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More advice on becoming an ER doctor

His freshman year in college was a disaster; can he still become a doctor?
Academic transformation:  yes, it can be done
More on the "Lucas strategy"
How sex might affect your career
Alternatives to obtaining an MD
Asset protection for doctors
Judging whether you are likely to regret going into medicine
A discourse on academic redemption
Suggestions on how to wipe your academic record clean and start over

Q:  Recently it came to my attention that I am 21 years old and my life sucks.  I sit on my ass most days surfing the web, watching TV, and playing computer games in the same room I've occupied for 13 of my 21 years.  After high school, I took three semesters of college, 42 credit hours in all.  I got "F's" on 23 of those credits, "A's" on the other 19.  I have been mostly a loner in school, ever since that first day in kindergarten.  I've never had sex.  For that matter, I've never had anything but bad experiences with girls.  Perhaps this is due to my scrawny body (6'1'' 120 pounds), bad teeth (.5 cm overbite, overcrowding), lisp, or just lack of confidence.

Did I mention the computer games?  See, part of my problem is that I've been addicted to them (and books, movies) since I was 12.  When not actually devouring entertainment media to forget my pathetic life, I'm thinking about how much fun blowing away my (online virtual) friends in Battlefield 1942 or going on a virtual killing spree in Grand Theft Auto 3.  This is why there are F's on my transcript:  when I should be studying or doing homework I'm procrastinating about those activities while zonking off on mindless entertainment.

If you're still reading this, and do not have the word "LOSER" flashing in your brain, you should see it from my end.  About half the time I am at least partly aware that I am a pitiful dropout living in his parent's house leeching off society.  At times I fantasize about constructing a crude firearm from a piece of threaded steel pipe, a screw-on cap, a shotgun shell, and a propane torch, then ending it.  Unfortunately, the adrenaline rush I get from experiencing even the glimmering illusion of modern entertainment, or the feeling from jerking off to internet porn, distracts me from taking even the most drastic measures to escape this life.

I may even feel cheered up enough after writing this to simply save the text and resume copious over-indulgence in mind-rotting entertainment.  Perhaps you're now thinking "Gee, what does this kid have to complain about?  He has food, running water, AC, a tiny amount of spending money, and spends all day indulging in entertainment.  Lots of folks have it worse."

Perhaps its the whole "potential" thing.   As a control system, my personality is supposed to make the best use of available resources, to lead my body to the best state achievable.  It's done an absolutely shitty job thus far, especially compared to my friends.  One of them is at Caltech, another has early admission to med school, a couple more have already graduated.  Moreover, this vicarious lifestyle is boring.  Nearly all my experiences have been processed through many others.  Whether it is from scriptwriter to actor to screen, or from programmer/artists to the crude simulations of a computer game, or from textbook to author to fictional novel, what I know and experience has been regurgitated.

When I was 18 my goals were (stupidly enough) to complete the circle.  I would spend my days in front of a computer terminal working to create software that might grant virtual experiences to someone else.  I would spend the money to possess the best sound and video equipment available, and would come home to more of the same.  I would rarely leave the wanton glow of a display system.

Alas, college turned out to be somewhat tougher than expected.  Somehow I ended up purchasing a decent computer system (19" screen, subwoofers) and skipping the whole learning to work for a living part.  So here I am, and this isn't what I want anymore.

Self-edit note:  sorry for bellyaching about my problems.  I may omit the above section and this note before sending.

Reading your site is like the buzz of an electric wire.  I think that's what life is about.  Simply imagining what your experiences must be like:  I can't imagine any other profession besides actual combat (which obviously isn't something doable for more than a short period of time, even if there are wars to fight in) depending so much on what one does right now!

I have perhaps 40 to 50 years of usable lifespan left.  If at all possible, I don't want to spend those years experiencing the same.  You clearly have seen and felt more intense experiences than I'll ever see in lifetimes on my current path.

A quick bit of figuring suggests that to complete an undergrad degree with the med school requirements will be about 100 hours of coursework.  Assuming a perfect 4 all the time, that gives me a 3.3 GPA.  Is that even playable?  Would it help my transcript to transfer to another school, giving me a fresh GPA for the work done there (but leaving the old transcript stapled underneath)?

You mention the "Lucas strategy":  approximately what would this involve?  On the one hand, I can imagine applying at another college and "forgetting" to send my transcript, being admitted on the basis of my high school transcript or a GED and SAT score.

Or, surely with a GPA above 3 and a good MCAT score there is a non-zero chance of getting into some reasonably credible med schools.  By spamming the system with enough applications or coming up with something else could I make it?  Unfortunately I am a white male, so my "non-zero chance" might be a fraction of that of a minority with a similar record.

Or, with your wisdom, what would you suggest?  Obviously, getting out of the immediate hole I'm in is one thing to work on, but I need somewhere to go.  You went through torment to reach your goal, solving obstacles at least as difficult as the ones I face.

Self-edit note: OK, time to call it a night.  I have more to say but I don't know if you really want to listen.

____________________________________________________________


I found out that I made a critical error that probably precludes me from being accepted to any American medical schools.  It seems they mostly care about science GPA:  specific introductory level science courses in particular (and MCAT scores).  Alas, my little rebellion of not attending the second half of the terms for these courses, during two semesters, gives me a total of 5 F's, about 20 hours.  It seems that the way the screening process is done, my application would be rejected because of these scores in introductory physics/math . . . even if I ace the far more difficult upper level courses.
 
While I may not get a second chance from this direction  (note that I had no intention at the time this disaster occurred of ever competing for difficult grad school positions, or doing much else besides playing another video game), I found several promising avenues that may have the potential to lead to the same place.
 
I might, with sufficient stellar performance and letters from the campus psychology department, be able to obtain academic forgiveness for these F's.  They would be changed to I's and would put me back in the running.  The AMCAS form explicitly asks for me to state this occurred and give reasons why, however.
 
I learned that there are medical schools in the Caribbean with laxer entry requirements (just bring plenty of money, though some let you use U.S. federal loans).  While I haven't done enough research to determine just how rigorous their curriculum really is, I understand 14 students from Ross last term were able to transfer to American schools after taking USMLE step 1.  My tentative plan is to attempt this, assuming I am unable to receive forgiveness from my school and am unable to get any American schools to really even look at my transcript.
 
I also learned there is another alternative called Doctor of Osteopathy.  I haven't seriously investigated the drawbacks to this route, but I do know that they can receive full licenses and can and do practice any type of medicine.
 
This is important to me.  I have friends who stayed straight in school and are already in med school.  It would be a constant regret for the rest of my days if I had to take orders from men their level and do scut work, simply because I messed up early in college.  Well, actually they may very well be taking orders from a non-practicing MD with a business degree who's forgotten half the stuff.  As I understand it, that's the way to go if you'd rather have more money, women, respect, etc.
 
I would love to hear your input on my tentative conclusions.  I need more information on whether any of these ideas could work. 
 
Another matter is more pressing.  I need to learn working techniques for memorizing long-term vast amounts of specific information.  I need to find out as quickly as possible whether my mental hardware can actually do it.
 
I saw your reference to The Memory Book on your site and have requested it from my local library.  I'll have a chance to read it in another week.  I've briefly skimmed several other books on the subject while I was there.  They all seemed to describe the same methods.  These include simple mnemonic words, storytelling, journey, "Roman room," and repetition.  Unfortunately it seems that some of these techniques (especially the ones that reuse the same mental space like Roman room and journey) have retention problems.  Not much point in slogging through 6 years of intense book studying if I forget most of it.
 
I've also ordered Fascinating Health Secrets.  Does it contain any information on chemical methods for improving memory performance? 
(Answer from Dr. Pezzi:  Yes, I included a chapter on enhancing brainpower.)
 
One final worry.  In the fifth grade, I was shoved and hit my head on the playground concrete.  The swelling and large bump occurred along the top of the dome near my symmetry line near the back.  (Guess I need to memorize some books on anatomy . . . .)  I remember the injury clearly (did not pass out).  I had a severe headache for hours following, and threw up my lunch in the nurse's office a few hours later.  The doctor stated I had a mild concussion and x-rayed my cranium for fractures.  None were found.
 
Doc, how many IQ points did I lose?  Seriously, should I be worried that my mental hardware has been damaged and that I might not be capable of certain tasks, like memorizing a few encyclopedias full of medical info?
 
About the somewhat despondent tone of my last message.  I feel better now (I jogged in the morning, which seems to help).  Now that I've admitted to myself that my computer addictions are the main source of my problems, and that everything I do I will have to live with for the rest of my span, I find canned entertainment strangely less appealing at the moment.   I hope it lasts, so that I can actually extract something of value from this life.

____________________________________________________________


The Memory Book contains much of the same information as other books on the subject, but it has more practice exercises.  Further, the high stature of the authors makes it easier to focus on.  Good recommendation.
 
Did you bother to protect yourself against lawsuits in ways besides turning the slider on your work habits all the way to "obsessive-compulsive perfectionist"?  Any lawyer or financial planner has books of methods to protect your assets from seizure.  Or, if appearance greatly affects your probability of a lawsuit, why didn't you work on that?  It has to be easier to tweak grooming and speech habits than to memorize med school textbooks.  Spend years becoming a doc . . . might as well learn to look like one, eh?
 
 I am most interested in:
(a) Getting into med school/alternatives (i.e., should I spend the next 3-4 years working to get there, or are my previous mistakes too dire to ever escape?).
(b) Will I regret investing my youth in this?  You do, but what would you have rather spent it on?

A:  I think you have doctor potential, but no one makes it through college and medical school without expending a lot of effort.  If you are willing to diligently perform the work, you'd probably be amazed by what you could do.  I recall being in tenth grade and receiving D-'s in chemistry, thinking that I could master that stuff, and much more, if only I'd try.  However, at that time, I was more interested in skipping school and illegally riding my motorcycle.

At that time, I wasn't a very likely candidate to become someone who, within a few years, would be at the top of my class in medical school and academically kicking the butt of "nose to the grindstone" people who attended the finest prep schools and colleges.  While they took Advanced Placement courses in high school, I was majoring in becoming a juvenile delinquent.  This transformation from lackadaisical dunce to topnotch scholar once seemed too implausible even for a pipe dream; originally, I thought I'd be lucky to squeeze into a foreign medical school and hopefully return to the United States for my residency so I could obtain a US medical license.  You're currently in a somewhat similar situation:  questioning whether a US medical school is out of your reach, and wondering if an alternative educational pathway is the best you can hope for.

My advice?  Don't underestimate yourself.  I did, and after I succeeded I chided myself for the self-doubt I once harbored.  You, and virtually everyone reading this, have more more potential than you can imagine.  However, that potential won't be evinced until you give 100%.  Here is the good news:  many of you have more potential than I did.  Now for the bad news:  many of you have had cushier lives than mine, and your idea of a 100% effort is my idea of barely trying.  That's why I left in the dust even medical school classmates who had Ph.D.'s in subjects pertinent to medicine, even though I'd had no exposure to some of those subjects in college.

I am grateful that I had it quite rough at times when I was a kid.  Deprivation and occasional starvation is a great motivator; leading a privileged life and having things handed to you on a silver platter is not.  Deprivation can create a tremendous impetus for giving an all-out effort.  Without your parent's well-intended but ultimately injurious support, you would have shucked your affinity for computer games and worked to support yourself and continued your education both expeditiously and assiduously, instead of lollygagging as you did.

With few exceptions, it is human nature to try only as much as you have to.  When this trait is coupled with the fact that many people underestimate the required effort, many career dreams are shattered when folks miscalculate what it takes to transform them from a blob of nondescript high school protoplasm into a doctor, lawyer, professor, or some other "somebody."  You are acutely aware that Round One of college left you with grades that will assure your rejection from even the world's worst medical schools.  But is all lost?  Nope.

You have potential.  I sense it.  Over the years, I've interacted with countless prospective doctors, and you are not near the bottom of the heap.  I don't doubt that you could do it, if you try, and if you rid yourself of your current abysmal college record.  Hence, you seem to be a prime candidate for employing the Lucas strategy (discussed on another page in this web site, for those of you skipping through these many pages).  You could seek salvation through more conventional means, but I think that pouring any more time into such an iffy proposition is inadvisable.  Wipe the slate clean, and start again.

Of course, all this is predicated on your avidly longing to become a doctor.  Should you?  As you undoubtedly know from reading my web site, being a doctor is not as wonderful a career as many imagine it to be.  Nevertheless, there is nothing else like it.  The intensity, the drama, the high stakes, the opportunity to help others, the prestige, the perks, and yes, the women.

You seem genuinely anguished over your lack of success with women, so I will address this issue.  First, some really basic advice.  You are painfully aware that you aren't physically perfect.  Well, the last time I looked, many women have the same problem.  I'm imperfect, too, but that hasn't prevented me from dating.  I even had the chance to date Katie Couric, America's sweetheart (which I declined).  My point?  Being imperfect should not hold you back.  Virtually everyone is imperfect in one way or another.  A few people are fortunate enough to have almost-perfect bodies, but they may have other flaws.  In the course of being a doctor, I realized how imperfect most people are.  Some flaws are more visible, but the flaws are almost always present.  Hence, don't beat yourself up just because you aren't a paragon of perfection.  If you become a doctor, you probably won't have a difficult time finding a spouse, and you'll likely be surprised by the women you will attract.  I almost married a woman who was more attractive than an average Hollywood actress, and I knew a surgeon whose fiancιe was a mouth-watering knockout, even though he looked like he'd been hit by a shotgun.  Twice.  I could give you plenty of other examples, too.

I think most people are better off postponing serious dating until their education is complete.  This would be feasible if we did not have hormones that compel us to seek a mate.  Most people your age are either dating and having sex, or wishing they were.  Either one can cause educational problems:  excessive diversions, pregnancy (or worrying about it), diseases, financial encumbrances, or just frittering away too much time fantasizing about the opposite sex.  Libido needn't handicap your career, however.  If you can harness that energy (in the well-known process of sublimation), it can be a powerful motivating factor.

Judging from the mail I receive from college students, people have a variety of opinions about the best way to handle sexual desire.  Perhaps not surprisingly, few people advocate sexual sublimation.  Instead of fighting one of the strongest urges, many think it is best to yield to their desires and have sex.  From a time management standpoint, it may make sense to spend an hour or two per week having sex rather than spending even more time fantasizing about it.  As a result, some study partners take "bedroom breaks" to assuage their sexual appetites and make it easier to focus on college subjects that are often comparatively dull.

In addition to the familiar risks of sexual intercourse, by prematurely having sex (that is, sex before you've obtained your degree and married), you risk another problem.  Ordinarily, I would not discuss this, but I will for you since you paid me to answer your questions (by the way, the IRS thanks you for the opportunity to collect more taxes from me, since they don't make any money when I answer questions for free).  For $30, you deserve a blunt, pull-no-punches answer, and that is just what you'll get.

When people initially have sex, they may find that sex is about as pleasurable as they'd imagined.  This isn't a problem.  However, you may be deeply disappointed by the experience, as I was.  Perhaps I had overblown expectations, fueled by the often ballyhooed hype that leads many young people into thinking that having sex will give mind-boggling pleasure.  I (and millions of others) thought, "This is it?"  Such a letdown can decimate your drive to succeed, if that was one of your motivating factors.  Incidentally, if you find yourself in this situation, don't spend too much time moping over the disappointment.  Just read my book The Science of Sex: Enhancing Sexual Pleasure, Performance, Attraction, and Desire.

On the other hand, sex may be far more pleasurable that you presumed.  Judging from my initiation into sex, I thought my preconceptions of what sex would be like were impossibly overblown.  Actually, after having sex with another woman, I realized that I'd greatly underestimated how pleasurable sex can be.  Sex with that woman wasn't just more pleasurable, it was about ten times greater than I thought.  Frankly, I did not believe that anything could be that incomprehensibly pleasurable.  Good news?  Perhaps not.  If you think that computer games are addicting, just wait until you sleep with a woman who can give you that level of pleasure.  I went from "three times per week is enough" to "three times per day is barely enough."  Clearly, libido is to some extent inducible, and with a supremely pleasurable inducement, your libido will skyrocket . . . and your grades may plummet.  Thankfully, I did not experience this until I was already a licensed doctor.  Pick up a typical medical textbook, which is only a tad more exciting than reading and memorizing a phonebook.  Now imagine trying to focus hour after hour on that dry material, or hopping into bed with your gifted girlfriend.  Think this won't interfere with your concentration?  Good luck.

Obviously, sex can be a quagmire.  Sexual and romantic entanglements interfere with the careers of everyone from would-be doctors to politicians.  Judging by how these difficulties are never-ending, young people are not doing a very good job of learning from the mistakes of their predecessors.  Instead of learning how to safely navigate that minefield, they keep stepping on the same ol' mines.  I think it is time for a new approach to managing sexuality in adolescence and young adulthood, but I will save that topic for another day.

I will now return to addressing other specific issues you mentioned.  First, I don't think it is wise to continue college and presume that you could receive a 4.0 in every course.  What if you had an English prof who didn't like the way you wrote?  What if you were mystified, as I was, about the nebulous nature of humanities?  What if you began boinking a woman who made you forget about school?  It happens.  Realistically, you won't end up with a 3.3 GPA.  Assuming you do as well in the rest of college as the average successful medical school applicant, your GPA would be approximately 3.  However, since people apply to med school well before graduating from college, you will not have had enough classes for your GPA to rise that much.  You can guess what happens to people with 2-something GPA's when they apply to most medical schools.  You could try to boost your chances by making a medical device, as I advocated elsewhere, but even this would probably not impress the admissions committee enough to make them forget about your lackluster grades.

Regarding your speculation about ". . . letters from the campus psychology department . . . to obtain academic forgiveness for these F's."  Forget about it.  Ask yourself this question:  would you want to be treated by a doctor whose poor performance was excused by a psychologist?  I doubt that any ethical psychologist would stoop to such attempted academic debasement.  Even if one would, I doubt it would carry any weight with the admissions committee.  If you want to excuse your early track record, do it yourself.  A psychologist cannot embellish it any more than you could.  You won't be able to camouflage the fact that your freshman year was a disaster.

Regarding the Caribbean school option.  This would be a logical step if being a second-rate student was the best you could hope for.  However, given that you seem to have untapped potential, you'd be better off not prematurely relegating yourself to an offshore school.

Regarding the Doctor of Osteopathy (DO) option.  Back in the old days, admissions requirements for osteopathic schools were a notch below those for most allopathic (MD) schools.  Times change.

Regarding your apprehension about the ephemeral nature of memory.  Count on it.  You will remember the things you use in your specialty, and forget most of the other facts.  Unfortunately, that is how memory works for most people, and even most doctors.

Regarding your angst about the possible head injury.  As a rule, only worry about things you can control.  If something was water under the bridge a decade or two ago, it isn't worth dwelling on.

Regarding asset protection.  Believe it or not, but I looked into that and met with an asset protection attorney.  I learned that asset protection laws vary from state to state, and that Michigan's laws make it very difficult to protect the assets of single people.  If an attorney read my entire web site, he'd probably think twice about suing me.  Doctors have made it very easy for attorneys to sue because, as a rule, we don't attack back.  We take it on the chin, and walk calmly away.  Big mistake.  Bullies love punching bags they can pummel at will, without having to worry about reprisals.  Considering the pernicious effects engendered by frivolous lawsuits (affecting both doctors and patients, as I described elsewhere), I believe that physicians have an ethical and professional obligation to strongly retaliate against attorneys.  To keep "malpractice" attorneys from leeching off society, doctors must first get attorneys off their backs (I put malpractice in quotes because, as the Harvard study demonstrated, most alleged malpractice is frivolous extortion).  As I've documented elsewhere, attorneys aren't just harming doctors.  By siphoning billions of dollars from the healthcare system, they are endangering patients as hospitals and doctors are forced into making cutbacks.  Doctors, nurses, and other healthcare workers can be spread only so thin before staffing shortages make future errors inevitable.  Any doctor who meekly lets this happen is doing a grave disservice to his patients.

Now to address your final questions:  "Will I regret investing my youth in this?  You do, but what would you have rather spent it on?"

Lacking a crystal ball, I don't know if you will regret the sacrifices it takes to become a doctor — which are, by the way, probably much greater than you can imagine.  I've read what many doctors wrote about what they endured during their years of training, and one of the most universal reactions can be paraphrased like this, "Holy shit!  I knew it'd be tough, but I never imagined it'd be that tough!"

If your only reason for going into medicine is because you want to help people, you are much less likely to regret your decision than if you are motivated by more superficial concerns.  But, altruistic or not, the sleep deprivation will get to you.  So will the endless years of work.  People want to have fun and experience some variety, not work 110 hours per week.  Almost anyone could do that for a short time, but imagine doing it month after month . . . after month . . . after month . . . after month . . . after month . . . after month . . . after month.

What would I have rather spent my youth doing?  Something in which I could have made better use of my potential.  I'll save that for another day, too.

Q:  Reading over your reply, the moment I came to your mention of the Lucas strategy I thought "crap!" and began pacing about the room.  Unlike the advice I get from my elders, this one wasn't free, so I have to process it.

The Lucas strategy seems frightening.  First, it would necessitate committing a felony, correct, to obtain a false Social Security number.  Not a very auspicious start to a career where the intention is to maintain better ethics than a priest.  Given the number of illegal immigrants who must attempt similar strategies (and fail, and are shipped back), the odds of getting caught seem rather daunting.

A:  First, some philosophical comments.  The United States of America is willing (or all too willing, depending on your point of view) to give redemption to Mafia hit men (via their Witness Protection Program), run of the mill murderers, rapists, corrupt politicians, incorrigibly wicked foreign dictators, embezzlers, robbers, welfare cheats, and boatloads of other criminals . . . but not a young person who made an incalculably less serious mistake, that of playing too many computer games when you should have been studying?  So this youthful glitch should forever preclude you from attending an American medical school?  It doesn't seem fair.

By listening to Sean Hannity's national talk radio program, I learned from the profoundly religious Mr. Hannity that redemption is a central facet of the Christian faith.  I heard about a clergyman who admitted to having an affair with a boy many years ago.  He was forgiven by his superiors, members of his church, and — strangely — even the local prosecutor.  Hence, it's possible to rape a child and get off scot-free without suffering any consequence more serious than publicly apologizing for that transgression.  But it is evidently taboo for a reformed student to obtain a fresh start?

Scales of justiceI don't buy it.  This does not mesh with my sense of justice and propriety.  First of all, you've already paid for your mistake:  you've wasted a year of your life.  Even when they are caught and convicted, many people receive lighter sentences, or suspended sentences, for crimes far more serious.  Think of that universal symbol which connotes proportionality of justice.  Justice that is not measured or proportional isn't justice.

I don't think it is criminal or unethical to want a fresh start academically.  In my mind, your "crime" has already been paid for.  Others may disagree, but I'd love to hear them explain exactly why someone in your shoes does not deserve to start over.  The only possible unethical aspect of this is that by retaking similar classes you might gain an unfair advantage over other students.  If this is true, it should be unethical to study in preparation for a class.  But that isn't unethical; it is a tool used by many industrious students.  And it should be unethical for high school students to take Advanced Placement courses . . . don't those courses give them an advantage over other college students, such as myself, who never took AP courses because we were too busy goofing off and unwilling to truncate our childhood until the very last minute?  It should also be unethical to audit or "sit in" on a class before taking it for a grade.  But that isn't unethical.  Many students do it, and I've heard professors recommend it.  Furthermore, it is questionable whether you learned enough in the classes you failed for this to be an ethical concern.  Finally, by repeating your freshman year, you aren't guaranteed of acing it and triumphing over others.

Medical school applicants frequently repeat the MCAT exam.  I've never heard of an admissions committee member discount a MCAT score because it belonged to someone who retook that exam.  If it's kosher to retake the MCAT, why can't you retake a class without incurring a perpetual black mark on your record?  Is that really so heinous?

Obviously not.  The difficulty arises when you lie about something in order to circumvent admissions committees from discovering your initial college failures.  That lie, and its ancillary embellishments, becomes the basis for the moral and perhaps legal transgression (I'm obviously not a lawyer, so you should consult one before deciding what to do).  However, think about this.  Social Security numbers (SSN's) were originally intended for one purpose only:  to identify people for eventual disbursement of Social Security funds.  In time, SSN's became a de facto universal identification number for Americans (many of whom paradoxically bristled at the notion of national ID cards after 9-11).  Here is a quick lesson in pop psychology:  most of us are sheep.  We're submissive, and easily swayed or led by bureaucrats who demand that we comply with their policies.  In time, those policies often become institutionalized and even codified.  Every year, the government and its minions tighten the screws a bit more.  If the Founding Fathers could see how outrageously intrusive our current government is, they would revolt against it.  Some of this intrusiveness is avuncular and well-intended, but much of it is petty and motivated by the desire to control our behavior.  In theory, we're free people.  In reality, politicians and bureaucrats attempt to control our behavior by byzantine laws and regulations, many of which are asinine.  For an illustration of this, read about how ER doctors cannot perform a stool Hemoccult test.  We can do heart surgery in an emergency, but we cannot be trusted to put a drop of fluid onto poop . . . go figure.  Virtually everything Americans do — from reproducing to flushing the toilet — is governed by laws that attempt to control our behavior by creating a blizzard of incentives and punishments.

The two years after 9-11 were especially tumultuous ones that caused me to ruminate about the nature of people and their susceptibility to subjugation.  If you think about this, you will realize that a relative handful of people control the world.  Their foremost intent is to usurp power and resources that enable them to live lavishly, often at the expense of their subjects.  If people weren't sheep, they could collectively muster the strength to annihilate their leaders and regain freedom.  If the people of Iraq showed the same mettle against Saddam Hussein as they are now showing against "the American invaders," Hussein never could have consolidated his power base.  The Shiites could have literally roasted him over a fire like a pig.  But they did not.  Why?  Because they caved in to his strength, and failed to use their power.

No one can become a sheep unless he buckles under.  I don't advocate general disobedience.  For society to function, we must live by commonsense rules.  However, the first rule should be that all rules make sense, but that was evidently ignored long ago.  Hence, unless one is willing to be a sheep, one should design his own moral compass and not live by ludicrous rules imposed by others.  In my opinion, you are now feeling pressure to either ruin your life by committing a possible crime, or risk ruining your life by buckling under to societal pressure to divulge your entire academic record.  Everything hinges on your Social Security number, because without that, they cannot tie you to your freshman flubs.  Your name isn't unique, and schools do not have the resources to extensively cross-check other data for background verification.  As a taxpayer, I would be enraged if the government and publicly funded schools wasted our limited resources on sleuthing out students wanting a second chance rather than using comparably powerful databases to uncover terrorists and their supporters.

I think you overestimate the power of schools.  For the most part, they believe what you tell them.  When a friend of mine claimed to be one-sixteenth Cherokee Indian to increase his chance of medical school acceptance, do you honestly believe that they verified his ancestry?  No, they just rubber-stamped his application, and went on to the next one.  Do you have any idea of how many applications schools receive?  Your application is just a needle in a haystack.

Believe it or not, but I am not trying to encourage you to do anything illegal; I am just trying to ratchet down your anxiety level.  If I were you, I'd do the following:

  • First, ascertain whether all American colleges require a SSN.
  • Second, if not all do, choose one that does not.
  • Third, if this "requirement" appears to be universal, refuse to give your SSN unless they can show you a law compelling this disclosure.  Bureaucratic power often evaporates the second you stand up for your rights and demand that they show you legal justification for their request.  By the way, don't fall for a lame excuse such as, "It's our policy" or "You have to."
  • Threaten to sue them.  I heard an attorney discussing this issue a few years ago, and he claimed it isn't legal for institutions to use SSN's for general identification purposes.  Demand that they instead issue you a plain-vanilla student ID number.
  • Alternatively, attend college in a different country.  Our medical schools are topnotch, but many US colleges are academic jokes and little more than misnamed high schools.
  • If need be, change your SSN.  This is legally permissible in certain circumstances, and the good ol' Federal Government is kind enough to spell out how to do this, and what the ground rules are.  You're smart enough to follow those rules, aren't you?  See SSA Publication No. 05-10064 (www.ssa.gov/pubs/10064.html).

You're home free.  You have another shot at becoming a doctor.  Don't blow it!


Review of
TRUE Emergency Room Stories
by Kevin Pezzi, M.D.

Available in trade paperback, e-book, and excerpted on audio cassettes.

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 unusual stories."

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 home.

In this book, you'll accompany Dr. Pezzi as he meets the world's unluckiest man and woman, deals with people who have strange requests, and attends to a bride whose genetic disorder wasn't discovered until her wedding night.  There is also the story of the man who didn't know that he had been shot in the head, and the case of the pit bull who picked on the wrong person.

True Emergency Room Stories has something for everyone.  Besides the strange cases, readers will be captivated by dozens of incredible, tragic, humorous, steamy, heartwarming, thought-provoking, and poignant tales.


The importance of reading the nursing notes
Why this isn't always feasible . . . and what to do about it
Administrators have the power, while doctors have the responsibility:  does this make sense?

Q:  I'm now training to become an ER doctor.  The more I learn about this profession, the more I realize that ER docs face many pitfalls.  Naturally, I'd like to avoid as many problems as possible.  Can you give me an example of a common mistake?

A:  Yes.  Here is one that I, and many other ER physicians, learned the hard way:  always read the nursing notes.  Like many of my colleagues, I once assumed that nurses would tell me about any especially noteworthy things.  Wrong.  A good nurse would never just scribble a bombshell note in the nursing notes and leave it at that, but all nurses are not good nurses.  In case you haven't had your daily dose of things to worry about, here is one more.  Take a look at all the papers comprising an ER medical record.  That record looks intact to attorneys when they review the chart, but all of the papers in that chart may not have been in it while the patient was in the emergency department.  I found out — again, the hard way — that some nurses keep records that are separate from the main ER record, and the nursing notes may be combined with that record only after the patient is discharged . . . when the ER doc is busy with another patient or ten.

Why do nurses keep these sequestered notes?  The obvious explanation is convenience, the charitable explanation is that they're perfunctorily performing their duty to chart, and the "give me nightmares" explanation is that it is a darn good way of passive-aggressively setting up a disliked doc for a lawsuit.  For example, a nurse could chart, "Patient having chest pain.  Doctor informed" even though the doctor was never informed.  By the way, that is a verbatim quote from a case I had years ago.  After reading the nursing notes just before discharge, I confronted the nurse because she hadn't mentioned anything to me about that chest pain.  She said that she intended to tell me, but got busy and forgot.  Great.  Had I discharged that patient without addressing his chest pain, it would appear as if I were grossly negligent if there were an adverse outcome.  It'd be such an open-and-shut case of malpractice that it would make a malpractice attorney jump for joy.

Unfortunately for ER docs, such a problem might easily occur if the nursing notes are appended to the ER chart after the discharge order is written.  In theory, it sounds so easy to prevent this problem.  Here is the Disney version of how things should work:

A good ER doc will always read nursing notes.  If they aren't in the ER chart, he will hunt them down.

Now here is the reality:

Searching an emergency department for notes that may or may not exist is a great way to waste time.  Those notes may be tucked in the pocket of a nurse who may be at lunch in a distant cafeteria.  Or they may be stashed away in some nook or cranny known only to the nurse.  Or they might not even exist yet.  Proving a negative in this case is impossible.  Search for an hour, or even a week, and if no notes are found, it isn't proof they don't exist.  Even if the first page of nursing notes are attached to the main ER chart, it is no guarantee that supplementary sheets aren't floating around somewhere.

As an ER doc, you will not have the time to embark on a wild-goose chase, searching for all the notes on all of your patients.  If you even tried to do that, you'd kill umpteen patients because your time is limited.  If you spend it doing "x," you can't do "y."  You will do the most natural thing, which is to attend to the most pressing problems (e.g., a baby turning blue) and hope that the nurses keep you informed on other patients.  Most nurses will, but keep in mind that malpractice attorneys can become multi-millionaires even if we give flawless care to 99.99% of patients in the ER.  Winning just one case in a lifetime could give them enough money to live like a king.  And they do.

If you're smart, you're probably now beset by the realization that while I've implored you to always read the nursing notes, this isn't always possible.  Welcome to the real world.  Even if you are the world's best doctor, you will not perform perfectly in the ER because the imperfections inherent in emergency departments guarantee that you cannot overcome all of the institutionalized errors.  The best that you can hope for is to minimize them.

I will now generalize this topic a bit.  Ask yourself this question:  doesn't it make sense for people who have the ultimate responsibility to be given the ultimate power?  Of course it does, but that principle no longer applies to medicine in general and ER medicine in particular.  I've never worked (or even heard of) an ER run by the doctors.  Instead, emergency departments are typically run by nurses who work for the hospital, and hence are ultimately run by hospital administrators who have the ultimate hiring and firing authority.  I would not mind this lack of power if the administrators would listen to our legitimate concerns and act on them, but all too often they don't.  A case in point:  we complained for years about an ER nurse with Alzheimer's disease who was as bright as a burned out light bulb.  You'd think that such a complaint would be taken seriously by an administrator, but no.  When it takes over 1000 days for such a problem to be resolved, you can bet that more minor problems can drag on forever . . . and they do.  (Just something to ponder:  if you think it's tough to find nursing notes, imagine the difficulty of finding notes generated by a nurse with dementia.  Even she might not know where the notes are!)

In my experience, administrators do an abysmal job of running emergency departments.  When those business-school grads are handed the keys to the ER, they take them because they're human and they like power.  Heck, they probably even think that such power is best vested in them, the geniuses that they are.  They like having that power.  They like being secluded in their walnut-paneled offices far removed from the ER tumult.  They like their private dining rooms, private bathrooms, and foxy secretaries.  I wouldn't be surprised if they have interns, ΰ la Bill Clinton and Monica Lewinsky.  With all that power and all those perks, why risk some unpleasantness by spending time in the ER?  Isn't life too short to step on a dirty floor?

I went into medicine with no preconceived notions of administrators, and now I loathe their inattention to potentially life-threatening problems.  Things will never change while they're in power — or if they will, I have one question for them:  what on Earth are you waiting for?

Given that administrators are content with the status quo, I think that physicians are morally obliged to regain control over medicine.  Administrators, politicians, lawyers, bureaucrats, and insurance companies aren't helping patients, they're mucking up the system and guaranteeing that any beneficial changes occur at a snail's pace.  If patients die as a result, who cares?

One of my former ER bosses told me about a conversation he had with the hospital president.  My boss met with him to discuss his concerns over how the shortage of nurses staffing the ER made it difficult to practice quality medicine and ensure patient safety.  The president's response was succinct, and chilling.  "If you ever tell anyone what I'm about to tell you, I'll deny that I said it.  I care about patients dying only to the extent that it affects the bottom line.  If I can save more money on cutbacks than I will spend on settling lawsuits resulting from those cutbacks, then those cutbacks are a good business decision, and I'll do them."

That president is no longer working at that hospital.  My guess is that his ruthless calculus was impossibly dreamy.  Lawsuits are so expensive that staffing cutbacks cannot pay for them.  Unfortunately, that depraved president is likely earning his "way more than doctors make" paycheck at another hospital.  I wish he could see the human carnage he left in his wake.  Such as my nephew (I'll call him Rob), who was born at that hospital and was a victim of yet another dumb policy implemented under the directorship of that president.  Rob has mental and physical handicaps that he'll carry with him for a lifetime.  It makes my blood boil every time I think of what caused those handicaps.  When Rob was born, that hospital had one of the most idiotic policies imaginable:  that babies could be delivered only by doctors, not obstetric nurses.  This policy was likely a harebrained response intended to limit their liability, so if anything went wrong, they could blame it on the doctor.

Obstetric nurses know how to deliver babies.  The extra knowledge and experience of doctors is needed only in complicated deliveries.  Rob's delivery wasn't complicated, except for one thing.  Because the doctor was not yet present and the nurse was afraid to violate the "nurses cannot deliver babies" policy, she delayed the delivery for 15 minutes until the doc arrived.  My brother was with his wife in the obstetric room, and he reported that the nurse put her hand on Rob's head and, with her arm outstretched, leaned forward to apply pressure to impede his delivery.  When Rob was finally delivered, my brother said that he wasn't just purple, he looked black (indicating severe cyanosis).  Depriving brain cells of oxygen is a great way to kill them.

Oh, about my old ER boss.  He went to business school, and earned an MBA.

Improving healthcare isn't rocket science.  Often, it just requires implementation of commonsense measures, such as demanding that there be one ER chart, preferably with integrated medical and nursing notes.  The old way (having separate pages for docs and nurses) leaves too much room for error.  Yet administrators have dragged their heels for decades and ignored this problem, and scores of other ones.  Why?  Distracted by the interns?

No one is just going to give doctors this power.  Americans are too busy watching reality TV, and they're content to point the finger of blame at doctors whenever anything goes wrong.  Are administrators ever personally sued for their mistakes and inattention to problems under their control?  Never!  It's always the powerless docs who are blamed.  I think it's time to change this system which is, frankly, nuts.  "You have the power, and I have the responsibility."  Administrators love that system, and doctors hate it.  If patients were smart and informed, they'd hate it, too.  After all, the doctors are just sued.  Some patients are dying.


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You will have sex about 10,000 times during your life.

Doesn't it make sense to read a book that can maximize your enjoyment, and the enjoyment you give to your partner?

Cast away your preconceptions of sex books as being a rehash of things you already know and hence a waste of time.  By reading this book, you will learn many things that Dr. Ruth and other sexologists have never considered.

The Science of Sex
Enhancing Sexual Pleasure, Performance, Attraction, and Desire

by Kevin Pezzi, MD

Available in printed and Adobe Acrobat e-book versions (will display on any computer)

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Organize your garage beautifully.

If you want a beautiful garage that is easy to keep organized, see the GarageScapes web site:  www.GarageScapes.com.

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 he did!

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