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Do you care if wild animals
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Best books to prepare for college chemistry and
Succeeding in college and medical school: how I went from dunce to doctor
What to do if you get a bad prof
My organic chemistry professor and his wacky wife
What not to do
Expanding your brainpower: it takes more than just schooling
Can geniuses be created?
An intriguing speculation on what will be "the next Internet"
Fostering the impetus to succeed
How I convinced a "10" that suicide wasn't the answer to being dumped
The biological basis of creativity
The role of creativity in enhancing intelligence
Q: I was wondering if you might have a bit of advice for me. What
book(s) do you feel are the most conducive to gain a firm grasp on college level
chemistry and physics? I ask because I did not have any form of chemistry
nor physics in high school. Also, I've been out of school for about 5
years, so I've been trying to refresh my memory on all manners of subjects.
I already plan to pick up that memory book you seem fond of. Even though I
do not plan to go into emergency medicine, I also intend to pick up your ER
book; I thoroughly enjoy your more candid approach to things. Anyway, any
advice you could provide I'm sure I'd find rather useful.
Thanks for your wonderful and informative web site; wit mixed with comedy and
liberally sprinkled upon good advice make it a must-see for any would-be ER
doctor. I'll make sure to bookmark it and check back for updates.
Thanks for reading and your time. Mike
A: Before college, I read Physics Without Mathematics by Clarence
Bennett. In college, you're sure to have a prof who liberally uses math to
define, elucidate, and quantitate concepts, but I still think that a
non-mathematical introduction to physics is valuable because it helps provide an
intuitive grasp of the subject. If you possess an intuitive understanding
of physics, you'll have a real advantage over most of your classmates, many of
whom will be lost in a mathematical fog. I'll never forget one time I
visited my physics TA (teaching assistant), who was a graduate student in
physics working toward his Ph.D. I had a question pertaining to an aspect
of physics that wasn't in my course. Before he answered my question, he
grilled me with questions to see if I truly understood physics. After
correctly answering every question, he told me that most students — even the
ones who get A's in class — have a shaky grasp of physics. Basically, he
wanted to know if I intuitively understood physics, and knew it well enough to
"really get it." He told me he'd never before had an undergraduate student
who could answer his questions. With the aid of Physics Without
Mathematics, those questions were easy. I can't give full credit to
that book, however. My high school physics teacher developed a wonderful
independent study program in physics that was tailored around another great book
(the name of which I forgot long ago). It had a moderate amount of math,
but explained the concepts very well. In college, we used Principles of
Physics by F. Bueche. I still refer to that book when I need to brush
up on something. If you read the foregoing two books, you'll have a good
foundation for physics.
My favorite book for chemistry is General Chemistry by Nebergall,
Schmidt, and Holtzclaw. That text was not used in any of my classes, but I
think it did a better job of explaining some things than the assigned course
books — none of which seemed very inspired. I wish I could give you more
input on chemistry books, but I know far less about chemistry than physics.
I have a few inventions that pertain to chemistry, but they're very basic
things. I don't know why I never mastered chemistry as much as I did
physics. Perhaps it was the lack of good preparatory books (I didn't
purchase General Chemistry until I was in college), or the absence of a
truly gifted teacher who gave me a good head start.
Q: Hello again! I wanted to send a quick thanks for your informative
and alacritous response. Thanks!
However, I'm a bit fearful. I recall reading that you didn't have much trouble
in college, and you still managed to pound out a 3.9+ GPA regardless of also
working a fairly regularly job?
A: A few jobs, actually. Mowing lawns, general yard work from gardening to
resurfacing driveways, tutoring a few subjects in college, and occasionally
filling in for my brother delivering newspapers and working as a security guard.
Keeping my car running was sometimes a job in itself. Now that I'm on the
subject of frittering away my study time, I suppose I should also mention my
neurotic level of anxiety, which wasted untold amounts of time. Then there was
my skin care regimen. In high school, I discovered that if I squeezed my facial
skin in the same way I would to pop a pimple, I could express sebum that might
otherwise form a pimple. Depending on how thorough I wished to be, this would
take an hour per day, and sometimes two. (You know that stereotype about greasy
Italian skin? It's true. Even at age 44, I still have acne!) And then there was
the time I spent playing with my neighbor's son. She was 17 years older than me,
but I had a crush on Maggie and blindly hoped that something would magically
click with her if I spent enough time with him. I couldn't bring myself to ask
her out, and, thanks to my shyness, I froze whenever she spoke to me. Still, I
spent hours almost every day babysitting/entertaining him, dreaming of romance
If I told you about all the other ways I wasted time, you'd probably wonder why
I was not booted out of college. It wasn't because of my innate intelligence. In
fact, from what my sixth grade teacher said to me, I think he believed I was
"slow." So how could I go from being a dunce to someone who aced
college, the MCAT, and medical school? Additionally, I wasn't just accepted into
an ER residency (the most competitive residency at that time), they rolled out
the red carpet for me and were so desperate for me to say yes that they offered
me an illegal, under-the-table deal. Furthermore, my aptitude for medicine pales
in comparison to my talent for inventing. I am not mentioning this to brag; I
mentioned it to address the fear you expressed in your question. Let me
paraphrase it and read between the lines a bit to clarify what I think your
concern is. You said you're fearful, and then mentioned my GPA and hours spent
working. I think this is your fear: "Anyone who can work a few jobs and still
get a 3.9+ GPA in college (in the days before grade inflation) must be some sort
of genius; therefore his advice doesn't apply to someone like me."
My response? In terms of innate intelligence, I bet you're far ahead of me. I
once suspected I was a dunce, and my sixth grade teacher confirmed it. My older
brother was the one in our family bound for college, and I was the one who
lifted weights and dreamed of being a world champion wrist-wrestler. That didn't
pay anything, so I planned on supporting myself by mowing lawns or working in a
factory. In fact, I ended up mowing a good chunk of southeastern Michigan, and I
worked in a few different factories. Great college material, wasn't I? Now let
me return to the central point I wish to make: how can anyone with such an
inauspicious beginning rocket to the top of his class in medical school? In
medical school, even the worst students are bright. I beat them, and also the
cream of the crop. As I mentioned elsewhere, many of my classmates had numerous
advantages over me, but I still beat them. How on Earth is that possible?
Even the kids destined to be shoprats were smart enough to escape the wrath of
my sixth grade teacher. Hence, judging by that, I wasn't just destined to be a
shoprat, I was destined to be a dumb shoprat. So how did I do it? I
learned to be smart. I observed (either in person, or by reading) how smart
people thought, and I learned to mimic these thought processes. Eventually, they
were so well internalized that they became not just second nature, they became
the way I thought. I discussed this process, which I term cognitive
mirroring, elsewhere on my web site. An aside: why don't educators teach
this process? They teach the nuts and bolts of other topics in microscopic
detail that they spoon-feed to their students, but they never mention this
process. Why? Do they hope that students will pick it up on their own? Do they
think that learning actually teaches people the best way to learn? (It doesn't.)
Do they believe that routine learning is the best way to optimize intelligence?
Wrong! Frankly, do they even know what cognitive mirroring is? I coined the term
for an intellectual process I used, but surely others do this, too. Even babies
mimic what adults do! I just took this process to a higher level. I suspect that
once people learn to think and reason on their own, they make the mistake of
believing that education is a process of acquiring new facts. I never neglected
the acquisition of new information, but I was always on the lookout for new and
better ways to think. By integrating those cognitive processes with an
ever-expanding base of knowledge, I was able to transform myself from dunce to
Here is what all the foregoing boils down to, Mike: if I, someone once
labeled as a dunce, could perform so well in medical school, you can do it, too.
In fact, if you apply my methods, you could probably do better than I did.
Q: I've been harrowed by so many horror stories of organic chem and/or
"pick your poison." And these anecdotes are actually from very intelligent and
rather assiduous persons.
A: I, too, have seen very bright students tremble with fear of organic
chemistry and some other "killer" courses that supposedly separate the men from
the boys when it comes to determining who has "The Right Stuff" to be the next
generation of physicians. However, remember this: even a onetime class
dunce — me — aced those courses. In fact, some of those courses were so easy
that I didn't even bother to fully apply myself; I'd just skim the textbook once
at high speed, and that was it. I could tell you dozens of stories about those
classes, but here is one. I took a class entitled Advanced Developmental Biology
in my third year of college. Half the students in the class were graduate
students working on their Ph.D.'s in biology. A few times after class the
professor asked me to walk with him because he wanted to know why I was the only
student who "got it" (understood what he taught). He was mystified that graduate
students and my other classmates weren't able to comprehend the material. Well,
so was I. I thought the material was so easy that it didn't merit anything more
than a half-hearted attempt, so that's what I gave it. And I aced its final exam
even though I arrived for it when half of the test hour was gone, because I'd
spent the last 30 minutes lying in a half-frozen mud puddle fixing my car so I
could make it to class. Hence, when my prof asked me if he was doing anything
wrong that might explain why the other students were lost, I couldn't give him
any advice. I thought the class was a dream come true in terms of being a
breeze. That reminds me of my last ATLS (Advanced Trauma Life Support) class.
That's a course taught to practicing physicians (ER and surgery) who care for
trauma patients. After the written portion of the exam, I heard some university
surgeons complaining about how difficult it was. Difficult, I thought?
The last time I had such an easy exam was . . . never. I was going to say
elementary school, but at that time, those exams weren't easy for me.
And then there was the supposed Big Daddy of the tough courses, organic
chemistry (OC). Like all neurotic premed students, I spent a lot of time shaking
in my boots about the fabled difficulty of mastering that subject. When I now
reflect on that, I realize what a waste it was to fear OC. You really can't ask
for a more straightforward class. There are some facts and principles to
memorize, but they're a piece of cake compared to some classes (more about that
in a minute). In my first OC class, I didn't bother studying it until three days
before the final exam, but I still received an A. In my next OC class, I
actually attended the classes, and when the prof would ask how to go from
"Chemical A" to "Chemical B," I could instantaneously think of how to do that,
even for complex reactions that required as many as 25 steps. (Keep in mind:
a onetime dunce did this. So, if I did it, you can, too.)
And then there was math, which I thought would prove to be my nemesis. I went a
year without missing an exam question, and the prof threw in a few tough extra
credit questions on every exam, and I got them, too. When I began college, I was
so poor at math that I couldn't even do basic algebra.
And then there was genetics, the toughest class I ever had. Genetics is not an
inherently difficult subject, especially if you keep to the basic stuff, but I
was either blessed or cursed (depending on how you wish to look at it) with a
professor who was such a genius and so much smarter than anyone I'd ever met
before that I could not comprehend how anyone could be so intelligent. His exams
were unlike anything I'd ever seen (both then and now, countless exams later).
Instead of just asking a question and having students regurgitate pat answers,
his questions were framed in such a way that the correct answers could only be
deduced by possessing a comprehensive and integrated knowledge of all the class
material, and then being able to extrapolate from that. If you had any holes in
your knowledge, and if you couldn't rapidly use that knowledge to make a series
of deductive conclusions for each question, you'd be utterly lost. You wouldn't
have just the usual test uncertainty, you'd be as lost as a blind man in a
dungeon basement on a moonless night. I walked out of that final exam absolutely
stunned; I had no idea it was even possible to conceive of such questions. That
test was the most challenging one I ever faced, but I aced it and received an A.
If a onetime elementary school dunce could do that, you can, too.
Q: I'm beginning to think that Physics/Chem has more to do with
instructors than coursework/students.
A: To some extent, it does.
Q: As I said, I'm fearful I'll get stuck with a putz for a professor.
A: If you get such a prof, just drop him and choose a different one. I did
that once. I had an organic chemistry prof who seemed very distracted. He was.
His wife, a Ph.D. researcher at our university, was so twisted that I'm
surprised she hasn't been the subject of a Hollywood movie. In a nutshell,
here's the pinnacle of her nuttiness. She evidently didn't like the fact that
there were students who did better in school and band than her kids, so rather
than accepting this, she tried to eliminate the kids and their families by
poisoning them. She planted various poisons in their homes and cars until one
day when she was discovered in someone's garage wearing a long coat (presumably
to hide her stockpile of toxins) and carrying a brown paper bag filled with more
goodies. My professor was never implicated as being a participant in this
attempted extermination, but he vigorously participated in her defense (which
seemed to me to be synthesizing cockamamie excuses, à la Johnnie Cochran). In
any case, in class the prof seemed a million miles away, and that's what I
wanted to be from him. I realized his thoughts were elsewhere, so I dropped his
class and enrolled in a different one.
Q: Do you think it would be wise to take my organic chemistry and
physics courses the same year (junior year?)
A: I think premed students should take OC in their second year. However,
let me address what seems to be your concern: is it wise to simultaneously
take two or more difficult courses? As a premed student, you won't be able to
avoid this unless you stretch out the curriculum beyond four years.
Q: I'm getting mixed signals from persons on this. One camp says that
it would be difficult to maintain a high GPA with that schedule; camp number two
maintains that it shouldn't be a problem, and it will actually be of significant
benefit to have organic chem and physics so close to MCAT testing time.
A: Camp number three (me) says that anyone smart enough to be a doctor can
ace more than two difficult classes taken simultaneously. Now, on to the MCAT.
The MCAT is more of an aptitude test than it is a test of knowledge. I re-read
my physics text before the MCAT, but after the exam, I realized that was a waste
Q: When did you take yours? Same year? You remember at all?
A: Heck, no. With the way this Alzheimer's is progressing, I can't
remember what I ate for breakfast. :-)
Q: I enjoy science quite a bit, but I was thinking of actually majoring
in psychology. It seems that psychology/sociology have notorious reps for being
"easy" and "fluff," but I feel they are very beneficial to many medical aspects,
especially if you plan on going into pediatrics, psychiatry, etc.
A: Your choice of a major shouldn't matter because all premedical
students must fulfill the requirements of the medical schools to which they will
apply — but your major matters, anyway. After you complete the year of
chemistry, the year of organic chemistry, physics, biology, math, blah, blah,
blah, you're well on your way to a degree in any of the basic sciences. Also,
don't forget that majoring in one of the traditional premed degrees such as
zoology (animal biology) does not prohibit you from taking several psychology
courses. I did. I took an intro psych course, a somewhat more advanced psych
course, a class in sexology, a class in abnormal behavior, and a class in
criminal psychology. The prof for those first three classes was strange, even
for a professor. He expected us to learn the material on our own by reading the
textbook, so during lecture he'd rant about truly wacko stuff, such as how women
in the class should direct all their sexual energy toward him. He instructed
them not to have sex or masturbate, so they'd focus their sexuality on a better
outlet: him. No doubt he was hoping to have some wild flings during his office
You think I'm digressing? I'm not. Such behavior is tolerated in the fluff
subjects, but not in the serious subjects. If a math professor tried such
shenanigans, he'd be working at Taco Bell the next week. But psych profs can run
on five cylinders and have less morals than Bill Clinton, and keep on teaching
year after year. Did I learn some psychology by reading my textbooks? Yes, of
course. However, I would have learned even more if my horny prof had more on his
mind than trying to seduce a few hundred coeds. Certainly, not all psych profs
are unbridled sex maniacs (my last two profs were very knowledgeable and they
disseminated a wealth of knowledge), but there are enough fruitcakes in that
field to tarnish its reputation and dilute the value of taking such classes.
Medical school Admissions Committee members know that psych classes are
comparatively easy, so they often discriminate against psychology majors. You
should take psych courses, because psychology is one of the underpinnings of
medicine. However, to optimize your chance of acceptance into medical school,
you should NOT major in psych. It's an automatic strike against you. Hence, your
major does matter.
Q: What do you think the admissions folks would think of such a major?
Probably a question more pointed towards a "premed advisor," but I'm beginning
to wonder if any of my college "advisors" even have their heads screwed on
A: I wondered the same thing about my advisor. I never met him until after
I'd been accepted into medical school (I thought it'd be a waste of time to
listen to someone who never attended medical school, so I didn't see him until I
needed his signature for something), and his only suggestion to me was that
since I would not obtain a college degree (I was accepted into med school after
three years of college), that I might want to return to college after medical
school to complete my degree in zoology. Yeah, right. I attended college for one
reason: to get into medical school. Once that was accomplished, what's the
point in obtaining an undergraduate degree?
At the time I applied, my medical school accepted one person per year with just
three years of college if their grades and MCAT scores were exemplary. Out of
256 students in my class, I was that person. Why do I keep harping on this
matter? Because I was once so slow that even the dumb jock coterie was ahead of
me. Sure, I had some good teachers along the way, but who doesn't? My classmates
achieved incremental improvements in brainpower, but nothing like the
transformation I achieved. In my medical school class, there were many bona fide
geniuses, and I beat them. Perhaps I am guilty of patting myself on the back too
often, but I think that anyone who can go from class dunce in elementary school
to the top of his class in medical school deserves a lot of credit for knowing
how to create brainpower. Think of all the Secretaries of Education we've had
since the inception of that cabinet position. Have they produced any measurable
improvement in our IQ's? Not one bit. (If that were true, the College Board that
administers the SAT exam would not have found it necessary to "recenter" scores
by giving every student an extra 100 points, as discussed in a recent Forbes
FYI magazine article.) Now think of the good I could achieve if I were given
that position and had its inherent advantages as a bully pulpit. I would teach
students ways to magnify their intellectual potential so they could exceed their
wildest dreams. I did it for myself, and I'm confident I could do it for them.
However, I am also practical enough to realize that it'd be a cold day in Hell
before I'd be nominated for the Secretary of Education, or any similar position.
I'm too politically incorrect to ever stand a chance of being nominated or
confirmed. Instead, we end up with politically correct, palatable nominees with
the right paper credentials but without any real capacity to produce educational
breakthroughs. That's one thing I detest about our culture: it values
style over substance. Currently, the U.S. Department of Education employs
4615 bureaucrats. Besides pushing paper and creating more paperwork for
others with their heavy-handed meddling, what do these people do except increase
your tax burden? Our children aren't any smarter or better educated than
they were before the creation of the Department of Education. The
September 15, 2003 issue of Time magazine reported that President Bush
increased federal spending by 21% in three years, during which time spending on
education rose a whopping 61%. We spent massive amounts of money on
education before Bush took office, and now our educational "investment" is
staggering . . . but what do we have to show for it? The educational
bureaucracy is great at burning money, but poor at producing results that are
commensurate with the expenditures.
In my mind, it's not just amazing that I did so well in school, it's a dang
miracle. Why? I hated school. In all my years of college and medical
school, there were a grand total of two lectures I enjoyed. I love learning, but
I despise structured learning, so I had to force myself to study and attend
classes. I think I have some elements of ADHD, and it's as difficult for me to
sit through a lecture as it is for Bill Clinton to not flirt with women. I think
I have an enormous fund of willpower, and that is what sustained me through
those years of study.
Bottom line? If an elementary school dunce with ADHD who hates school can ace
medical school, you can do it, too. But do yourself a favor: don't worry
about whether or not you can do it. There aren't many people less qualified than
I once was, and look at how I did. I wasted too much time fretting about the
future, and it didn't do anything except give me an ulcer. If there is one thing
I learned in the ER, it's that life can be unpredictably short. You cannot shrug
off the need to study and expand your mind, but once that's accomplished, let
your mind be free. Don't waste energy worrying. Most premed students are imbued
with more worry than an average college student. Do your work, but don't worry.
Your future will take care of itself. Trust me, I'm a doctor. :-)
Q: You make it sound so fantastic. I'm talking about your
"transformation." After reading some of your anecdotes, it just seems so
surreal. I mean, I believe them, but it seems like a different world to me. I'm
wondering if there was something about the way things worked in college that
made things "click" in your mind? It seems almost as if it was the different
environment of college that proved to be a catalyst for your academic
transformation. And if your success merely hinged on mimicry of your professors'
habits, I'd think there must have been something more to it because even the
majority of professors do worse than you did in college. You did say you also
did this mirroring through reading as well, so I guess it would be possible.
A: The onset of my "transformation" (or cognitive metamorphosis, if you
will) preceded college, so it wasn't entirely due to exposure to my professors.
I read extensively, devouring many books and countless magazines. Magazines are
sometimes dismissed as being pabulum, but some are not, such as Scientific
American. That magazine now seems much more simplistic than it once was, but
there is still some value in it — and who is to say that you can't read the
classic issues of a few decades ago? Other magazine favorites were Popular
Science, Popular Mechanics, and the now defunct Mechanix
Illustrated. In general, these magazines fueled my intellectual growth not
by discussing abstruse, esoteric subjects, but by covering technology in such a
way that it seemed tantalizing, fascinating, and utterly engrossing. If you pick
up a current copy of Popular Science, you'll likely wonder why I was so
intrigued. The operative word in the preceding sentence is "was," because that
magazine is nothing like what it used to be. It now seems sterile and devoid of
fervor. Popular Mechanics has succumbed less than its competitor (Pop
Sci) to the trend for magazines to cover topics in a superficial, insipid,
detached, and politically correct manner, yet it also is blander than before. My
primary criticism of these magazines is that their editorial focus has shifted
from "you can do it, and we'll show you how" to "you can't do it, so
we'll assign one of our writers, who rarely ventures out of his New York
high-rise condo, to cover a subject in which he won't need to get his hands
dirty, God forbid." In the days of yore, those magazines covered some spellbinding subjects:
how to make your own submarine, Tesla turbine, rocket engine, or boat. DIY (Do
It Yourself) magazines now think they're challenging their readers if they show
them how to make a brick patio or change a lawnmower spark plug. Big whoopee.
However, if you wish to maximally expand your brainpower, you must do more than drool
over the plans for a Tesla turbine. Your introduction to technology and science
is provided by your classes and myriad other ancillary sources such as magazines
and books. To achieve a greater intellectual boost than you can obtain by
conventional learning, you must "strain your brain" (to use one of my phrases)
by giving yourself difficult challenges to solve. To illustrate this, I'll
synopsize a few of the ones I've worked on, either for the sheer joy of mental
stimulation, or because I had a burning need to use the device (incidentally, I
won't tell you exactly how I solved the problems, in case you wish to ruminate on
Problem: Make a printhead that is small and lightweight
and uses very little power and is easily fabricated and is
economical to manufacture and does not require complex interface
circuitry and has a long life and is capable of producing
excellent graphs. The difficult part was fulfilling all of those criteria. Using
a dab of glue and two things you might find in a trash bin (a small scrap of
thin plastic and a postage stamp-sized piece of aluminum or other foil), I
thought of a way to do this.
Problem: Try to reinvent the wheel. Literally. When people discuss
reinventing the wheel, that familiar saying is often prefaced by an exhortation
to not do it, or a rhetorical query that boils down to "why even try?"
Aside from the fact that it is useful mental exercise, sometimes there is a need
for it. I encountered this need a few weeks ago while working on a device for
which the existing means of locomotion (wheels, tracks, legs) were not optimal.
I scoured the Internet over the course of a week and found many variations on
these themes, but nothing that was ideal for my application, so I invented my
own solution that fulfilled all my design criteria and added some new
Problem: Think of a way to make a complete circuit using no
return wire. Ever notice how even the simplest circuits have at least two
wires? Even if you just hook a light bulb to a battery, you need one wire
to carry current to the light bulb from the negative terminal of the battery,
and one wire to return the current to the positive terminal of the battery.
I discussed this problem in more detail elsewhere on my web site. The
solution is surprisingly easy, but only if you aren't locked into the notion
that a circuit needs a complete loop to flow.
Problem: Think of a way to program a memory chip (such as a ROM,
or read-only memory) to behave as a complete computer for some simple tasks.
I did this years ago while working on a medical device for which size, weight,
cost, and power consumption were critically important.
Problem: Make a robotic lawn mower. I did this in the
summer between my first and second years of medical school, because I thought
humans have better things to do than mowing. The current robotic mowers
are technologically unsophisticated; they mow at a snail's pace, and just wander
aimlessly within a predefined area. After a few weeks of mowing, some
areas may be untouched while others were mowed a hundred times. Aren't
robots supposed to be smart, or at least efficient? Mine would mow in
lines straight as an arrow, turn itself around at the exact programmed spots,
avoid existing and new obstacles of all sorts, and collect the grass clippings
for people who prefer that to mulching. The mower would even put the
clippings in bags at a predefined spot whenever it sensed the grass
catcher was full, then return to the point it left off and resume mowing.
Problem: How could you make a snowmobile with zero inches
of suspension travel give a smoother ride than the latest models with
long-travel (10" to 16") suspensions? It may seem axiomatic that
suspension travel is a prerequisite for ride quality, but it's not. If you
can think outside the box, this one is a no-brainer.
Problem: How can a hole be threaded from the inside out? If you've
ever seen a standard tap, you'd think it was impossible. Trust me, it's not.
While working on my car in medical school, I botched a spark plug hole by
cross-threading it and
suddenly had a need for such a gizmo. If you wish to see the first such
device I made, it is pictured and
described on my web site.
I've worked on hundreds of such problems, some of which were considerably
more difficult. The utility of such mental exercise is that thinking on
your own in uncharted territory is far more challenging than correctly answering
an exam question in college, which typically just requires a recall of the class
material or application of a formula taught in school. Parroting material
is at best a second-rate challenge, so if you wish to develop a first-rate mind,
you need to tackle something more formidable. However, to make this
exercise feasible, it must be palatable. Otherwise, you won't be inclined
to dwell on it. Sometimes I'll think of a solution to a problem in a
flash, but other times it takes hours, days, weeks, months, years, or even
decades. If you're bored by the subject, you'll likely drop it.
Hence, pick something that gets your juices flowing.
Most adults never stop to think about things around them, from wheels, to
threads in holes, to circuits. By ignoring them, they pass up
opportunities for mental growth. Albert Einstein attributed his
intellectual development to the fact that he was "retarded" (to use his
characterization) early on, which delayed his thinking about things that kids
explore as they study the world around them. By the time most people are
teenagers or adults, they're adept at using things, but rarely give them much
thought any longer. Not Einstein. He deeply contemplated things that
most of us take for granted, and in the process, he revolutionized physics.
All of his deep thought may have done something else, too: make him a
genius. Judging by facts such as his delayed onset of speech (at least the
age of 2½, according to his sister in an unpublished biography), Einstein may
not have been a born genius. This raises an arresting possibility:
can genius indeed be created by intense, protracted rumination? Bear in
mind that I am not confusing correlation with causation. You may think
that geniuses are more apt to deeply ponder subjects, thus making it utterly
unsurprising that genius is associated with such reflection. However,
unless there is preceding evidence of genius (and there was not in Einstein's
case), this lends credence to the notion that it was the thought that created
the genius, not the genius that created the thought.
The problem is that modern life is filled with too many distractions.
Some people are obsessed with computer games and spend almost every free waking
moment playing them. Others spend countless hours in computer chat rooms,
while others veg out in front of the TV. I am not opposed to some mental
downtime, since I think that such R&R is essential. However, I think that
too many people fill their lives with things that occupy their minds but don't
cause them to really think.
The more you learn about a wide variety of subjects (especially those
pertaining to science and technology), the easier it is to conceive of a
worthwhile intellectual challenge and its solution. Creativity involves
the formation of new links between seemingly unrelated facts. An enhanced
knowledge base makes this synergistic process more likely by providing more
facts for you to link. Hence, memorization is essential, but it isn't
If devising a new printhead or wheel seems too daunting, begin with something
easier, such as designing a home to optimize space efficiency. Discard
your preconceived notions of home design, and think of how to make every cubic
inch count. Or think of alternative methods of home construction. I
thought of a way to form the basic structure of a home that would require no
skilled labor and could be erected in 30 minutes by just one person. Or
design a piece of furniture that isn't just a stylistic variation of an existing
type of furniture. Or think of a neologism. Or think of a new
kitchen appliance. Or create a new toy or game. Or devise novel ways
to thwart an ongoing terrorist attack. Imagine that you were a passenger
on Flight 93. Charging the cockpit as they did was heroic but did not
allow them to regain control of the jet. What else might they have done to
heighten their odds of success? Or think of an addition to our
infrastructure that would revolutionize our lifestyles as much as the Internet.
Here is one inevitable addition: imagine a subterranean network of "pipes"
that could carry things from any home or business to another destination at
hundreds of miles per hour. The sheer convenience of such a system would
be addictive. Amazon.com could ship you books or other merchandise within
minutes, or you could order food from a restaurant in another state. If
you need a cough suppressant in the middle of the night, you wouldn't need to
trudge to a store. If you're an ER doc needing an antivenin, it could be
rapidly shipped from a regional distribution center. If you're a
manufacturer, your production line wouldn't grind to a halt if you ran out of
microchips. If someone were breaking into your home, you could dial 911
and the police could send over a small robot (a policebot?) capable of
halting any attacker. Or if your husband was dying from a heart attack and
the nearest ambulance was 30 minutes away, the 911 center could dispatch a team
of "EMSbots" to code your husband. These aren't pipe dreams; I could whip
up the policebot in a few weeks and the EMSbots in a few months. Granted,
the infrastructure that would deliver these saviors is not currently in place,
but as an interim measure, a drone could drop them in your yard.
Although deep thought is vital for enhancing brainpower, in my opinion there
are some adjuncts that enhance its effectiveness. One of these things is
poverty. Not the degree of poverty that results in starvation and death
(but that's essentially nonexistent in the United States), but a state of
relative deprivation that fuels your desire to succeed and provides you with
innumerable opportunities to solve the challenges that face you. For
example, when I was a teenager I could not afford to buy the exercise equipment
that I wanted, so I made my own . . . and devised better machines than were
commercially available. I also could not afford the latest, greatest
commercial mowers, so I took junked mowers and turned them into something that
mowed better and faster.
For all the good that money can do, the one indisputably bad thing it does is
to truncate the search for a solution to a problem. If you have the bucks,
solving a problem is usually no more difficult than finding someone who provides
a solution to it. This may be convenient, but it stymies your intellectual
growth. If long-term mental expansion means more to you than short-term
convenience, don't solve all your problems with your credit card or checkbook.
I endured poverty for years when I grew up. It never seemed oppressive
at the time, even though we were poor enough that I was awed by people with
enough money to eat at McDonald's whenever they wished. That degree of
poverty is increasingly nonexistent. Is that good? In some ways yes,
and in some ways no. The more things you get, the less inspiration you
have. That's a generalization and not always true, because some people
(such as myself) retain the desire to solve our own problems even if we can
afford to purchase a ready-made solution. However, it's human nature to
take the easy road. There aren't many people with platinum credit cards
who will spend days, weeks, or months contriving their own solutions when they
can whip out their wallet and solve their want or need in a heartbeat.
It's natural for parents to desire to give their children every possible
material advantage, but these good intentions often backfire. I had some
wealthy friends in my childhood, such as one fellow, Jim, whose father was a
vice-president at GM. I used to envy the things my friend had: a
luxury car in high school, his own credit card, a beautiful home on a lake, a
couple of boats, a motorcycle, a snowmobile, neat toys, nice clothes, and on and
on. I stopped envying his freebies when I realized how they dissipated his
gumption, or gut-level desire to succeed. Jim was just as smart as I was,
and his dreams were just as grand, but he was forced to drop one dream after
another when he realized that he couldn't hack the demands entailed by those
careers. Success requires hard work in addition to intelligence. Jim
had the intelligence, but not the inspiration to endure a long period of hard
work. Had he been poor or simply not given so much, I think he would have
achieved more on his own.
Another impetus for success is sexual sublimation, in particular the
postponement of sexual activity with a partner. I realize that I may come
across as an old fogy for espousing abstinence, but I think that unmet sexual
desire can be channeled into a tremendously powerful stimulus for success.
Let me be frank: if your parents shower you with material possessions and
your girlfriend fulfills all your sexual needs, what motivation do you have for
the future? At best, you can hope to replicate your current state of
having every wish satisfied. However, the desire to maintain the status
quo is not as intense as the desire to obtain something you've always wanted but
never had. Our brains are intrinsically wired to prefer novel experiences,
not the same ol' stuff. Shooting for a target you already have is a great
way to disincentify that pursuit.
I'm inclined to find the silver lining in every cloud. If you can
similarly appreciate that there is a positive aspect to many
misfortunes, you may be more receptive to my next topic. One of the most
universal human desires is to find the perfect partner as soon as possible.
We don't want to wait until we're senior citizens to find true love, we want it
now — even if "now" is age 14. I've seen kids that age attempt
suicide because they were so heartbroken over the end of a relationship with a
person whom they thought was the perfect one. Years ago, I had a patient
of that age who was exceptionally attractive and physically precocious, but for
reasons I cannot fathom, she had no conception of her appearance and believed
that no other man would want her. She told me that she tried killing
herself because the thought of living without a boyfriend was too much to bear,
and with her poor self-image, she was convinced that she was destined to live
her life alone. That was too much for me to bear, so I canned the
pat responses that doctors often give and had a frank discussion with her.
I told her that she was so ravishing that virtually any male would find her
attractive, so finding a new boyfriend would be easy. She was more than
skeptical, so I went to Plan B. I generally eschew pumping up the egos of
women who are tens, but in this case I wanted to do everything possible to avert
the tragedy of another suicide attempt — which in my mind would make as much
sense as Bill Gates killing himself because he didn't have enough money.
Hence, I crafted a solution to her problem that didn't meet the standards of
staid propriety that often constrain physician recommendations, but yet was
powerful enough to inculcate my message that she was no dog destined to become
an old maid. I took her on a walk in the hospital and had her introduce
herself to ten teenage males. After a brief conversation, I told her to
mention that she was looking for a boyfriend, and to casually inquire if they
knew anyone she might date. The patient was convinced she would strike out
and get not one nibble in ten tries, but the results were hilarious. After
hearing her plea for a boyfriend, each male she approached enthusiastically —
even rabidly — said that he'd like to date her. Their responses
were utterly predictable from my standpoint, but a shocking revelation for my
patient, who was finally convinced that she could find a boyfriend.
For the first time, I saw her smile. Another life saved. Ah, the
arduous life of an ER doctor.
OK, enough reminiscing about my medical stories. That patient is hardly
alone. When I was 16, I considered ventilating my skull with a 20-gauge
shotgun when I was distraught over some sappy teenage crisis that is so trivial
I can no longer recall what it was, other than the fact that it involved despair
over the difficulty of finding a suitable partner. (Given that I'm still
looking, perhaps I should have pulled the trigger! :-)
Flippancy aside, there is a benefit to not finding a wonderful partner, or at
least not finding her right away. The unfulfilled desire for love and
companionship can be sublimated into a more intense yearning for success in
other ways. I channeled this frustration into academic success and a
perpetual quest to enhance my creativity and brainpower. Had my needs been
fully contented years ago, I'm sure I would have achieved less.
Update: I recently read two
articles that pertain to the above discussion on enhancing brainpower. I
will synopsize these articles, then discuss the implications.
- As reported in the September 26, 2003 issue of Science, Professor
Terrence Sejnowski from the Salk Institute and Professor Simon Laughlin of the
University of Cambridge are generating a new paradigm for how the brain
operates. The old view was that the brain is a fixed network of
bewildering complexity. Professors Sejnowski and Laughlin theorize that
the brain is a dynamic network that changes to adapt to new demands and needs.
- The September, 2003 issue of the Journal of Personality and Social
Psychology contained an article by Professor Jordan Peterson from the
University of Toronto and
Shelley Carson and
Daniel Higgins from Harvard University in which they discussed their discovery
of one of the biological bases
of creativity. They found that creative people are more cognizant of
environmental stimuli. Most people usually filter out information or
stimuli that they think is inconsequential "old news" by subconsciously using
a process termed latent inhibition. Generally, ignoring
irrelevant stimuli and focusing on relevant ones is a good thing because we
are all bombarded with countless stimuli that are usually unrelated to the
matter at hand. However, this selectivity can suppress stimuli that may
be useful in a new context. In the article, entitled "Decreased Latent
Inhibition Is Associated With Increased Creative Achievement in
High-Functioning Individuals," the authors said that when previously
irrelevant stimuli are not screened out, this might contribute to original
thinking, especially in people with high IQs. Such individuals exhibit
more creativity, openness, imagination, intellectual curiosity, unconventional
attitudes, flexible and divergent thinking, and less rigidity of mental
categories. Perhaps not surprisingly, these people tend to be productive
high achievers. Previously, reduced latent inhibition was associated
with a propensity toward schizophrenia, especially when coupled with low IQ.
However, in certain personality configurations, reduced latent inhibition is
now known to impart cognitive advantages that magnify the potential of high
IQ. A person with normal levels of latent inhibition tends to classify
objects and forget about the ones they deem to be unworthy of further
attention, thinking that they are irrelevant to survival or the attainment of
a particular goal. This helps people with normal IQs avoid being
sidetracked by overwhelming their ability to process many simultaneous
thoughts. However, a person with reduced latent inhibition, good working
memory, and high IQ can think about many things at once. This enables
them to take information that seems irrelevant to ordinary people and
synthesize new ideas. This is the crux of advanced creativity.
The work of Sejnowski and Laughlin explains why someone like me (an erstwhile
dunce) can metamorphose into an intelligent person, given a sufficient demand that "strains the brain" (to use my old terminology).
The current educational system is laughable in terms of its ability to really
stimulate people. Far too many courses involve nothing more complex than
"monkey see, monkey do." This game is too simple to spark marked
improvements in intelligence and creativity.
Step 1: The teacher presents a fact.
Step 2: You echo this fact on a test.
Step 3: Repeat from step 1.
The repetition of this process does not compensate for the fact that it is
not inherently challenging, but this is the foundation of most educational
systems — and it is why most of them are abject failures in terms of being able
to produce marked improvements in brainpower. Take a slow kid and give him
traditional education, and he's still slow. Take an average kid, repeat
the process, and you typically have a graduate with average intelligence.
Take a smart kid, educate him, and he usually isn't any smarter . . . just more
knowledgeable. Why can't educators improve IQ? Is it immutable?
No! The brain can respond and essentially rewire or reprogram itself,
if it is challenged in the right way. Memorization fosters creativity
by providing a larger set of facts that can be combined in novel ways, but
building a larger database will not automatically enhance creativity. I am
obviously not opposed to memorization, but teachers give scant attention to
something that is equally important: the
process of thinking. If computer engineers made the same mistake, they'd
focus their attention on the memory chips and ignore the CPU. It's the CPU
that is the processing "brain" of the computer. If you want a "smarter,"
more capable computer, you need to focus on the CPU, too. However,
teachers figuratively zero in on
the memory chips, thinking that sufficient stimulation of them will somehow
improve the CPU. Wrong. No gold stars for this uninspired stagnation
of education. And we're paying several hundred billion dollars per year
Creativity is not given sufficient emphasis in education. I think that
educators view creativity as an unnecessary embellishment — sort of an icing on
the cake that might benefit students in "soft" subjects like art, but not in
"serious" classes in science and math. Nothing could be further from the
truth. Once creativity does its magic in augmenting brainpower, that
intellectual boost is generalized, improving what we think of as intelligence.
You might ask, "If creativity can amplify IQ, then why aren't more art
students as smart as rocket scientists?" The answer is because not all
types of creativity are equally capable of improving intelligence. You
could spend a decade sculpting and painting, and you wouldn't be any more able
to rise to the top of your class in medical school. The creative process
can be either a mindless series of whimsical choices, or an intriguing challenge
that launches you into protracted deep thought. It is that arduous thought
process, repeated countless times in a variety of situations, that helps rewire
the brain. The hallmark of intelligence is the ability to perform
difficult mental tasks. I am no better at adding two plus two than an
average high school dropout. The differentiating factor is not the ability
to do the simple stuff, but the hard stuff. Since intellectual challenges
are an essential component of expanding brainpower, they should be an essential
element of education. Instead, teachers typically show students how to do
something, then ask them to replay that process. Imitating the actions of
others is not sufficiently challenging! Instead of being guided down a
well-worn trail, you need to head off into uncharted waters. Fortunately,
the creative process can be easily tailored to provide stimulation that is
challenging but not overwhelming. In other words, don't begin by searching
for a cure for cancer.
Improving brainpower requires the proper mix of creativity and traditional
learning, which is primarily memorization followed by regurgitation of facts and
procedures. Now that I am discussing this topic, isn't it ironic that
while traditional education is focused on memorization, teachers usually ignore
techniques that are proven to foster memorization?
I will segue into my next topic by presenting an excerpt from
Fascinating Health Secrets:
Besides caffeine, there are several drugs that can potentiate cerebral
performance. The utility of these agents should not be underestimated.
A person's baseline level of intelligence, concentration, memory, association,
and creativity can be enhanced by the judicious use of various drugs.
Those who object to the augmentation of cerebral performance are usually
blissfully unaware of the role played by this phenomenon in the technological
advancement of the world. Thomas Edison, for example, used cocaine.
Whether or not he could have conceived all of his inventions without cocaine is
problematic, but it is likely that he would not have been so creative without
it. As discussed above, neurostimulants like caffeine and cocaine enhance
the association of apparently unrelated information, a process central to
creativity and invention. An average person has about as much use for this
capability as a housewife does for the muscle-building effect of anabolic
steroids. However, there are people who have jobs in which their
performance can be heightened by the use of drugs. It is indisputable that
the performance of a football player, wrestler, or other strength athlete, can
be substantially advanced by steroid use. Society may find this
unpalatable, but their moral objections cannot negate the veracity of this
benefit. Similarly, there are people with intellectually demanding
occupations (scientists and inventors, for example) who could, with the use of
drugs to enhance mental performance, improve their ability to conceive of new
solutions to problems. With such enhancement, they would be more likely to
achieve significant breakthroughs, possibly devising a cure for AIDS or cancer,
or a solution to the energy problem. The utility of such advances would be
immeasurable, and of perpetual benefit to society. Yet a scientist caught
with cocaine would be stripped of his job, thrown in jail, and mankind would be
forever denied the potential fruits of his mind. The notion that all men
are created equal, are equal, and should be treated equal in the eyes of the law
sounds good to most people, but it ignores the fact that progress is dependent
upon the achievements of a relatively small number of people, and that the
latitude bestowed to them is sometimes a prerequisite for the realization of
their full potential. In his day, Edison was one of these people. So
was Nicola Tesla, a contemporary of Edison. Their collective works are
integral to the present and future world, and our debt to them will never be
Enhancing the mental performance of such individuals via the use of cocaine,
or more modern alternatives, is justifiable because the potential benefit to
society is immeasurable. The risk, in contrast, is negligible. The
societal danger imposed by Edison's stash of cocaine, relative to that of an
urban junkie, is inherently disparate and essentially incomparable in either a
moral or functional sense. Any attempt to view Edison's drug use in the
same light as that of a common addict is an execrable simplification.
Society often makes allowances for certain groups of people to engage in
behavior that is proscribed for the rest of us. It tolerates, and even
encourages, such behavior because the potential benefit is thought to outweigh
the potential risk. On a mundane level, for example, police officers and
ambulances are allowed to speed while driving. In the end, one must
realize that there are risks and benefits associated with all behavior.
Society either encourages or discourages certain activities based upon whether
the net good is positive or negative, respectively. To allow drug use by
modern-day Edisons, irrespective of the potential good engendered by the
pharmacological enhancement of their creativity, would to most people smack of
elitism and favoritism. Society obviates the need to justify such
exceptions by issuing a blanket condemnation of such behavior.
My vehement objection to the universal prohibition of certain neurostimulants
is based upon the nefarious and increasingly common tendency for society to
ignore the uniqueness of people that are truly unique and capable of great good.
If their achievements could be aided by the use of certain drugs, then society
should accept this as being another instance in which the overall benefit
overshadows the potential risk. However, there is an onerous trend in
America to intransigently disallow anything that smacks of elitism. The
apparent nobility of such a concept is appreciated only by those who are
oblivious to the horrific consequences of uniformity. The egalitarian
concept of bland conformity is a recipe for intellectual stagnation.
Luckily for you, there is no need to use illicit drugs to enhance mental
performance. Today, there are a number of legal drugs that can enhance the
workings of the mind. Most people have no need for them, but scientists,
doctors, inventors, students, artists, authors, and engineers can benefit from
their use. Progress is dependent upon the achievements of such people, and
anything which enhances their ability will simply accelerate the advancement of
the world. In my mind, that is a benefit which cannot be ignored.
If you research the subject of latent inhibition, you will likely encounter a
discussion of drugs that increase it (dopamine receptor antagonists
with antipsychotic action, such as haloperidol [Haldol®]),
and drugs that reduce it (amphetamine, nicotine*, and corticosterone**). I
don't advocate using drugs to reduce latent inhibition because there is a
better, safer way to tap into your creative potential: just begin working
on creative challenges. This may sound somewhat circular, but the best way
to get better at something is to do it. The brain is plastic, not fixed.
* By increasing dopamine release in the nucleus accumbens.
** Shalev U, Feldon J, Weiner I. Latent inhibition is disrupted by acute and repeated administration of
Int. J. Neuropsychopharmacol. 1: 103-113. Comment: This makes me
wonder if stress might indirectly reduce latent inhibition.
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You will have sex about 10,000 times during
Doesn't it make sense to read a book that can maximize
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Cast away your preconceptions of sex books as
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The Science of Sex
Enhancing Sexual Pleasure,
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by Kevin Pezzi, MD
Available in printed
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An "entry-level job" as an ER doc? Sorry, but
there are no shortcuts
Q: (Regarding being an ER doctor) How would a person get an
entry-level job in this field? Thank you very much for your time!
A: An entry level job as an ER doctor? Go to college, medical school, do
an ER residency, pass your boards, and pay for a medical license. Obviously, an
entry-level job in medicine is more difficult to attain than an entry-level job
in most other fields.
Should I call my doc at home? (Seguing into
another negation of the "rich doctor" myth)
Q: (A long story involving multiple doctor visits, trips to the ER,
various tests, and ongoing pain. The question boiled down to the
following.) Should I call and bother the doctor at home?
A: Yes, I would. It's clear that you are in distress, and that's why
doctors are around: to help people. It doesn't matter if it's
Sunday, during the day or at night, or when Santa is making his annual trip down
the chimney . . . a doctor's responsibility is 24/7, 365 days per year. In
the old days, we used to be paid to accept such responsibility. Now we
must live with the fact that high school dropouts can make more than we do.
For example, a friend of mine told me about his brother-in-law who makes over
$250,000 working six months of the year putting in basements — more than I ever
made working a full year in the ER. Incidentally, the basement man
effectively made more than that, because many of his jobs were "cash deals" that
he never reported to the IRS.
TRUE Emergency Room Stories
by Kevin Pezzi, M.D.
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
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.
Why is it so risky to be an ER doc?
An illustration of how our tort justice system is
Q: Why is the practice of emergency medicine so risky from a legal
standpoint? I've heard that obstetricians and neurosurgeons often pay
sky-high insurance premiums, but why is the same true of ER?
A: I will begin by explaining why obstetricians and neurosurgeons face
such risk: because people often possess unreal expectations of perfection,
and when docs can't deliver that, a witch-hunt often ensues. The same is
true for ER doctors. A number of factors conspire to make emergency
medicine a risky profession:
Many people don't know that the science of medicine is not nearly as impressive
and complete as it appears to be. This leads to people thinking that docs
can fix 'em up in a jiffy whenever they're sick. When expectations exceed
capabilities, this breeds the potential for disappointment and anger that may
engender a lawsuit.
When people are sick, they want attention now, not three hours from now.
This isn't always possible in an ER, because such places are sometimes filled
with dozens and dozens of people who want the same thing. I've always been
amazed by the sudden transformation in behavior when patients complaining about
their wait suddenly become understanding when they see us wheel a patient out of
the cardiac room or trauma room, and that patient is covered with IVs, breathing
tubes, catheters, wires, and beeping monitors. I've seen their faces melt
from a "why aren't you taking care of me?" scowl to a "holy shit, there are
patients in here a whole lot worse off than I am" look of surprise. Hence,
I'm not entirely kidding when I say that one way in which ERs could reduce
patient complaints is by hiring an actor to play the role of the critical
patient, and periodically wheeling that person around whenever patients are
livid about their waits. I don't relish the duplicitous nature of this
charade, but it's far more effective than trying to explain the wait to each and
every patient. I used to work in an ER that seemed to be perpetually busy,
and at the beginning of my shift at 11 PM there would often be a backlog of
patients who'd been waiting since 7 or 8 PM. When I'd walk in to see them,
many were so furious that they'd vent for five minutes. If twelve patients
did that (and this was not uncommon), I'd just wasted an hour, so everyone's
care was delayed by yet another hour!
Patients usually don't know the ER doc, so if something goes wrong — or even if
they think it did — they're more likely to sue.
Knowing that people are so apt to sue, ER docs must be very careful in what they
do and how they document it in the medical record. Unfortunately, this
takes time, and delays the care of subsequent patients. Family doctors can
be much more lax about documentation, because they often have a bond of goodwill
with their patients that prevents lawsuits. Some family docs take
advantage of this by being far less thorough than ER docs. For example, I
saw the medical record of a patient who saw his family doc for a sore throat.
His chart said, "Sore throat." That was it for that visit! That was
the history, physical, and diagnosis all rolled into something that's more of a
symptom than it is a medical diagnosis. No treatment was listed. If
I saw a patient in the ER complaining of a sore throat, at a minimum I'd
look in his throat, nose, eyes, and ears, then listen to his lungs, heart, and
abdomen, palpate his belly, examine his skin, assess his mental status, and then
document in his chart everything I found and did not find. These
days, thanks to lawyers, it doesn't suffice to document just the positive
findings; we need to go on and on and list all the pertinent negative findings.
I'd also document the tests I performed, the true primary and secondary
diagnoses (not some brainless and meaningless "diagnosis" such as "sore
throat"), the prescriptions I gave, and the aftercare instructions (e.g., "see
your doctor if _______, _______, or _______; return to the ER if you have
_______, _______, or _______"). Depending on the patient, thoroughly
documenting that would take a page or two of typed, single-spaced notes.
Can you see the potential for a snowball effect developing here? ER docs
must be more careful, so that slows them down, and makes people more angry, and
hence more likely to sue. A family doc doesn't need to worry as much about
a lawsuit, so he can do a half-ass job and get away with it.
Merely being in an ER changes people's expectations of how quickly their
evaluation can be completed. For example, I've had many patients complain
about waiting two or three hours for a complex evaluation that involves blood
and urine tests, an EKG, a CT scan, an ultrasound, and x-rays. Sheesh!
A comparable workup directed by a family doc might take weeks and involve the
patient running around town for various appointments . . . and, of course, often
waiting for each of those tests. If I could compress that into three hours
(all the while taking care of a few dozen other patients), they ought to give me
a tip or at least a half-hearted "thank you." Instead, I've seen
patients write complaint letters because a three-hour workup for them or a
family member caused them to miss their golf tee-off time!
Too many people harbor the notion that ER doctors aren't "real doctors."
This was true in the days when emergency rooms were staffed by interns, but
times have changed. As usual, perceptions lag behind. Thus, people
often walk into the ER thinking they're going to see an idiot, so they
reflexively assume their care will be substandard. This increases the
likelihood of a suit.
While ER docs aren't idiots (in fact, they're the cream of the crop, given the
competition for ER residency slots), they can't know everything about
everything. I'll never forget one day in medical school when I
worked in a dermatologist's office and gave a case presentation to the almighty
zit and rash Pooh-Bah. I rattled off the patient's meds, one of which was
Dyazide®. Here's how our conversation
Dermatologist: What's that?
Me: It's a combination of hydrochlorothiazide and triamterine.
Dermatologist: What's it used for?
Me: The patient takes it for hypertension.
Dermatologist: Hmm, never heard of it before. Are you sure
that's the correct name?
Me: Yes, it's a very common drug. I've had hundreds of
patients who use it.
This man knew dermatology, but little else. How he could be oblivious to
Dyazide was beyond me. I wouldn't be surprised if he didn't know which end
of an EKG was up, or how to read an x-ray. Trust him to save your life
when your heart stopped? Heck, you'd be better off summoning a Boy Scout.
In contrast, an ER doc must know how to manage common dermatology problems
(e.g., impetigo, cellulitis, hives, diaper rash, contact dermatitis, pityriasis
rosea, folliculitis, assorted fungal infections, herpes simplex, herpes zoster,
genital herpes, scabies, lice, etc.) and some fairly uncommon ones (e.g.,
dyshidrotic eczema) in addition to a far more extensive knowledge in a few dozen
other medical fields. We can't just be experts at reading EKGs and
unclogging arteries that grew up on Happy Meals and graduated with triple
cheeseburgers, we must know how to treat thousands of different problems.
Not only that, but we must do it in a few minutes for patients we've never seen
before, some of whom have multiple medical problems, a foot-thick medical
chart, and can't speak English. We have to treat these people at the same time we're treating
scores of others, then repeat this process several thousand times per year and
hope that we do it with such perfection that the inevitable ticked-off patient
won't have any grounds for a suit. Even then, a doc's worries are not
over. Until the day arrives when physicians can prevent all disease,
disability, and death, people are going to have adverse outcomes. Even
when care is perfect, people still suffer and die. Attorneys sometimes
capitalize on this and sue when they know the doctor isn't negligent, simply
because they know they can often extort a settlement from the doc's insurance
company. There is an even more nefarious incentive to sue: plain ol'
revenge. Sometimes an attorney is friends with someone we'll call Bob, and
he will agree to sue a doctor who treated Bob even if he knows the doc did
nothing wrong. If the patient is mad at the doc, the attorney can attack
just as a favor to Bob. It's an abuse of power, but people — politicians,
judges, police, prosecutors, bureaucrats, building inspectors, you name it —
sometimes abuse their power. So when attorneys do it, it's no surprise.
Even apart from their doctor shakedowns, I think attorneys are often
disgustingly unprincipled. My brother Ray used to work for a company that
sold books and software to lawyers, and Ray told me how some attorneys would
smugly brag about how they overcharged and otherwise bilked their clients.
Hence the shark appellation.
Speaking of dermatologists . .
For a moment, consider if the various specialists
had to justify their incomes before God or some other authority who cannot be
hoodwinked. Imagine if the following specialists pled their cases:
ER doctor: "I will treat anyone who
walks in the door, even if they're abusive and can't pay me. I'll work any
shift any day of the year, including holidays. I'll work in a noisy,
stressful, and chaotic environment. I'll put up with some co-workers with
obnoxious personalities. I'll accept the legal risks of practicing
emergency medicine, even though I know that lots of patients and most attorneys
just want a scapegoat in case something goes wrong, even if that's the fault of
the patient or Mother Nature, and not a medical mistake. I don't care — I
just want to help save lives."
Dermatologist: "I want to help people
have better skin, but I'll only treat paying patients who don't cough or sneeze
on me. If they scream or make threats, I'll call the police. I want
to work banker's hours. Working holidays? Forget about it!
Furthermore, I want to work in a nice, cushy office with pleasant employees.
If anyone so much as looks at me wrong, I'll fire her. I want to leave the
high-risk cases to the ER doctors and other suckers. Oh, by the way, I
want to make more money than ER doctors."
Viewed in this way, the fact that dermatologists are
better paid than ER doctors is unjustifiable and absolutely ludicrous. So
why do they make more money? Because the government and insurance
companies who place a value on physician services think that popping a pimple is
more valuable than saving a life. Nuts, isn't it?
Lately, there's been a lot of discussion about whether the government should cap
liability for companies making the smallpox vaccine. Interestingly, all of
these discussions are predicated on one assumption: that the vaccine
company will produce the safest, most technologically advanced vaccine that
current technology allows, but yet the relatives of the small minority of
patients who die should nevertheless be able to sue and get rich quick.
Why are they justified in suing? The last estimate I heard was that 37
people receiving the vaccine would die, out of over 250 million vaccinations.
If 99.99999% of people don't die, is the vaccine truly faulty?
Obviously not. Through no fault of the vaccine manufacturer, some people
have weakened immune systems or other factors that predispose them to an adverse
reaction. That's the real culprit — not the vaccine. If patients are
that feeble, they might die in the near future from inhaling dust or some other
trivial exposure that most people shrug off with ease. The only thing that
would justify punishing the vaccine manufacturer with a lawsuit is if they made
a flawed product that was inferior to what another vaccine manufacturer could
make. If no existing company could do any better, why punish them?
Smallpox is not a trivial disease; without a vaccine, an epidemic could wipe out
a significant proportion of our population. Hence, we should be willing to
tolerate more risk in the prophylaxis of smallpox that for less serious
diseases. Viewed in this context, it is a blessing to have a vaccine that
protects 99.99999% of us and hastens the demise of only a very small minority of
biologically enfeebled people. So what's the justification for suing the
vaccine manufacturer? The fact that anyone can seriously discuss suing
them for making the best smallpox vaccine ever produced underscores just how
warped our legal system is — and just how unrealistic people have become with
Product liability laws and malpractice laws were intended to punish faulty
actions that resulted in harm, not create a lottery system that gives millions
to anyone with a bad outcome whether or not that result was attributable to a
definable error. However, in our rush to be a compassionate society that
attempts to right every wrong, we've gone too far and created a horrendously
unjust system that punishes corporations and doctors even if they didn't screw
up. This is one reason why I urge people to think long and hard before
they choose to become a doctor. Until you've been sued for something that
was not your fault, you have no idea how devastating and infuriating this is.
Being charged with a crime that you're not guilty of is one of the most heinous
fates that can befall a person. Even if you're lucky enough to win the
suit or have it dismissed, you will still lose: you'll have a perpetual
black mark on your record, it'll cost you money (e.g., for your insurance
deductible) and time, and it will subject you to untold hours of anguish.
Attorneys know all this, and they use it to help extort the largest possible
settlements from doctors and their insurance companies. They just want the
suit and the threats to go away, so all too often they succumb to even
outrageous demands for unwarranted claims. As I previously mentioned,
sooner or later a doctor who is livid about such injustice will "go postal" on
the lawyer. Instead of being a tragedy, I think that day will be a turning
point in American justice because it will finally send a message to attorneys
that they cannot ride roughshod over innocent people without one of them
snapping and turning an attorney into hamburger. In reality, such an
action will likely save lives and improve healthcare. The drawbacks of
being a doctor in this era are so numerous that some of the best and brightest
students choose another career. This forces medical schools to now accept
people who once stood no chance of acceptance. Will these second-rate
students become first-rate doctors? Dream on. Those second-rate
students will become second-rate doctors, and they'll give more second-rate care
than will the first-rate docs. Hence, someone will suffer from this
diversion of the cream of the crop. Will it be you? Your son or
If you're smart enough to see the big picture, you will realize that when
attorneys unjustifiably make a medical career more noxious, this is not a
victimless action. It's hurting people, and that is wrong. Yet the
nexus is indirect, so it is often overlooked. Therefore, don't look for
any immediate solution to this problem. If you want to go ahead and fight
the battle, well, be my guest. Personally, I think battles are best
avoided. That's why I try to deter people from a medical career, and I'm
not alone. Many of my physician friends discourage their children and
relatives from pursuing a medical career, because they don't want to see them
subjected to such a noxious lifestyle. My strategy is simple: deter
the deterrable, and help the undeterrable become the best possible doctors.
Do docs always do their best job?
How to increase the chance you'll get a 110% performance rather than a half-ass
Q: I am researching how physician attitudes affect the quality of their
performance. In speaking with doctors, I keep hearing the same old
rhetoric: "We're professionals. Of course we always try our best and
give 100% . . . blah, blah, blah." I'm trying to find a doctor who has the
guts to tell me what he really thinks, rather than just reciting the old party
line. It's my contention that a doctor will do a better job if he likes a
certain patient. Judging from your web site, you seem to be a real
straight shooter, so I'm hoping you're willing to spout off on this subject.
A: I am. Anyone who claims that physicians always give 100% isn't
living in the real world. Unfortunately, cutting corners is now so routine
in medicine (and especially emergency medicine) that suboptimal performances
have become the norm, leading many docs to think they're doing everything even
when they're not. For example, let's say that a patient sees an ER doc for
repair of a cut. The docs sutures the cut, gives some cursory wound care
instructions, and tells the patient when to have the sutures removed. This
would pass as "doing everything" in the minds of most ER docs, but it is far
from complete. Here are a few more things I'd do:
Assume the doc removing the stitches knows less than I do about wound care,
which he probably does. Hence, while I'd give a recommendation as to when
the stitches should come out, I'd explain that suture removal may need to be
delayed if healing is slower than expected. Too many docs think, "You're
here for suture removal? OK, let's yank out your stitches." Instead,
they should assess the wound and determine if removal is warranted then.
Whenever sutures are removed, too many patients and doctors think that the
critical period is over. In reality, healing is just beginning, and the
wound is nowhere near maximum strength. Hence, I'd advise placing
Steri-Strips® (butterfly bandages) over the
wound to reduce the chance of wound disruption and scar widening. I'd give
the patient Steri-Strips® and instructions on
how to apply them, care for them, and remove them.
I'd discuss various factors that might disrupt the wound or widen the scar.
This discussion would include local pressure, referred pressure or tension,
joint position, etc.
I'd discuss how various factors affect wound healing, including smoking, certain
medications, nutrition, and even seemingly esoteric subjects such as hydrostatic
forces and venous pressure.
Granted, emergency rooms are often so busy that docs might wonder how I had the
time to cover so many subjects. If I was short on time, I'd begin my
lecture while I cleansed the wound and continue it during suturing.
I realize the foregoing does not address your question about how physician
attitudes affect performance, but I first wished to illustrate that docs often
do not do a complete job even when they think they are. Now on to the
topic of attitudes and performance.
In the ER, I had some truly loathsome patients, including murderers and men
who'd raped children. While I would have liked to test their allergy to
hot lead (that is, shoot the bastards), I didn't think it was my role to mete
out punishment. Hence, I'd give them 100%. But would I give 110%?
Nope. Of course, I didn't give 110% even for most of the decent patients
because there simply wasn't time. In a busy ER, it isn't a question of
whether the doc will need to cut corners, it's a question of who he chooses to
shortchange. Ah yes, another hot potato topic, and one that'll never be
covered in a chatty hospital newsletter or hometown newspaper.
Assuming I wasn't rushed, I'd give a 110% performance for everyone, unless the
patient was radiating enough bad karma to make me think that a perfunctory 100%
performance was good enough. However, it wasn't often that time was never
a consideration. Now it's time to perk up your ears. Yes, I had
favorites. Yes, I did a better job for people I liked. Yes, I'm
Here's an example. I repaired the wounds on countless people whose faces
were mangled in car accidents. Overall, I think I'm better at suturing
than an average ER doc, so most of these repairs turned out very well.
However, if I liked someone and the ER wasn't filled to the rafters with
patients on their deathbeds, I'd do not just a good job, but a job so superb
that even the surgeons were impressed.
In regard to giving better care for patients I liked, I know I'm not alone.
One study showed that docs spent more time with patients who give them a piece
of candy at the onset of the visit. If such a trivial token can make us go
the extra 10%, it is no surprise that something which really matters — such as
being treated with kindness — can elicit a similar desire to go the extra mile.
ContactMeFree is a dream
come true for anyone involved in online dating. If you have your profile
posted on a personals site but don't pay for a membership, you know how
limited you are in terms of being able to send or receive messages. You
probably assume that those limitations disappear if you pay for a
membership. Guess what? You are still far more limited than you realize.
Frankly, if you knew how limited you were, you would be furious that the
personals site was charging you $20 to $50 per month and still keeping the
shackles on you! The person who created
ContactMeFree was so
outraged by those limitations that he decided to do something about it. So
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!
Why structured play is inimical to intellectual
Television and Attention Deficit Disorder
Q: I wanted to become a physician, but for various reasons (an
unplanned pregnancy, less than stellar grades, etc.) I never accomplished my
goal. I'd like to help my children succeed in medicine or a similarly
prestigious profession. In addition to the tips you've previously
enumerated, what can I as a parent do to foster their success?
A: Don't subject your kids to structured play. Too many children are
now ferried from band practice to soccer practice to yet another organized
function. What do I have against such activities? They stymie
independent thought and intellectual development. Play is often disparaged
as being an aimless pursuit whose principle value is entertainment. I
disagree. Play has been shown to stimulate intellectual development, but
not all play is equally beneficial. When children are very young, they
need adult interaction and guidance to reap optimal benefits from, say, playing
with alphabet blocks. However, by the time kids are in the soccer age
group, they don't need to have their play spoon-fed to them. In fact,
structured play at this time hinders their individuation and suppresses
creativity, which is an important facet of intelligence. That brings up
another point: just what is intelligence? In our culture,
intelligent people are recognized by their ability to perform well in school and
on tests of intelligence or aptitude, such as the SAT or MCAT exams. The
American Heritage dictionary defines a genius as one who possesses "extraordinary
intellectual and creative power." However, standardized tests and most
schools do little to either spur or test for creativity. That's a shame,
because I think creativity is a better measure of true intelligence than the
ability to do well in school, which entails little more than mimicking or
regurgitating what was taught. Is this the best measure of intelligence?
Monkey see, monkey do? Not in my opinion. It's easier to robotically
repeat what you've been taught than it is to conceive of something truly novel.
Some people who have a bone to pick with standardized ways of assessing
intelligence harbor their grievance because they didn't score very well.
Hence, their criticism is sometimes dismissed as an attempt to mitigate the
import of their shortcomings. That isn't the impetus behind my criticism
of anything that purports to measure IQ but ignores the fact that creativity is
one of the cornerstones of intelligence, because I did very well in school and
on intelligence/aptitude tests. Therefore, in my case, it's not sour
grapes. With that in mind, I will continue assailing robotized play.
Structured, regimented activities do an abysmal job of fostering creativity
because participation in those activities is often governed by a rigid set of
rules and expectations. Such cookie-cutter regimens do an abysmal job of
catalyzing intellectual growth because they do little or nothing to encourage or
reward creativity. One can be an automaton and do very well in those
activities. Our culture gives lip service to championing individualism and
creativity, but it is really a fairly repressive intellectual climate that
champions an increasing narrow range of behavior and thought. The
collateral damage from this enforced uniformity affects individuals and society
as a whole. When was the last time that our society gave birth to an
Einstein or Edison? It's been far too long. Had Edison's mother
monopolized his time by ferrying him from one organized activity to another,
it's quite likely that he would not have grown into the multifaceted inventor
that he became.
Another tip. As much as possible, keep your kids away from the television
unless the programs they watch are truly educational. Most aren't.
Furthermore, it wouldn't surprise me if television is eventually implicated as
contributing to Attention Deficit Disorder. Look at how rapidly scenes
change on television. For TV shows, a scene change every few seconds is
common; for commercials, scenes change sometimes a few times per second.
In real life, things don't flit by so rapidly, so its glacial pace may seem
boring. In reality, it's life that is exciting, and television that is
boring. Take away the adornments that make television seem palatable —
beautiful people, exotic situations, racy language, clever quips, lots of money,
and a dearth of morals — and what do you have? Not much. Certainly
not enough to justify the enormous number of hours people spend watching TV.
Want to be smarter? Start inventing
Q: I'm a high school junior interested in expanding my intelligence.
I haven't settled on a career goal, but whether I choose medicine or another
career, being smarter will help me achieve my dreams. Hence, I'm writing
to ask if you can give me more tips on this subject. I read all the tips
you gave on the various pages of your web site, but I wondered if you have even
more. Thanks, Jenny
A: Yes, I do. Here is one recommendation: read the four-volume
set Ingenious Mechanisms for Designers and Inventors. Or, if you
don't read it, at least look at its pictures — like men do with Playboy.
Why should anyone who isn't a designer, inventor, or engineer read these books?
Because the ability to invent, make, and use tools is one of the foundations of
human intelligence. Many people are adept at using tools, but the
facet of intelligence involved in creating them is sadly neglected by
most. If you wish to maximize your intelligence, you should stimulate your
brain as much as possible in as many ways as possible — not totally neglect
something that is one of the hallmarks of human intellectual superiority, as
most people do with the creative aspects of inventing and making things.
If you think about it, you will realize that one of the most basic elements of
intelligence is to take various building blocks (such as objects or words or
ideas) and assemble them into something that is greater than the sum of its
parts. The steps involved in this cognitive synthesis don't merely benefit
the process of creating tools, because the enhanced neural circuitry confers
more global benefits. For example, when children learn to use a toy
hammer, they learn more than just how to use a hammer. They improve their
eye-hand coordination, and they learn the effects of one type of tool.
These skills benefit them in using hammers and manipulating/understanding
a number of other things in the future.
Studying mechanical mechanisms is akin to studying the dictionary. You
need to understand words if you wish to use them to construct sentences, and you
need to understand mechanical things if you wish to use them as building blocks,
too. Even if your eventual occupation has nothing to do with actually
building things, I think the intellectual potentiation is sufficient
justification for mechanical tinkering. So, after you complete those four
books, buy an Erector set or a Lego set and build something that you've
conceived, not something for which you're just following directions. If
you feel adventurous, buy a metal lathe and milling machine and turn some
nondescript hunks of steel, aluminum, or plastic into something truly unique and
useful. Or learn how to make electronic circuits, and create a circuit
that solves a problem for you. For example, a couple decades ago I built a
circuit to automatically compensate for road noise near my home, which was too
close to a major road frequented by loud gravel trucks that would drown out the
TV sound. When a truck or another noise source approached, the circuit I
made would automatically ramp the TV sound upward. When the noise source
retreated, the TV volume would proportionately taper down.
Many people make the mistake of assuming that the world is already so complex
and so advanced that they'd have no chance of conceiving anything unique.
I disagree. You're probably far more creative than you ever imagined.
If you exercise your creativity, it may blossom into something that will
surprise you. Your creation need not be stuffed with microchips for it to
be significant. Do you think all the basic things (wheels, paper clips,
etc.) are perfected? No way! A few weeks ago I sat down and thought
about the shortcomings of current wheels/tires for a specific application I had
in mind. I did what I usually do while working on a project: come up
with some ideas, write them down, and go on to something else. In time,
alternative ways of achieving this goal will pop into my mind, and in the case
of the wheel/tire idea, it didn't take long. Within two days I thought of
a wheel/tire that is totally unlike anything I've seen before. I'm not
talking about minor refinements such as a new tread or cord design (that's
engineering, not inventing), I'm talking about totally re-thinking the whole
concept of a wheel/tire. I spent a few days scouring the Internet and
performing patent searches to check for the existence of a similar creation, but
found nothing remotely similar. The basics of wheels seemed to have been
perfected by an unknown caveman eons ago. A wheel, an axle, that's it.
Subsequent developments have been nothing more than refinement. Until now.
Frankly, before I took this task on, even I would have guessed that creating a
wholly new type of wheel was a pipe dream. Thank God I've never stopped
dreaming. Nor should you. Too many people let others do their
dreaming for them. In the process, they allow their neural circuits that
govern creation to wither away. That's a recipe for intellectual
stagnation, not growth. If you want to expand your mind, you must
stimulate it in every way possible. You've heard the slogan, "Milk.
It does a body good." I have a new one. "Invent. It does a
Still more ER
questions Part 1
Still more ER
questions Part 2
If you want a beautiful garage that is easy to
keep organized, see the GarageScapes web site: