of his class? I think my advice is valuable not just because of my
achievements, but because of what I had to overcome. Hence, I mention my
successes not to gloat or brag, but to give students some basis for deciding
whether or not that advice is worthwhile.
In my opinion, justifiable pride in one's accomplishments is far preferable
to the duplicitous false modesty our society tacitly encourages. I like
people who are straight-shooters and say exactly what they think instead of
stumbling through life playing mind games with themselves and others. I don't
understand people who lambaste Donald Trump and Donny Deutsch (host of CNBC's
The Big Idea Show) for being arrogant. They have high opinions of themselves
but that pride is warranted and based on their achievements, not fantasy. Thus,
their apparent arrogance is nothing but an acknowledgement of reality.
While discussing the subject of braggarts on The Big Idea Show, Mr.
Trump said, "You have to have the goods." Well, he does. I think his apparent
bluster annoys people who secretly wish they had accomplished much more. Rather
than blaming themselves for wasting their lives watching sports and frittering
their time away in other unproductive ways, they assail the poster boys of
success, such as Trump and Deutsch. Speaking as a doctor, this is a pathological
misdirection of anger.
In conclusion, I should mention that success is often achieved because
of prior adversity, not in spite of it. People who've led cushy lives
often never learn to dig deep into themselves and find latent strengths. Quoting from the cover of Scientific American MIND (March/April 2014): “CREATIVITY UPDATE: Embrace Your Inner Eccentric and How Hardship Actually Helps.”
Anyone who reads this and this and concludes I am arrogant has an obvious supratentorial defect.
The article Early traumas and young people's reactions to terror said people are “at increased risk [of post-traumatic stress reactions] if they have experienced violence or sexual abuse in early life.” Being shot, cut, threatened, beat up, and called names like “nigger nose” and “nigger lips” bothered me less than being feet away from my Mom when she was repeatedly beat up when I—then in mid-elementary school—was too young to defend her. I was also emotionally scarred by seeing her repeatedly cry about bills she couldn't pay at that time, which was years before my first job in 7th grade. But we succeeded in spite of those and myriad other stresses, and she rose out of poverty, achieving a peak net worth of $1.6 million (adjusted for inflation in 2016 dollars) in spite of having a high-school education and misogynistic bosses who felt entitled to pay her less because she was a woman; her best-paying job was as a grocery store clerk. So, Mr. EMT seeking an ER Tech position, I am not sure what makes you feel entitled to write to people you don't know and criticize them when you don't know 1% of what they've gone through. Remember the quote, “Be kind; everyone you meet is fighting a hard battle.”
Article by Dr. Craig Malkin: Why a Little Narcissism Can Be Healthy
Excerpt: “Healthy narcissism—feeling a little special—helps us to see ourselves and those we love through slightly rose-colored glasses, remain resilient when we fail, feel passionate about what we love, and pursue our dreams even when they seem a bit beyond our reach.”
“Never underestimate a man who overestimates himself.”
— Franklin D. Roosevelt
“Forget everything Mom told you about being humble and succeeding with modesty: the job usually goes to the one who brags loudest, says a new study by the University of British Columbia. When faced with two applicants with equal experience and qualifications, the interviewer will usually pick the more narcissistic of the two, found UBC psychology professor Del Paulhus.” (source)
Comment: I figured that out long ago. My lack of self-confidence was pathological and painful; it took decades of accomplishments to erase some of those overly negative self-assessments and replace them with realistic ones. My girlfriend is a nurse and psychologist who detests arrogant doctors. If I were one, she wouldn't date me, nor would she try to boost my self-esteem and tell me that I'm much too hard on myself. And I am; I am my own worst critic.
“Public opinion is a weak tyrant compared with our own private opinion. What a man thinks of himself, that it is which determines, or rather indicates, his fate.”
— Henry David Thoreau in Walden
It is very advantageous to think I am never good enough because that keeps me working overtime and incentivized me to achieve things I otherwise likely wouldn't have done. Thus while social rejection can fuel motivation, personal rejection can, too. I've solved some of mankind's most pressing problems; now all I need is investors to turn my prototyped and proven ideas into products that will have people calling me the next Steve Jobs, but what I'll do for you will dwarf the benefits of iPods, iPads, and iPhones. Consequently, I learned to love my lack of self-confidence because it helped me do much more to help others. When you find out what inventions I have up my sleeve, you will be thrilled with what they can do for you, with benefits that now seem like a pipe dream.
Therefore, it is best when people internally lack self-confidence so they always work hard but externally appear brimming with narcissistic ego. Appearing on Fox News (7-10-2014), Drexel University psychologist Dr. Charles Williams corroborated this by pointing to evidence that narcissistic people are more likely to become CEOs and earn more than more humble CEOs.
Despite what people say about how they hate narcissists, they gravitate to them, throw money at them, and vote for them. People who are naturally humble, such as myself, can feign some of the manifestations of narcissism to reap some of its rewards. I knew that decades before professors let others in on this secret. I never liked doing that, but I cannot control what others choose to reward. Since we live in The Age of Blame, we could blame the narcissists and ones feigning it, but it makes more sense to blame the sheeple who set the rules and create the incentives for narcissistic behavior. If the incentives vanished, the dreaded behavior would, too.
“Whether you think that you can, or that you can't, you are usually right.”
— Henry Ford
“… it's real money at stake, it's big egos at stake …”
— Shark Tank star Daymond John discussing the Sharks Comment: Note the popularity of the Sharks—people LOVE them—even though they're all brimming with ego. Also note that the one least flamboyant in that regard (Kevin Harrington) is long gone.
No discussion of self-esteem and bragging is complete without mentioning Muhammad Ali, who repeatedly and boldly proclaimed, “I am the greatest!” and “I'm the king of the world!” During his memorial ceremony, a friend (John Ramsey) recounted telling him, “Muhammad, you're the greatest.” Muhammad responded, “Tell me something I don't already know.” Ali was one of the most admired and universally loved people to ever live.
“The moment you doubt whether you can fly, you cease forever to be able to do it.”
— J. M. Barrie, author of Peter Pan, in The Little White Bird
“Men who are more ‘of themselves,’ more out there and conquering—this has been a mating advantage, so to suggest to men, ‘Hey, take a step back, don't puff out your chest so much’—well, you may not get dates and you might not get the promotion and your family might go hungry.”
— Psychiatrist Dr. Keith Ablow discussing research on narcissism (3-6-2015)
“Self-esteem is the switch in the circuit of your life that dims or [brightens] your future. Bring it low and you dont shine your light; raise it up and you brighten the corner where you are.”
— Israelmore Ayivor
“The worst enemy to creativity is self-doubt.”
— Sylvia Plath in The Unabridged Journals of Sylvia Plath
“Fear defeats more people than any other one thing in the world.”
— Ralph Waldo Emerson
“If a man thinks he is not conceited, he is very conceited indeed.”
— C.S. Lewis
“False humility is quite like the worst of both worlds: both that of Meekness and that of Conceit.”
— Criss Jami
Are You Over-Confident? Take This Test... That reminds me of the Lake Wobegon effect, named after Garrison Keillor's fictional town where “all the children are above average.” In real life, almost everyone thinks they're above average. As LinkedIn influencer Don Peppers wrote, “the only group of people known to exhibit highly accurate self-assessments, with realistic memories of their achievements, are the clinically depressed!”
Another LinkedIn influencer, venture capitalist Yoshito Hori, wrote that Asian investors “prefer speakers who deliver their presentations in a quieter, humbler manner” while Western investors “prefer their speakers to be aggressive, physically dynamic and somewhat self-promoting [with] a show of energy.” He added, “the high-energy style that works well in the West can come across as disagreeably boastful and egoistic in Asia.”
“Early in life I had to choose between honest arrogance and hypocritical humility. I chose the former and have seen no reason to change.”
— Frank Lloyd Wright
“False modesty can be worse than arrogance.”
— David Mitchell
“You need to have tremendous confidence in your work, even a touch of arrogance, chutzpah. Many very fine researchers lack intellectual daring. It's human nature to want to be cozy, secure. But that can be a cul-de-sac.”
— Neuroscientist Vilayanur S. Ramachandran
Why Are People Overconfident So Often? It's All About Social Status Excerpt: “People who believed they were better than others, even when they weren't, were given a higher place in the social ladder. … falsely believing one is better than others has profound social benefits for the individual. … these findings suggest one reason why in organizational settings, incompetent people are so often promoted over their more competent peers. [People] did not think of their high status peers as overconfident, but simply that they were terrific. … overconfident individuals were more convincing in their displays of ability than individuals who were actually highly competent. … Prof. Anderson hopes this research will give people the incentive to look for more objective indices of ability and merit in others, instead of overvaluing unsubstantiated confidence.” Comment: I hope the same thing. The downfall of the United States is partly attributable to how too many of us are duped by overconfident, narcissistic leaders.
Stress in adolescence prepares rats for future challenges Comment: Obvious parallels to humans. To stymie someone's potential, coddle them. The children of wealthy parents are likely to have a slew of advantages (such as good educations) that should give them a head start to success, but try naming rich children who did anything great.
Why the best hire might not have the perfect resume
“Usually the wacky people have the breakthroughs. The 'smart' people don't.”
— Burt Rutan, innovative aerospace engineer
“Smart people are a dime a dozen. What matters is the ability to think different … to think out of the box.”
— Walter Isaacson, biographer of Steve Jobs
The following song, A Daisy A Day, reminds me of the love that one of my relatives, President Chester Arthur, had for his wife Ellen. Note how Jud Strunk said he was proud he wrote it. Is there anything wrong with saying that? Absolutely not! It is a beautiful song; he should be justifiably very proud of it.
Strunk died at age 45 when he suffered a heart attack while taking off in his airplane, which crashed.
“Humility, I have learned, must never be confused with meekness. Humility is being open to the ideas of others.”
— Simon Sinek
“There is overwhelming evidence that the higher the level of self-esteem, the more likely one will be to treat others with respect, kindness, and generosity.”
— Nathaniel Branden
“As a surgeon you have to have a controlled arrogance. If it's uncontrolled, you kill people, but you have to be pretty arrogant to saw through a person's chest, take out their heart and believe you can fix it.”
— Mehmet Oz Comment: As I've written elsewhere, the least arrogant doctors were the most dangerous to patients. Arrogant doctors continually have something to prove to themselves and others; one mistake can shatter their self-conception, so they burn the midnight oil and go the extra mile to ensure every patient receives the best possible care. Less arrogant docs have less to prove, so they don't try as hard. When a physician doesn't think much of himself, another bad result or premature grave is no big deal. Trust me, you want an arrogant doctor.
“I'm Billy the Kid, the fastest draw. It's not arrogance. It's the truth.”
— David Geffen
“I would just say that nobody could do what I do unless you had a big ego. It's the only way you can really put it. You have to be arrogant enough to challenge the arrogance of the human race.”
— Paul Watson
More research: Self-esteem mapped in the human brain Excerpt: “A team of UCL researchers has devised a mathematical equation that can explain how our self-esteem is shaped by what other people think of us … ‘Low self-esteem is a vulnerability factor for numerous psychiatric problems including eating disorders, anxiety disorders and depression.’”
The “we're one of the top hospitals” scam
Q: In an advertisement in the newspaper, our local hospital proclaimed
it was voted "one of the top 100 hospitals in the country."
Frankly, this is hard to believe. Given that
there are 50 states, that leaves an average of two hospitals per state that won
this award. That hospital is just
a hole-in-the-wall, and we have several university hospitals that are
considerably better. So how did they win this award?
A: I have a one-word explanation: payola. Every
hospital I've worked in claimed it won similar awards and was, for example, one
of the top 100 cardiology hospitals in the country. I wondered how that
was possible, given that we didn't even have a cardiology department! Our
cardiology patients were cared for by two Internal Medicine docs who anointed
themselves the local cardiology specialists, and a ragtag group of ER docs,
including yours truly. How such a make-do assemblage could constitute one
of the top cardiology hospitals is beyond me. One night I worked with the
usual complement of ER staff, which was a grand total of one nurse . . . but
this nurse was one of the top 100 nurses in the country, no doubt. Anyway,
to complete my illustration of just what a farce it was to proclaim us one of
the top 100 cardiology hospitals in the country, this nurse and I were
besieged by three patients in cardiac arrest, all of whom were dumped on our
doorstep at the same time. If you've spent much time watching medical
shows on television, you know that it takes more than two people to optimally
code even one patient. But three at once? We quickly made the rounds
as we went from patient to patient, with me trying to figure out which person
was least dead. We focused on that one, saved his life, and bid the others
farewell after we thanked them for visiting one of the top 100 cardiology
hospitals in the country.
I'm not privy to the machinations behind these scams, but I bet that the quid
pro quo goes something like this: a hospital pays a fee to participate in
a survey. Any hospital that pays the fee is voted one of the top
hospitals. The hospital brass, astute graduates of the Machiavellian
School of Business, figure that the bucks spent on the payoff will be recouped
by additional revenues as more sheep flock to the Misleading Mecca of Medicine.
UPDATE: After a local Top 100 hospital killed one of my friends and committed a long string of other errors, I was so skeptical of their Top 100 designation that I spent months investigating the hospital award racket, which I concluded was a clever scam in which awards can be purchased—indirectly, of course, for obvious reasons. Hospital big shots love these awards because they use them to justify their bloated salaries. Even though the hospital is so financially strapped that some nurses are losing the equivalent of a day's pay per week, the CEO is paid over a million dollars per year with yearly increases way above the rate of inflation. The rich get richer . . . .
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Best strategy for dealing with initially poor
My opinion on prestigious schools
The importance of possessing a diverse knowledge base
Will you be my mentor?
Q: I have a few questions for you and maybe you could help me if you have
the time. I'm currently a junior in college who is trying to get into medical
school. I used to party too much my freshman year and a little bit of last year,
but haven't done so in about a year. I currently have a 2.3, and I know I
wouldn't be able to do anything with that GPA. But until recently, I've been
studying my butt off and raising my grades. Here's my first question for you:
Do medical schools look down upon students who retake a class and get an A in it
the second time around?
A: Yes. It's certainly better than NOT taking it, and leaving the original
low grade as your only mark in that class. However, it will never totally redeem
or erase the first poor score. Here's why. Given the pace in medical school,
Admissions Committees need to select people with a good chance of mastering
material the first time. You may very well possess that ability, given that your
earlier efforts were not your best efforts, but how could an Admissions
Committee know that or compensate for that? They don't know if your original
grade was attributable entirely to bad study habits (now amended) or difficulty
and slowness in learning. Hence, they'd quite likely prefer an applicant who
obtained a 3.5 on his first attempt in a class instead of someone who obtained a
4.0 on his second attempt. I can sympathize with where you're at, because I had
the same problem in early high school as you do in college. As a high school
freshman and sophomore, I was concerned with riding my motorcycle and lifting
weights so I could one day become a world champion wrist wrestler. Studying
didn't fit very prominently into my priorities.
Q: Once I graduate, I've been thinking about going to get my master's
in some type of biology course to better my chances of getting into medical
school and help me with the MCAT. Would this be wise to do?
A: If you're a junior with a 2.3 GPA, you don't need me to tell you that
you don't stand a snowball's chance in hell of being accepted into medical
school at least not now, given that students traditionally apply in their
third year. You could pursue your above strategy of completing your
baccalaureate, but even if you do very well in the remaining year and a half,
it's going to be tough for medical schools to choose you over someone who did
well from the beginning. If you obtain all 4.0's from now on, you won't be able
to raise your GPA high enough to give you a reasonable chance of acceptance. You
could pursue a master's degree and, if your grades are exceptional, have a
reasonable chance of getting into medical school. That's not a bad idea, since
even if you don't get in med school, at least you'll have a more saleable
degree. However, there is another master plan that I call the "Lucas strategy,"
in honor of a friend of my brother. Dr. Lucas is now a cardiologist, but in
early college he was a lackluster student. Rather than trying to explain away
his early abysmal grades, he took the classes over again at a new college, never
telling his second college about the first one. I assume it was easier to pull
off this scam in those zany days of yesteryear when schools were less diligent
about identifying you, but sans a retinal scan, you're home free if you don't
mind taking mundane steps to change your identity. With a clean slate, you can
retake the classes, probably ace them, and quite likely get into medical school.
It may seem wasteful to dump 2½ years of college down the drain, but what's the
alternative? You can complete your bachelor's degree and probably not get into
medical school. You can get a master's degree and maybe get into medical school.
Even if the latter strategy succeeds, it would likely take another 3½ years or
so. In about the same time, you could repeat college. You're probably more
likely to get in med school if you hide your current record and ace your second
college attempt than you are to apply with a master's degree and need to explain
away years of poor grades. However, it comes down to what is more important to
you: maximizing your chance of getting into med school, or accepting a
somewhat lesser chance in return for getting a more saleable master's degree. I
can't make that choice for you. Doc Lucas thought the former strategy, although
risky, was better for him. Medical schools reject plenty of people with master's
degrees and a so-so undergraduate GPA, but they reject very few applicants with
stellar undergraduate grades.
Q: Another route I thought about is going to John Hopkins Pre-Medical
program (which is another B.S. degree). Would this be smart to do before
applying to medical school?
A: I don't know enough about that program to give you a good answer, but
in general I am not enamored with the supposed benefits of prestigious schools.
I know Harvard grads who can't write without making multiple spelling and
grammar errors every paragraph, and some of them are such dingbats I wouldn't
trust them with a screwdriver, let alone a scalpel. If you don't believe me,
read my review on my web site of
White Coat: Becoming a Doctor at Harvard Medical School by Ellen Lerner
Rothman, MD, then ask yourself if you'd fully trust her. Docs don't need to know
just medical things; to be fully proficient, they must also have a diverse
knowledge base. Yes, I know that the supposedly top-tier schools bend over
backwards to accept a diverse class, but that's not the type of diversity I'm
discussing. Ivory Towers think there is value in diversity based on melanocyte
activity and if you spent a year living with a tribe in Mozambique, but I fail
to see how such diversity benefits your patients. The type of diversity that
benefits doctors and their patients is a broad base of knowledge of
everything from baking to welding to soldering to building homes to etching
glass to making stained glass to unusual sexual practices. Why? Because you'll
have patients with problems traceable to those activities. If those activities
are Greek to you, how can you fully understand the etiology of your patient's
condition? You can't. You probably have no idea of just how narrow the knowledge
base is for some docs. I know one doctor (and I'm sure he's not the only one)
who had no idea what a 2 x 4 (pronounced "two by four") is. How can anyone NOT
know that? Even after I explained to him that it's a common board used in wall
studs and other building applications, gave its nominal and actual dimensions,
and explained its composition, he still had no idea what it was. Think that's
hard to believe? Then how about a Harvard grad who evidently doesn't know what
Styrofoam is? Read my review of White Coat, and look at the
tongue-in-cheek graphic I developed that expressed my exasperation of how
Harvard can graduate people whose general competence is incomprehensibly
pathetic. My point is this: doctors interface with real people who lead
real lives filled with real activities. If those activities are a mystery to a
doctor, he cannot optimally care for his patients. Docs certainly can't know
everything about everything, but is it too much to expect a doc to know what
Styrofoam or a 2 x 4 is? Most elementary school children know that! If a doctor
is clueless about Styrofoam, it's a good bet that the doc will be equally
uninformed about welding and countless other common activities. Unfortunately,
medical schools do not test for such a diverse knowledge base, much to the
detriment of the patients cared for by its graduates. Instead, they give an edge
to applicants whose diversity does more for notions of political correctness
than it does for real patients and their real problems.
Here is my opinion on this matter of knowledge diversity: if a person
fully deserves to be called a doctor, he should know far more than just the
basics. Frankly, I expect a kindergarten student to know what Styrofoam is, so
if a doc knows that, I'm not about to give him a gold star. As an example of
what I think "doctor-level" knowledge is, let's return to the case of Styrofoam.
Apart from merely identifying it, I think docs should know about its
polymerization process, and in particular how this polymerization is not 100%
complete and why this is important. I also think docs should possess some
knowledge of common polystyrene additives. This stuff is not valueless trivia. I
discuss it in my sex book (The Science
of Sex: Enhancing Sexual Pleasure, Performance, Attraction, and Desire)
because those chemicals can have adverse hormonal effects. So is it pointless
for a doc to know about them? Obviously not. I saw many patients with sexual
problems even in the ER, and private practitioners see such problems with
greater frequency. Besides polystyrene, docs should possess at least rudimentary
knowledge of other plastics and their additives. Some are toxic, and some will
cause men to grow breasts. If a doctor sees a man with the latter problem, he'll
come up with an inappropriate solution, such as telling the man to lose weight,
or learn to live with it and accept it as a consequence of aging, or refer him
to a plastic surgeon. If the doc understood the true etiology, he'd know what
treatment is best . . . and it's none of those. I could give thousands of other
examples to illustrate how a diverse knowledge base benefits patients, and why
the type of diversity now being championed does far less to improve patient
care. However, we live in a culture that glorifies the value of superficial
diversity and gives short shrift to the value of true diversity.
I think that medical students should take a mandatory class that would help fill
in their knowledge gaps on basic subjects, the awareness of which will likely
affect patient care. If I taught such a class, I'd give a brief presentation on
a few hundred subjects with clinical relevance, such as a five-minute talk on
"What you need to know about welding" and an hour lecture on how you can help
your patients build a healthier home or cope with problems in their current one
that contributes to health problems. Yes, there are books on those subjects, but
the onus of knowledge is on the doctor, not the patient (isn't
that why the doc is being paid for his superior knowledge? What brains does it
take to tell a patient to go read a book?) Furthermore, I've read about this
subject, and I've yet to find an author who divulged some of the tips I know. I
wouldn't try to teach students how to weld or build a home, because there is no
need for that and time is far too limited. However, there are some very specific
things every doc should know. To truly master medicine, a doctor must know much
more than just medicine.
Q: I'm currently the VP of Biology/Medical Careers club, and found your
website very informative. I talked to the head biology professor at my college
(my advisor), and he's interested in informing students about ER medicine. Lots
of students do not understand a whole lot about it, so he would like them to
hear it from a pro. Would it be ok for us to print out some of the questions in
your FAQ, quote you and hand them out to students?
A: That's fine, if the quote is unaltered, attributed to me, not for
profit, and my web site URL (www.ERbook.net)
Q: Also, I'm looking for a mentor, and I must say that I look up to you
a whole bunch. Would it be possible for you to mentor me?
A: I do my best to answer as many questions as possible. Since I receive
more questions than I can feasibly answer, I usually restrict my replies to
subjects that will be most beneficial to others. I am a very slow and
inept typist, which (along with dozens of other activities that consume my time)
limits my productivity.
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
Pezzi's book is packed with nothing but unusual stories. There are no
"the patient's in v-tach, shock 'em with 200 J and give 'em 100 mg of
lidocaine, stat" type of cases. While such cases are a mainstay of the
show ER, Dr. Pezzi believes that they quickly become repetitious.
Instead, he presents an amazing collection of true stories. The book
begins with a story of how he may have saved Michael Jackson's life by
averting an assassination attempt by a person who claimed to be a
Cosmopolitan cover model, and ends with an interesting tale of how he was
propositioned on a beach by a relative of a recent ER patient. In
between, he recounts stories of unusual murders and other crimes, truly odd
reasons for dialing 911, unfathomable reasons for visiting the ER, and people
with an extraordinary affinity for their pets. Then there's a shocking
end to a pregnancy, a twisted tale of revenge that would be a spellbinding
plot for a movie, and the story of a man who attempted to remove his liver at
In this book, you'll accompany Dr. Pezzi as he meets the world's unluckiest
man and woman, deals with people who have strange requests, and attends to a
bride whose genetic disorder wasn't discovered until her wedding night.
There is also the story of the man who didn't know that he had been shot in
the head, and the case of the pit bull who picked on the wrong person.
True Emergency Room Stories has something for
everyone. Besides the strange cases, readers will be captivated by
dozens of incredible, tragic, humorous, steamy, heartwarming,
thought-provoking, and poignant tales.
The "Lucas strategy": is it cheating?
Q: I am troubled by the "Lucas strategy" you recommended to someone
with a poor undergraduate GPA who wished to become a doctor. Are you
A: No, I'm espousing a second chance. Even murderers are sometimes
given redemption, aren't they? So why shouldn't someone whose only crime
is partying too much in college be given another shot at fulfilling his dreams?
Should a couple of wanton years haunt him forever?
Keep in mind that anyone who follows the Lucas strategy is automatically
penalized, both financially and in terms of time. Hence, this built-in
punishment ensures that their second chance is no free lunch. They'll be
chastened, trust me.