Welcome to the ERbook.net:  the Web's foremost site for Emergency Room stories.
Discussing the specialty of emergency medicine, medical school, academic success, and unusual true Emergency Room stories.

Quick Search  
Advanced Search

Site map

Home


Reviews of other ER books

Contact me

Submit a question

Submit an ER story

Have an interesting ER story?  If I use it, I'll give you a free book.


Question & Answer pages

For more Q & A, see my
www.er-doctor.com site

ER crossword puzzle

Interview with Dr. Pezzi

ER-MCAT

Test your knowledge of ER terms by solving my ER crossword puzzle that was featured in the Prudential Securities Healthcare Group 2002 calendar.  Or take the ER-MCAT to see if you have what it takes to be an ER physician.


My favorite ER memories

Pictures of me

Biography

My personal pages

Including my:
Medical Inventions page
Misc. Inventions page
Snowmobile page

Accelerometer page
Smart Seat page
"If I had a hammer" page
"Sheds I've Built" page
Dremel bit holders page


ER stuff
 ER stuff
A mold to make ER cookies and ER Jell-O!  Or how about a glow-in-the-dark chest x-ray?


My postings on ER forums

ER links

Bad news about Accutane

Amy's Corner

Amy reviews ER computer games

Tell a friend about this page by e-mail

Recent magazine interviews

Some of my other sites

Do you care if wild animals needlessly suffer and die during wintertime? If so, see www.shelteranimals.org.

Still More ER Questions
Part 1


ER doc too busy to make love to the woman he's dating?

Q:  I started dating (if you can even call it that) an ER doc about a month ago. He is always really tired or really busy — works 14 shifts a month, but what exactly is a "shift"? I know they're rotating shifts. I REALLY like this guy and can't tell if he truly works a ton of hours or if he's just blowing me off. I'm thinking "if you're too busy to f*ck me, you are TOO BUSY" but I'd like to give him the benefit of the doubt. Should I continue to wait for his call or move on?

A:  An ER shift is typically anywhere from 8 to 12 hours. However, by the time the doc completes his dictations, paperwork, and wraps up the care on his patients, each shift may be prolonged a few hours — or it may not, depending on how busy the shift was. Working 14 shifts per month may not seem like much, but ER work can really sap one's energy. I've worked many jobs in my life, and nothing — I mean NOTHING — was even a tenth as exhausting as ER work. I used to mow lawns, primarily using a push mower. Trust me, you've never seen anyone mow a lawn as fast as me. I souped up my mowers so they could still do a good job of mowing even when pushed at a breakneck speed. In the blink of an eye, I could turn the mower around and accelerate to my mowing pace (which was faster than most people run). I'd do this all day long, seven days per week. Tiring? Just a pleasant stiffness in my muscles at night. Compared to ER, it was like being on vacation.

If you think I'm getting off-topic, just bear with me for a minute:  I'm giving you this background information so you can fully grasp what I'm about to tell you. Physically, the most taxing job I had was when I worked for a guy carrying building materials up a hill (he was building a home on a hill so steep that no truck could ascend it, so he hired me to carry the boards from the base of the hill, a few hundred feet to the top. The man was really a slavedriver, insisting that I carry two thick sheets of plywood at a time up the hill. An average man couldn't even pick up two such sheets of plywood, let alone carry them hundreds of feet up a hill, and do that over and over again — building a home requires umpteen tons of lumber. Was I tired afterward? A bit, but that job was a walk in the park compared to being an ER doc.

I could regale you with tales of my other 18 jobs, but the take-home message is the same:  nothing is nearly as exhausting as being an ER doc. Obviously, ER work isn't especially demanding from a physical standpoint:  witness the paunchy physiques of most ER docs. However, ER work is mentally taxing, and that is far more onerous than physically demanding jobs. If you care to think about this from an evolutionary perspective, humans evolved to tolerate prolonged physical activity quite well, and also sporadic mental stress — like being chased by a saber-toothed tiger. Our "fight-or-flight" response is great for dealing with such periodic stresses, but it does a miserable job of coping with mental stress that goes on and on and on . . . such as what ER doctors face. It's been scientifically proven that humans and animals have a more difficult time coping with stress when the stressor(s) are not under one's control. You may think the ER doc is in control of the ER, but he isn't. He can't control how many patients flood the ER at any one time. If the patient volume is overwhelming, he can't prevent another dozen people from walking in the door, all screaming for attention NOW. He can't control what his patients are like, some of whom are so out-of-control that one such patient could sap all his time. There are hundreds of factors that are not under the control of ER doctors, and these stressors malignantly affect the docs. After all, they're human.

Most ER docs love to feel that they're tough and can handle anything. Unfortunately, they can't evade biological reality. Protracted, severe stress induces biochemical changes within the body that produces noticeable changes:  muscles atrophy a bit, and there's a bit more fat, especially on the trunk. There are a dozen other changes, but you didn't tune in for a lecture on endocrinology, so I'll cut to the chase and discuss how chronic stress impacts libido. Briefly, it reduces it, primarily mediated by a fall in the testosterone level.

Don't think that I'm writing all this to excuse the apparent sexual exhaustion of your quasi-boyfriend. I'm not. I've worked full-time in one ER and part-time in another ER while doing other jobs on the side, such as writing and inventing. Even though I'm typically a high-energy person, sometimes I'd be so drained that on my days off, all I'd want to do is sit in a chair and stare at the wall. I had so much that I wanted to do, but I was so pooped that I couldn't muster the energy . . . except when it came to sex. On those rare occasions when I had a girlfriend, I was never "too tired."

My diagnosis? There's a problem here. Either the doc you're dating has a problem with his libido, or he isn't attracted to you. Since he is dating you, I suspect that he must be attracted. Ergo, there is likely a problem with his libido. Working rotating shifts (in which the schedule changes from day to afternoon to night shifts in a cyclic fashion) is a great way to wreak havoc on the body. People who work the night shift typically live a few years less than average, and people who work rotating shifts face even greater stress, because their body never has a chance to adapt to the constantly changing schedules. Hence, it isn't surprising that an ER doc working rotating shifts would manifest some collateral damage.

Other than the stress of ER, there are countless factors that may impair sexuality. I won't try to offer a definitive diagnosis for him over the Internet, but I'd like to help. I know more about sex than Dr. Ruth.  That may seem like bragging, but it's true, I assure you. She knows the basics, but — yawn — what doctor doesn't? Compared to what I know, she is still in kindergarten. Therefore, I have a lot to offer, so I will send you a complimentary copy of my book, The Science of Sex: Enhancing Sexual Pleasure, Performance, Attraction, and Desire, if you don't mind reading an e-book. Reading that book will give you a lot to mull over, including some things you've certainly never considered. If you think I'm just hyping the book (but why I'd do that to encourage someone to accept a free copy is beyond me), I'm not. There isn't a doctor in the world who knows more about sex than I do. I read every book I can get my hands on that is even remotely similar to mine, because I believe in checking out my competitors. Consequently, I've read countless books in this genre, and most are laughably mickey-mouse and an utter waste of time. My book will have your head spinning, and if the information in it can't turn your man into a sexual dynamo, well, it's time to search for another man.

You know that writer's block you get when you sit down to write the essay portion of your personal profile for online dating? And you know the difficulty you have trying to think of a catchy headline? Well, MyProfileWriter allows you to create a profile essay and headline without typing, just by clicking!

A reader thinks I'm arrogant
Note:  The following message is unedited:

Q:  Hi, I'm writing about your answer to the question of how to become an ER tech (assistant.) in your answer you stated that the girl who asked the question sounded very intelligent and that she should go for RN or MD. I believe that that was great advise and that everyone should strive to be their best, but I am an EMT seeking an ER Tech position. I take pride in my skills and the work I put into getting my certificates. I am a very intelligent person and I do hope to continue on to nursing. I'm also a 20 year old who is married and has a 3 year old diabetic son. Attaining my goals are going to take a little longer but I'm confident that I will succeed. With all due respect, I think you sound a little arrogant.

A:  What on Earth is wrong with complimenting someone? Your non sequitur is inscrutable.

“People who repeatedly attack your confidence and self-esteem are quite aware of your potential, even if you are not.”
Wayne Gerard Trotman

“Whoever is trying to bring you down is already beneath you.”
Habeeb Akande

Regarding your statement, "I think you sound a little arrogant." I don't know what prompted that characterization, which strikes me as a non sequitur. I readily admit that I am very proud of my accomplishments. I had a superb undergraduate GPA, aced the MCAT, got into medical school after 3 years of college, graduated in the top 1% of my class, and was such a shoo-in for an ER residency position (the most coveted residency at that time) that I was offered an under-the-table deal because they wanted to ensure that no other hospital lured me away. During and after medical school I took Accutane: an acne drug that can cause pseudotumor cerebri; it gave me excruciating chronic headaches that made it difficult to concentrate—but when you're young and foolish enough to value appearance over feeling good, I put up with pain that would send most people to an emergency room.

I've designed and built hundreds of things from scratch, such as a pocket echophonocardiograph and the world's best electronic stethoscope that gives the user the acoustic impression that he is actually inside the patient's chest — not the typical muffled, muddy sounds that most stethoscopes give. I've written several books and developed dozens of websites that are packed with information (like this one) or are truly innovative. Once I discovered how to unleash my creativity, I did much more, such as inventing devices that cure certain infections much faster and more reliably than antibiotics. I sold that technology to a company founded by a friend of Bill Gates but leapfrogging the capabilities of all pharmaceutical companies was what I'd call a single (to use a baseball analogy); my best ideas are comparatively like a home run that wins the World Series. I can't yet talk about them, but they will change the world for the better, save countless lives, and put smiles on billions of faces.

So am I proud? You bet! You're proud of what you have accomplished, and when you accomplish more, you'll be even more proud. Pride is one thing, and arrogance is something altogether different. The two are not direct synonyms. According to my American Heritage dictionary, pride means "pleasure or satisfaction taken in an achievement" or "a sense of one's own proper dignity or value; self-respect." Arrogant means, "making or disposed to make claims to unwarranted importance."

“If being an egomaniac means I believe in what I do and in my art or music, then in that respect you can call me that … I believe in what I do, and I'll say it.”
John Lennon


The key difference is whether the sense of accomplishment is warranted. If you're going to call me arrogant, I wish you would explain why my pride is not justified. We live in a plastic world filled with people who truly are arrogant because they've accomplished little or nothing on their own, but yet think they're hot stuff because they were born beautiful, rich, or famous. When I think of arrogance, I think of Hollywood folks who believe they're America's royalty. Their success is attributable to their good looks. Take away their pulchritude, and what do you have? Not much. Their talent? Ha, I'm laughing about that. Take Ben Affleck, for example. I mentioned him only because I saw him in a movie last night, and I was stunned by his performance … not because it was good, but because it was so pathetic. As a doc with years of experience in the ER, I can tell if someone is on drugs or has brain damage. I don't know if laypeople key in on the speech patterns that alert docs to those possibilities, but the cadence and intonation of his speech, and his glassy-eyed countenance, made me wonder if he was drunk, on drugs, deficient in some nutrient vital to mentation, or if his neurons had a third-rate wiring job. He is treated like royalty just because he happens to be one bodaciously handsome man. Let's say Affleck had twice the talent that he does, but he looked like the Wal-Mart greeter I saw this morning, or he looked like me, you, or just another face in the crowd. Would he still be a star? The answer to that rhetorical question is obvious, so let's move on.

“Who would you impress if the world was blind?”
Shannon L. Alder


Another group of people who are frequently arrogant are beautiful women, even the ones not in Hollywood. Men are all too eager to shower such women with things that less attractive women rarely get or have to earn on their own. Eventually, some beauties come to possess an exalted opinion of themselves, just because they're beautiful. Have they ever saved anyone's life, as I have numerous times? Would they risk their lives to save the life of a poor black male, as I did? Have they ever spent hours making handmade gifts for sick people, just because they wanted to see them smile? I have. Have they ever spent hours removing the snow from the driveway and porch of a disabled veteran? I have. Take away their God-given beauty, and what do you have? In many cases, not much. I've dated some real beauties, and once I stopped drooling over them, I realized that most coasted through life on their looks alone. (For more information, see the beautiful woman syndrome site.)

I wasn't born famous, beautiful, rich, or smart. My Dad abandoned us when I was young (and was later murdered), and my Mom worked two jobs to support us. I'd frequently awaken in the middle of the night to the sound of my Dad pounding my Mom or just a wall.  I'd stay in bed, frozen in place with fear, staring in the darkness at the ceiling, wondering if my brothers were awake and heard all this shit.  I was too scared to speak, so I spent those nights waiting for the time I could get up, dab some more grease into my hair (hey, this was in the 1960s), and do my best to pretend that everything was hunky-dory.  I wondered how any father could look his children in the eye after hitting their mother, then I'd go to school.  How I kept awake without coffee is beyond me.

My vision was so poor that I'd run into walls and couldn't see what teachers wrote on the chalkboard until I began wearing glasses at age 16. Before then, I used one finger to push on an eyeball to partially correct its astigmatism. It still mystifies me how I could go through that many years of school without one teacher noticing that I was blind as a bat; aren't they trained to recognize such problems?

I lived in a home with peeling lead paint that I dutifully removed with a paint scraper over a period of months, never wearing any mask or gloves to protect me from the neurotoxic lead. I simply didn't know better. Worse yet, when my Dad was still around, we'd decorate our Christmas tree with icicles made of pure lead. As a young child — when the developing brain is especially vulnerable to lead — I would roll those icicles into balls, and then eat cookies, without washing my hands. I was exposed to lead from other sources, such as helping my Dad cast lead bullets and work with lead type. With so much lead exposure, it's a wonder that I ever learned to tie my shoes. My sixth-grade teacher said I was “slow,” and I struggled my first two years of high school until I serendipitously stumbled upon a way to significantly increase brainpower. Before that, I was so tired of floundering academically that I planned to drop out and get a job working in an auto assembly plant.

I began working when I was in junior high school, and I kept working up to three jobs at a time to support myself in college and medical school. On my first morning delivering newspapers in college, a man amused by my appearance called me a “retarded boy” and told me to get out of there. I couldn't afford a winter coat, so I wore every shirt and jacket I had, trying to keep warm. I wasn't given any bag or advice on how to carry so many thick Sunday newspapers, so I improvised a solution by using my plastic laundry basket as a sled, which I pulled with a rope over the sidewalks covered with fresh snow.

I used to drive junkers that often broke down, and had various mechanical problems that wasted my time (such as a car that wouldn't budge until it was warmed up for 20 to 30 minutes—that's 40 to 60 minutes wasted per day). One car smoked so much that I had to drive it to college before sunrise and stay there until it was dark outside. If I didn't, the plume of oil smoke trailing it would result in another ticket that I couldn't afford.

My poverty forced me to sometimes room with people who were either exasperating or even downright nuts, and that wasted time, too. When my Mom's (and later my) money ran out I sometimes starved and developed diseases stemming from nutritional deficiencies, but I was either too stupid or too hard-headed or too proud (that word again!) to ask for help. My acne was so bad that I wasted thousands of hours popping pimples and trying to unclog my sebaceous glands—up to two hours per day!

I had a bleeding ulcer that bored a hole in my gut twice the size of a bullet. The only doc I could afford to see was such a quack that he couldn't diagnose an ulcer, and instead opined that I had a back problem, for which he prescribed a 4-millimeter shoe lift! While my classmates were studying, I was writhing in pain and shitting out blood for years because I thought he must know what he was doing … he was a doctor, wasn't he? I performed minor surgery (dermabrasion and excision of gangrenous tissue) without anesthesia a few times on myself because I couldn't afford to see a surgeon. When I was younger and even poorer, one of my knees would swell internally so much that I couldn't begin to bend it. I had other joint pain so bad that it was difficult to sleep, but I didn't get even an aspirin for it. I had untreated strep throat that led to rheumatic heart disease. I developed objective tinnitus so severe it'd awaken me as soon as I entered anything deeper than a light sleep. Did it last for weeks? No, many years. Without medical insurance, I had to put up with the tingling in my hands and feet after I broke my neck. So did I lead a charmed life? Not quite. In a blog article, I mentioned more challenges I faced.

Thanks to ADD (attention deficit disorder) that likely arose from earlier lead exposure, I found it almost impossible to concentrate on schoolwork; my mind incessantly wandered until I found a temporary antidote for it. I was also poisoned by mercury that produced symptoms making restful sleep impossible for decades.

Many of my classmates in medical school had advanced degrees, such as Ph.D.s in pharmacology and biochemistry. Many of them came from well-to-do, famous families, and had all the advantages that money can buy: the best prep schools, the best colleges, the best medical care, the best food, the best lodging, the best advisors, the best connections for those all-important letters of recommendation, and even a reliable car. Most importantly, many of those students were supported by their parents, eliminating their need to work. So, as I was slaving away mowing thousands of lawns, baking in a couple of factories while getting ripped off by union bosses, and performing countless odd jobs (some of which were brutal, dangerous, or just plain God-awful), my cohorts could have been studying, doing research, prepping for the MCAT or the boards, or doing something else that would have given them a competitive edge over me. Frankly, I was intimidated by their achievements, their money, their connections, and their other advantages. But guess what? There were 255 people in my medical school class besides myself, and I beat 254 of them. If you had overcome the difficulties I faced and accomplished what I did, you'd be proud, too.

I sincerely doubt that you or anyone else is interested in my accomplishments. That's why I never bothered to mention them for years. The only reason I've done so in this venue is because I present myself to the public as someone who is qualified to counsel people on how to succeed in college and medical school. Not all doctors possess equal brainpower and qualifications; some graduated at the bottom of their class, and some at the top. If I were a student listening to the advice given by supposed experts, I'd give more credence to the topnotch docs. Or would you prefer to follow the guidance of someone who graduated at the bottom of his class? I think my advice is valuable not just because of my achievements, but because of what I had to overcome. Hence, I mention my successes not to gloat or brag, but to give students some basis for deciding whether or not that advice is worthwhile.

In my opinion, justifiable pride in one's accomplishments is far preferable to the duplicitous false modesty that our society tacitly encourages. I like people who are straight-shooters and say exactly what they think instead of stumbling through life playing mind games with themselves and others. I don't understand people who lambaste Donald Trump and Donny Deutsch (host of CNBC's The Big Idea Show) for being arrogant. They have high opinions of themselves but that pride is warranted and based on their achievements, not fantasy. Thus, their apparent arrogance is nothing but an acknowledgement of reality.

While discussing the subject of braggarts on The Big Idea Show, Mr. Trump said, "You have to have the goods." Well, he does. I think his apparent bluster annoys people who secretly wish they had accomplished much more. Rather than blaming themselves for wasting their lives watching sports and frittering their time away in other unproductive ways, they assail the poster boys of success, such as Trump and Deutsch. Speaking as a doctor, this is a pathological misdirection of anger.

Incidentally, anger and other emotions exist to modify behavior in adaptive ways that foster our success and survival. Whether it is pride telling me that I did a good job or disgust telling me that I did not, I listen to my emotions. If you want to be very successful, you should do the same. Years after medical school, alarmed by how I'd wasted much of my potential, I rekindled it using an outside-the-box motivational method that worked wonders and sent my creativity and productivity into overdrive.

In conclusion, I should mention that success is often achieved because of prior adversity, not in spite of it. People who've led cushy lives often never learn to dig deep into themselves and find latent strengths. Quoting from the cover of Scientific American MIND (March/April 2014): “CREATIVITY UPDATE: Embrace Your Inner Eccentric and How Hardship Actually Helps.”

Anyone who reads this and this and concludes I am arrogant has an obvious supratentorial defect.

The article Early traumas and young people's reactions to terror said people are “at increased risk [of post-traumatic stress reactions] if they have experienced violence or sexual abuse in early life.” Being shot, cut, threatened, beat up, and called names like “nigger nose” and “nigger lips” bothered me less than being feet away from my Mom when she was repeatedly beat up (to the point of bone fractures) when I—then in mid-elementary school—was too young to defend her. I was also emotionally scarred by seeing her repeatedly cry about bills she couldn't pay at that time, which was years before my first job in 7th grade. But we succeeded in spite of those and myriad other stresses, and she rose out of poverty, achieving a peak net worth of $1.5 million (adjusted for inflation in 2013 dollars) in spite of having a high-school education and misogynistic bosses who felt entitled to pay her less because she was a woman; her best-paying job was as a grocery store clerk. So, Mr. EMT seeking an ER Tech position, I am not sure what makes you feel entitled to write to people you don't know and criticize them when you don't know 1% of what they've gone through. Remember the quote, “Be kind; everyone you meet is fighting a hard battle.”

Research shows that people feel best about themselves when their self-esteem is proportionate to the basis for it, not being too high or too low. See Too Much Undeserved Self-Praise Can Lead to Depression based on Emotional costs of inaccurate self-assessments: Both self-effacement and self-enhancement can lead to dejection. Perhaps that's why the Millennial generation (Generation Y) is so troubled: Narcissistic, broke, and 7 other ways to describe the Millennial generation. Also see The Feel-Good Curriculum: The Dumbing Down Of America's Kids In The Name Of Self-esteem.

More research: Cheerful Women Are Not Associated With Leadership Qualities, but Proud Ones Are, Study Finds.

Article: How Your Big Ego Can Actually Help Your Coworkers: “Egos are necessary and, believe it or not, they don't have to be obnoxious and productivity-killing. They can actually make you, and everyone around you, better.” In my blog (this isn't it), I presented a true case illustrating how my self-confidence/ego saved at least one life and likely countless more in the future.

A Big Ego Is Crucial For Success

Article by Dr. Craig Malkin: Why a Little Narcissism Can Be Healthy
Excerpt: “Healthy narcissism—feeling a little special—helps us to see ourselves and those we love through slightly rose-colored glasses, remain resilient when we fail, feel passionate about what we love, and pursue our dreams even when they seem a bit beyond our reach.”

Article: Bragging Rights: Study Shows That Interventions Help Women's Reluctance to Discuss Accomplishments

Article by Lisa Seacat DeLuca: My Innovation Journey, So Far (she has reason to brag; why shouldn't she?)

Article: When Being Called 'Incredibly Good' Is Bad for Children.

Article: Kid swagger: How children react to winning and losing
Excerpt: “Children start to recognize 'achievement pride' at age 4 and 5.”

Self-affirmations may calm jitters, boost performance

Article by Jessica Peyton Roberts: It's Not Bragging if It's True: Asserting Yourself When Writing Resumes and Cover Letters

“Never underestimate a man who overestimates himself.”
Franklin D. Roosevelt

“Forget everything Mom told you about being humble and succeeding with modesty: the job usually goes to the one who brags loudest, says a new study by the University of British Columbia. When faced with two applicants with equal experience and qualifications, the interviewer will usually pick the more narcissistic of the two, found UBC psychology professor Del Paulhus.” (source)

Comment: I figured that out long ago. My lack of self-confidence was pathological and painful; it took decades of accomplishments to erase some of those overly negative self-assessments and replace them with realistic ones. My girlfriend is a nurse and psychologist who detests arrogant doctors. If I were one, she wouldn't date me, nor would she try to boost my self-esteem and tell me that I'm much too hard on myself. And I am; I am my own worst critic.

“Public opinion is a weak tyrant compared with our own private opinion. What a man thinks of himself, that it is which determines, or rather indicates, his fate.”
— Henry David Thoreau in Walden

It is very advantageous to think I am never good enough because that keeps me working overtime and incentivized me to achieve things I otherwise likely wouldn't have done. Thus while social rejection can fuel motivation, personal rejection can, too. I've solved some of mankind's most pressing problems; now all I need is investors to turn my prototyped and proven ideas into products that will have people calling me the next Steve Jobs, but what I'll do for you will dwarf the benefits of iPods, iPads, and iPhones. Consequently, I learned to love my lack of self-confidence because it helped me do much more to help others. When you find out what inventions I have up my sleeve, you will be thrilled with what they can do for you, with benefits that now seem like a pipe dream.

Therefore, it is best when people internally lack self-confidence so they always work hard but externally appear brimming with narcissistic ego. Appearing on Fox News (7-10-2014), Drexel University psychologist Dr. Charles Williams corroborated this by pointing to evidence that narcissistic people are more likely to become CEOs and earn more than more humble CEOs.

Despite what people say about how they hate narcissists, they gravitate to them, throw money at them, and vote for them. People who are naturally humble, such as myself, can feign some of the manifestations of narcissism to reap some of its rewards. I knew that decades before professors let others in on this secret. I never liked doing that, but I cannot control what others choose to reward. Since we live in The Age of Blame, we could blame the narcissists and ones feigning it, but it makes more sense to blame the sheeple who set the rules and create the incentives for narcissistic behavior. If the incentives vanished, the dreaded behavior would, too.

… it quickly becomes clear that tech arrogance is partly a front to win partners, investors, and recruits.

Excerpt from Career Chutzpah: Why We Don't Ask for What We Need in the Workplace by Industrial & Organizational Psychologist Dr. Marla Gottschalk: “In today's fast paced workplace, playing the ‘shrinking violet’ is likely a losing strategy. We need to get over that.”

The single most important trait: arrogance—great for entrepreneurship!
Shark Tank star Barbara Corcoran

“Whether you think that you can, or that you can't, you are usually right.”
Henry Ford

“… it's real money at stake, it's big egos at stake …”
Shark Tank star Daymond John discussing the Sharks
Comment: Note the popularity of the Sharks—people LOVE them—even though they're all brimming with ego. Also note that the one least flamboyant in that regard (Kevin Harrington) is long gone.

“It helps to have an ego …”
— Justine Musk in How can I be as great as Bill Gates, Steve Jobs, Elon Musk, Richard Branson?

Super-you: How to harness your inner braggart

No discussion of self-esteem and bragging is complete without mentioning Muhammad Ali, who repeatedly and boldly proclaimed, “I am the greatest!” and “I'm the king of the world!” During his memorial ceremony, a friend (John Ramsey) recounted telling him, “Muhammad, you're the greatest.” Muhammad responded, “Tell me something I don't already know.” Ali was one of the most admired and universally loved people to ever live.

“The moment you doubt whether you can fly, you cease forever to be able to do it.”
— J. M. Barrie, author of Peter Pan, in The Little White Bird

“Men who are more ‘of themselves,’ more out there and conquering—this has been a mating advantage, so to suggest to men, ‘Hey, take a step back, don't puff out your chest so much’—well, you may not get dates and you might not get the promotion and your family might go hungry.”
Psychiatrist Dr. Keith Ablow discussing research on narcissism (3-6-2015)

“Self-esteem is the switch in the circuit of your life that dims or [brightens] your future. Bring it low and you don’t shine your light; raise it up and you brighten the corner where you are.”
Israelmore Ayivor

“The worst enemy to creativity is self-doubt.”
Sylvia Plath in The Unabridged Journals of Sylvia Plath

“Fear defeats more people than any other one thing in the world.”
Ralph Waldo Emerson

“If a man thinks he is not conceited, he is very conceited indeed.”
C.S. Lewis

“False humility is quite like the worst of both worlds: both that of Meekness and that of Conceit.”
Criss Jami

Are You Over-Confident? Take This Test... That reminds me of the Lake Wobegon effect, named after Garrison Keillor's fictional town where “all the children are above average.” In real life, almost everyone thinks they're above average. As LinkedIn influencer Don Peppers wrote, “the only group of people known to exhibit highly accurate self-assessments, with realistic memories of their achievements, are the clinically depressed!”

Another LinkedIn influencer, venture capitalist Yoshito Hori, wrote that Asian investors “prefer speakers who deliver their presentations in a quieter, humbler manner” while Western investors “prefer their speakers to be aggressive, physically dynamic and somewhat self-promoting [with] a show of energy.” He added, “the high-energy style that works well in the West can come across as disagreeably boastful and egoistic in Asia.”

Forget Modesty, Narcissists Best Suited for Job Interview Success

Bragging as a strategy: What boasting buys, and costs, a candidate

“Early in life I had to choose between honest arrogance and hypocritical humility. I chose the former and have seen no reason to change.”
Frank Lloyd Wright

“False modesty can be worse than arrogance.”
David Mitchell

“You need to have tremendous confidence in your work, even a touch of arrogance, chutzpah. Many very fine researchers lack intellectual daring. It's human nature to want to be cozy, secure. But that can be a cul-de-sac.”
Neuroscientist Vilayanur S. Ramachandran

Why Are People Overconfident So Often? It's All About Social Status
Excerpt: “People who believed they were better than others, even when they weren't, were given a higher place in the social ladder. … falsely believing one is better than others has profound social benefits for the individual. … these findings suggest one reason why in organizational settings, incompetent people are so often promoted over their more competent peers. [People] did not think of their high status peers as overconfident, but simply that they were terrific. … overconfident individuals were more convincing in their displays of ability than individuals who were actually highly competent. … Prof. Anderson hopes this research will give people the incentive to look for more objective indices of ability and merit in others, instead of overvaluing unsubstantiated confidence.”
Comment: I hope the same thing. The downfall of the United States is partly attributable to how too many of us are duped by overconfident, narcissistic leaders.

Vanity is Good: A Hierarchy of Social Drivers

A bit of disgust can change how confident you feel

Stress in adolescence prepares rats for future challenges
Comment: Obvious parallels to humans. To stymie someone's potential, coddle them. The children of wealthy parents are likely to have a slew of advantages (such as good educations) that should give them a head start to success, but try naming rich children who did anything great.

Why the best hire might not have the perfect resume
Relevant quotes:
“Usually the wacky people have the breakthroughs. The 'smart' people don't.”
— Burt Rutan, innovative aerospace engineer
“Smart people are a dime a dozen. What matters is the ability to think different … to think out of the box.”
— Walter Isaacson, biographer of Steve Jobs

The following song, A Daisy A Day, reminds me of the love that one of my relatives, President Chester Arthur, had for his wife Ellen. Note how Jud Strunk said he was proud that he wrote it. Is there anything wrong with saying that? Absolutely not! It is a beautiful song; he should be justifiably very proud of it.



Strunk died at age 45 when he suffered a heart attack while taking off in his airplane, which crashed.

“Humility, I have learned, must never be confused with meekness. Humility is being open to the ideas of others.”
Simon Sinek

“There is overwhelming evidence that the higher the level of self-esteem, the more likely one will be to treat others with respect, kindness, and generosity.”
Nathaniel Branden

“As a surgeon you have to have a controlled arrogance. If it's uncontrolled, you kill people, but you have to be pretty arrogant to saw through a person's chest, take out their heart and believe you can fix it.”
Mehmet Oz
Comment: As I've written elsewhere, the least arrogant doctors were the most dangerous to patients. Arrogant doctors continually have something to prove to themselves and others; one mistake can shatter their self-conception, so they burn the midnight oil and go the extra mile to ensure every patient receives the best possible care. Less arrogant docs have less to prove, so they don't try as hard. When a physician doesn't think much of himself, another bad result or premature grave is no big deal. Trust me, you want an arrogant doctor.

“I'm Billy the Kid, the fastest draw. It's not arrogance. It's the truth.”
David Geffen

“I would just say that nobody could do what I do unless you had a big ego. It's the only way you can really put it. You have to be arrogant enough to challenge the arrogance of the human race.”
Paul Watson

Research: Finding what's right with children who grow up in high-stress environments: Researchers say children's unique traits could be used to tailor education, jobs and more effective interventions


The “we're one of the top hospitals” scam

Q:  In an advertisement in the newspaper, our local hospital proclaimed it was voted "one of the top 100 hospitals in the country."  Frankly, this is hard to believe.  Given that there are 50 states, that leaves an average of two hospitals per state that won this award.  That hospital is just a hole-in-the-wall, and we have several university hospitals that are considerably better.  So how did they win this award?

A:  I have a one-word explanation:  payola.  Every hospital I've worked in claimed it won similar awards and was, for example, one of the top 100 cardiology hospitals in the country.  I wondered how that was possible, given that we didn't even have a cardiology department!  Our cardiology patients were cared for by two Internal Medicine docs who anointed themselves the local cardiology specialists, and a ragtag group of ER docs, including yours truly.  How such a make-do assemblage could constitute one of the top cardiology hospitals is beyond me.  One night I worked with the usual complement of ER staff, which was a grand total of one nurse . . . but this nurse was one of the top 100 nurses in the country, no doubt.  Anyway, to complete my illustration of just what a farce it was to proclaim us one of the top 100 cardiology hospitals in the country, this nurse and I were besieged by three patients in cardiac arrest, all of whom were dumped on our doorstep at the same time.  If you've spent much time watching medical shows on television, you know that it takes more than two people to optimally code even one patient.  But three at once?  We quickly made the rounds as we went from patient to patient, with me trying to figure out which person was least dead.  We focused on that one, saved his life, and bid the others farewell after we thanked them for visiting one of the top 100 cardiology hospitals in the country.

I'm not privy to the machinations behind these scams, but I bet that the quid pro quo goes something like this:  a hospital pays a fee to participate in a survey.  Any hospital that pays the fee is voted one of the top hospitals.  The hospital brass, astute graduates of the Machiavellian School of Business, figure that the bucks spent on the payoff will be recouped by additional revenues as more sheep flock to the Misleading Mecca of Medicine.

UPDATE: After a local Top 100 hospital killed one of my friends and committed a long string of other errors, I was so skeptical of their Top 100 designation that I spent months investigating the hospital award racket, which I concluded was a clever scam in which awards can be purchased—indirectly, of course, for obvious reasons. Hospital big shots love these awards because they use them to justify their bloated salaries. Even though the hospital is so financially strapped that some nurses are losing the equivalent of a day's pay per week, the CEO is paid over a million dollars per year with yearly increases way above the rate of inflation. The rich get richer . . . .

Article: Hospital rankings may rely on faulty data


● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ●

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)

● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ●


Best strategy for dealing with initially poor college grades
My opinion on prestigious schools
The importance of possessing a diverse knowledge base
Will you be my mentor?


Q:  I have a few questions for you and maybe you could help me if you have the time. I'm currently a junior in college who is trying to get into medical school. I used to party too much my freshman year and a little bit of last year, but haven't done so in about a year. I currently have a 2.3, and I know I wouldn't be able to do anything with that GPA. But until recently, I've been studying my butt off and raising my grades. Here's my first question for you:  Do medical schools look down upon students who retake a class and get an A in it the second time around?


A:  Yes. It's certainly better than NOT taking it, and leaving the original low grade as your only mark in that class. However, it will never totally redeem or erase the first poor score. Here's why. Given the pace in medical school, Admissions Committees need to select people with a good chance of mastering material the first time. You may very well possess that ability, given that your earlier efforts were not your best efforts, but how could an Admissions Committee know that or compensate for that? They don't know if your original grade was attributable entirely to bad study habits (now amended) or difficulty and slowness in learning. Hence, they'd quite likely prefer an applicant who obtained a 3.5 on his first attempt in a class instead of someone who obtained a 4.0 on his second attempt. I can sympathize with where you're at, because I had the same problem in early high school as you do in college. As a high school freshman and sophomore, I was concerned with riding my motorcycle and lifting weights so I could one day become a world champion wrist wrestler. Studying didn't fit very prominently into my priorities.

Q:  Once I graduate, I've been thinking about going to get my master's in some type of biology course to better my chances of getting into medical school and help me with the MCAT. Would this be wise to do?

A:  If you're a junior with a 2.3 GPA, you don't need me to tell you that you don't stand a snowball's chance in hell of being accepted into medical school — at least not now, given that students traditionally apply in their third year. You could pursue your above strategy of completing your baccalaureate, but even if you do very well in the remaining year and a half, it's going to be tough for medical schools to choose you over someone who did well from the beginning. If you obtain all 4.0's from now on, you won't be able to raise your GPA high enough to give you a reasonable chance of acceptance. You could pursue a master's degree and, if your grades are exceptional, have a reasonable chance of getting into medical school. That's not a bad idea, since even if you don't get in med school, at least you'll have a more saleable degree. However, there is another master plan that I call the "Lucas strategy," in honor of a friend of my brother. Dr. Lucas is now a cardiologist, but in early college he was a lackluster student. Rather than trying to explain away his early abysmal grades, he took the classes over again at a new college, never telling his second college about the first one. I assume it was easier to pull off this scam in those zany days of yesteryear when schools were less diligent about identifying you, but sans a retinal scan, you're home free if you don't mind taking mundane steps to change your identity. With a clean slate, you can retake the classes, probably ace them, and quite likely get into medical school. It may seem wasteful to dump 2½ years of college down the drain, but what's the alternative? You can complete your bachelor's degree and probably not get into medical school. You can get a master's degree and maybe get into medical school. Even if the latter strategy succeeds, it would likely take another 3½ years or so. In about the same time, you could repeat college. You're probably more likely to get in med school if you hide your current record and ace your second college attempt than you are to apply with a master's degree and need to explain away years of poor grades. However, it comes down to what is more important to you:  maximizing your chance of getting into med school, or accepting a somewhat lesser chance in return for getting a more saleable master's degree. I can't make that choice for you. Doc Lucas thought the former strategy, although risky, was better for him. Medical schools reject plenty of people with master's degrees and a so-so undergraduate GPA, but they reject very few applicants with stellar undergraduate grades.

Q:  Another route I thought about is going to John Hopkins Pre-Medical program (which is another B.S. degree).  Would this be smart to do before applying to medical school?

A:  I don't know enough about that program to give you a good answer, but in general I am not enamored with the supposed benefits of prestigious schools. I know Harvard grads who can't write without making multiple spelling and grammar errors every paragraph, and some of them are such dingbats I wouldn't trust them with a screwdriver, let alone a scalpel. If you don't believe me, read my review on my web site of White Coat: Becoming a Doctor at Harvard Medical School by Ellen Lerner Rothman, MD, then ask yourself if you'd fully trust her. Docs don't need to know just medical things; to be fully proficient, they must also have a diverse knowledge base. Yes, I know that the supposedly top-tier schools bend over backwards to accept a diverse class, but that's not the type of diversity I'm discussing. Ivory Towers think there is value in diversity based on melanocyte activity and if you spent a year living with a tribe in Mozambique, but I fail to see how such diversity benefits your patients. The type of diversity that benefits doctors and their patients is a broad base of knowledge of everything from baking to welding to soldering to building homes to etching glass to making stained glass to unusual sexual practices. Why? Because you'll have patients with problems traceable to those activities. If those activities are Greek to you, how can you fully understand the etiology of your patient's condition? You can't. You probably have no idea of just how narrow the knowledge base is for some docs. I know one doctor (and I'm sure he's not the only one) who had no idea what a 2 x 4 (pronounced "two by four") is. How can anyone NOT know that? Even after I explained to him that it's a common board used in wall studs and other building applications, gave its nominal and actual dimensions, and explained its composition, he still had no idea what it was. Think that's hard to believe? Then how about a Harvard grad who evidently doesn't know what Styrofoam is? Read my review of White Coat, and look at the tongue-in-cheek graphic I developed that expressed my exasperation of how Harvard can graduate people whose general competence is incomprehensibly pathetic. My point is this:  doctors interface with real people who lead real lives filled with real activities. If those activities are a mystery to a doctor, he cannot optimally care for his patients. Docs certainly can't know everything about everything, but is it too much to expect a doc to know what Styrofoam or a 2 x 4 is? Most elementary school children know that! If a doctor is clueless about Styrofoam, it's a good bet that the doc will be equally uninformed about welding and countless other common activities. Unfortunately, medical schools do not test for such a diverse knowledge base, much to the detriment of the patients cared for by its graduates. Instead, they give an edge to applicants whose diversity does more for notions of political correctness than it does for real patients and their real problems.

Here is my opinion on this matter of knowledge diversity:  if a person fully deserves to be called a doctor, he should know far more than just the basics. Frankly, I expect a kindergarten student to know what Styrofoam is, so if a doc knows that, I'm not about to give him a gold star. As an example of what I think "doctor-level" knowledge is, let's return to the case of Styrofoam. Apart from merely identifying it, I think docs should know about its polymerization process, and in particular how this polymerization is not 100% complete — and why this is important. I also think docs should possess some knowledge of common polystyrene additives. This stuff is not valueless trivia. I discuss it in my sex book (The Science of Sex: Enhancing Sexual Pleasure, Performance, Attraction, and Desire) because those chemicals can have adverse hormonal effects. So is it pointless for a doc to know about them? Obviously not. I saw many patients with sexual problems even in the ER, and private practitioners see such problems with greater frequency. Besides polystyrene, docs should possess at least rudimentary knowledge of other plastics and their additives. Some are toxic, and some will cause men to grow breasts. If a doctor sees a man with the latter problem, he'll come up with an inappropriate solution, such as telling the man to lose weight, or learn to live with it and accept it as a consequence of aging, or refer him to a plastic surgeon. If the doc understood the true etiology, he'd know what treatment is best . . . and it's none of those. I could give thousands of other examples to illustrate how a diverse knowledge base benefits patients, and why the type of diversity now being championed does far less to improve patient care. However, we live in a culture that glorifies the value of superficial diversity and gives short shrift to the value of true diversity.

I think that medical students should take a mandatory class that would help fill in their knowledge gaps on basic subjects, the awareness of which will likely affect patient care. If I taught such a class, I'd give a brief presentation on a few hundred subjects with clinical relevance, such as a five-minute talk on "What you need to know about welding" and an hour lecture on how you can help your patients build a healthier home or cope with problems in their current one that contributes to health problems. Yes, there are books on those subjects, but the onus of knowledge is on the doctor, not the patient (isn't that why the doc is being paid — for his superior knowledge? What brains does it take to tell a patient to go read a book?) Furthermore, I've read about this subject, and I've yet to find an author who divulged some of the tips I know. I wouldn't try to teach students how to weld or build a home, because there is no need for that and time is far too limited. However, there are some very specific things every doc should know. To truly master medicine, a doctor must know much more than just medicine.

Q:  I'm currently the VP of Biology/Medical Careers club, and found your website very informative. I talked to the head biology professor at my college (my advisor), and he's interested in informing students about ER medicine. Lots of students do not understand a whole lot about it, so he would like them to hear it from a pro. Would it be ok for us to print out some of the questions in your FAQ, quote you and hand them out to students?

A:  That's fine, if the quote is unaltered, attributed to me, not for profit, and my web site URL (www.ERbook.net) is listed.

Q:  Also, I'm looking for a mentor, and I must say that I look up to you a whole bunch. Would it be possible for you to mentor me?

A:  I do my best to answer as many questions as possible. Since I receive more questions than I can feasibly answer, I usually restrict my replies to subjects that will be most beneficial to others.  I am a very slow and inept typist, which (along with dozens of other activities that consume my time) limits my productivity.


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

Book info  Ordering info

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 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 "Lucas strategy":  is it cheating?

Q:  I am troubled by the "Lucas strategy" you recommended to someone with a poor undergraduate GPA who wished to become a doctor.  Are you espousing cheating?

A:  No, I'm espousing a second chance.  Even murderers are sometimes given redemption, aren't they?  So why shouldn't someone whose only crime is partying too much in college be given another shot at fulfilling his dreams?  Should a couple of wanton years haunt him forever?

Keep in mind that anyone who follows the Lucas strategy is automatically penalized, both financially and in terms of time.  Hence, this built-in punishment ensures that their second chance is no free lunch.  They'll be chastened, trust me.


Still more ER questions Part 2

Still more ER questions Part 3

Organize your garage beautifully.

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

 

Copyright © 1995 – 2011 by Kevin Pezzi, MD • Terms of use