For more Q & A, see my
Test your knowledge of ER terms by solving my ER crossword puzzle that was featured in the Prudential Securities Healthcare Group 2002 calendar. Or take the ER-MCAT to see if you have what it takes to be an ER physician.
Amy reviews ER computer games
Do you care if wild animals needlessly suffer and die during wintertime? If so, see www.shelteranimals.org.
As for whether or not another undergraduate major would be a better choice for you, I can't say without knowing more about you. If you love engineering, as I do, a degree in that might be a better choice.
How can a student with borderline qualifications increase her chance of acceptance into medical school?
Q: Your website is the best. :-) I have a friend who got her degree in biology, but was not accepted to med school so she went to nursing school instead. She plans on applying to med school again next year. If I am not accepted right away, what should I do to strengthen my credentials? One person told me to go to the Peace Corps or a post-baccalaureate program; should I? Sincerely, Sara
A: Your friend made a wise choice, for reasons that I enumerated above. In regard to your situation, I answered similar questions elsewhere, (including here in regard to activities like the Peace Corps, and in several other topics in regard to post-baccalaureate programs). Joining the Peace Corps would be a plus, but a minor one. Compared to other options that you could choose, it is less effective, more arduous, and certainly more dangerous in this post-9/11 world in which misguided religious zealots think that becoming a suicide bomber is all that it takes to spend eternity with 72 beautiful virgins in heaven. Even apolitical, non-American human aid workers are now fair game in their eyes. So should you risk your life for something that likely won't make a tangible difference in your career? I don't think so.
For a moment, put yourself in the shoes of a medical school admissions committee member. You have an applicant with Peace Corps experience. What does that tell you about the applicant? It speaks well of the applicant's desire to serve others, but says nothing about their brainpower. Becoming a doctor is so intellectually demanding that medical schools must emphasize the importance of good grades and MCAT scores. They can't risk filling their seats with students who might stumble academically, even if those applicants are as dedicated as Mother Theresa.
The key to getting into medical school is to impress the admissions committee with your intelligence. Most students do this with grades and MCAT scores. Weaker applicants often seek to impress the admissions committee with activities that suggest, "I'm a good person. I'm willing to help others." Think about this. Is it really the best strategy? If they have doubts about your brainpower, the way to impress the committee is to convince them that you are smarter than they think you are. Some ways to do that are time-consuming and difficult (e.g., getting a master's degree or Ph.D.), and some are not. For example, you could invent and make a medical device, as I discussed here, here, and here. That could take anywhere from a few days (if you did it with me) to a few months if you started from scratch and did it all on your own, but that is cheaper and quicker than obtaining a post-baccalaureate degree, and possibly more effective. Unless you excel in a post-baccalaureate program, the admissions committee will probably just yawn and go on to the next file in their mountainous stack of applications; they see applicants with post-baccalaureate degrees all the time. You need to stand out from the crowd, and make them say, "Wow!" If you can do that, you can begin shopping for a white coat, a stethoscope, and other MD accouterments. If you invent and make a new medical device, you are bound to impress the admissions committee.
Besides brainpower, one of the essential attributes that doctors must possess is dedication and the willingness to work hard. Inventing and making a medical device is far easier than you probably imagine, but it does require more work than some people are willing to expend but those people will never become doctors.
Emergency departments: where the wild,
wild west lives on
Q: I want to become an ER doctor. From what I've read, working in the ER can be a wild experience. Just how out of control can things get, anyway? Tim
A: Probably more than you could ever imagine. It was certainly more than I ever imagined! To obtain some idea of what you will eventually encounter, turn on the Fox network's Cops series, then try to envision how unruly ruffians can be when the police are no longer around. Most hospitals employ security guards, but when facing an enraged musclebound 300-pound patient, security guards often devise some clever strategies for shirking their responsibility. For example, I've had security guards tell me, "You're the doctor. You go get him." There were times when I feared for my life, and I've seen tough, experienced nurses frightened out of their wits. ER personnel are sometimes murdered at work. I once worked in an ER in a pleasant, upscale tourist town. If you saw this place, you might think that it was Shangri-la . . . until you saw the bullet holes in the glass door.
Some ER doctors tuck a pistol under their waistband. I never did, but there are ER personnel who might still be alive if they had a handgun for self-defense. I think that all ER workers should have immediate access to a Taser, especially if no security guards are present.
Do ER docs always work at a breakneck pace?
Q: I read your 15 minutes in the life of an ER doctor essay, and I'm frightened, considering the fact that emergency medicine is my career aspiration. Are things always that bad? Sharon
A: Of course not. There were also times in which a beautiful young woman gave me a long hug, and later thrust a note into my hand saying that she was grateful for what I did and that she would do anything for me, followed by her phone number. "Anything" was underlined twice. The message was unmistakable. This is getting off track, but some of you are likely wondering if I took her up on her offer, so I'll spill the beans before I continue. No, I never called her, but I was very tempted. I think it is important for doctors to always do the right thing and avoid situations in which someone might misconstrue their motivations. In this case, the young lady (I'll call her Megan) was in the ER to visit a terminally ill relative who had only months to live. I pulled her through this episode, but the grandmother's chronic lung disease and continued smoking indicated that the writing was on the wall. When I confirmed Megan's suspicions that recovery was hopeless, she began hugging me. At first, I thought she just wanted consolation, but the hug turned into something much longer than I'd imagined. From the way that she kept pulling me in, she obviously did not want to let go. Neither did I, but I wasn't being paid to hug nubile women. Megan left the ER and returned an hour later, bearing the note, but less clothing. She now had on a tight, skimpy dress that revealed an exquisitely attractive body, and her eyeglasses were gone, exposing even more of her gorgeous face. I'd never before had a patient's relative go home and change just to impress me. Believe me, I was impressed. Inside, I was almost apoplectic. I hadn't had a girlfriend in years, and here was a stunning woman practically throwing herself at me. Had I accepted her offer, I'm sure my next weekend off would have been much more exciting.
My hesitancy to pursue Megan The Magnificent stemmed from a concern that someone might misconstrue my motivation for hugging her. While my intentions were purely professional (I've hugged more than my share of women at work who are not attractive), I did not want to create a situation in which someone might think that hugging a beautiful young woman was just a calculated step to move in on the relative of a patient. I've become friends with patients before, but only when I thought there wasn't the slightest hint of impropriety. Considering the fact that my standards are much more restrictive than even some Presidents, I sometimes wonder if I am being too circumspect. Perhaps that is why I am still single.
With this as a preface, it is clear that every minute in the ER is not torturous. However, the chaos depicted in my "15 minutes in the ER" essay occurred too often in my career. It isn't just me who doesn't like to be rushed so much. I somehow survived at that hospital for 5½ years before I quit, but we recruited ER docs from other trauma centers who were so exasperated by the pace that they quit after anywhere from one day to one week. That might explain why I could get a $20 per hour raise just by telling my boss that I was pissed and thinking of quitting.
In retrospect, that was a dumb career move. My tolerance for working in an ER likely would have been longer had I accepted less pay at a hospital with a more humane pace or, better yet, just worked in an Urgent Care center.
* Oh, in case you're wondering about my longest hug: I'll tell that story another day. Right now, I'm really missing the ER. I'm not kidding. Sure, emergency departments can be real hellholes, but they are also places in which you can experience life at maximum intensity.
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
Q: I don't think I can adequately express how much I enjoy your writings. You have so many interesting stories to tell, and lots of advice for students with an eye on a medical career. That is why I am writing today: to ask for another tip on memory (I read your other ones). Is there anything you haven't yet covered? Jeff
A: Oh, yes! I have plenty of pending topics, but just 24 hours in a day to write and perform other jobs.
Here is a tip that may seem incredibly basic, yet it is something that most
students don't do. Research (and experience) has shown that memorization
is solidified if people review new information soon after they are first exposed
to it. Some evidence suggests this review should occur within 24 hours,
but I think that time varies from person to person. In medical school, my
routine was to not review anything until the weekend, at which time I did a
comprehensive review of everything covered the preceding week.
● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ●
You will have sex about 10,000 times during your life.
Doesn't it make sense to read a book that can maximize your enjoyment, and the enjoyment you give to your partner?
Cast away your preconceptions of sex books as being a rehash of things you already know and hence a waste of time. By reading this book, you will learn many things that Dr. Ruth and other sexologists have never considered.
The Science of Sex
by Kevin Pezzi, MD
Available in printed and Adobe Acrobat e-book versions (will display on any computer)
● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ●
Are the expectations of patients realistic?
Q: I am writing an article on how patients view their ER experiences, and I have a question for you. Do you think that the expectations of patients are realistic? Thank you, Linda
A: Sometimes yes, and sometimes no. As an example of the latter, it never ceased to amaze me when patients and their families would complain about the evaluation "taking so long" when we could perform countless lab tests, x-rays, EKGs, CT or MRI scans, ultrasounds, and sometimes even nuclear medicine tests and consultations by various specialists all within a few hours! To stop their whining, I'd sometimes explain that if they had the same workup performed as an outpatient, they'd spend far more time over the next few weeks making appointments, driving to and from the test sites and doctors' offices, and waiting their turn at each facility. It's a miracle that we can compress so much medical care into such a short time, especially considering the fact that we're often juggling a couple dozen patients at any one time. However, not one patient ever expressed gratitude or even understanding of this. Instead, all I heard was bellyaching.
Are all drug reps gorgeous?
Q: I just read your discussion of beautiful drug reps. As a male who hopes to become a doctor one day, I must admit that I find this topic intriguing. Are all drug reps gorgeous? Charlie
A: No. There are only so many supermodel clones available who are smart (pharmaceutical companies do not hire dumbbells) and in need of a job. However, a disproportionate number of female drug reps are indeed stunningly attractive. Of the remaining, most are either very attractive or attractive. A few are Plain Janes, but they're usually relegated to the backwater. This banishment from the upscale metropolitan areas is necessarily subtle, so as to avoid meddling by nasty governmental bureaucrats and lawyers who'd relish the chance to make millions from suing for discrimination. Years ago, I had a friend who was a Plain Jane drug rep, and she gave me a verbatim account of how her boss kept her exiled in the less lucrative areas of the state.
I'm on this subject, I should point out that drug companies aren't the only ones
who use pulchritude as one of their main hiring criteria. I once worked in
a hospital in which a significant proportion of the female employees were
drop-dead gorgeous. I'm not talking about everyday attractiveness, I'm
talking about women so ravishing that they were more beautiful than most
Hollywood actresses. Judging from the rarity of finding captivating women
in the surrounding areas, it was obvious to me that whoever did the hiring at
that hospital went out of his way to find arresting women.
Interested in an OB/GYN career? Better think
Hello. I'm a senior in high school, and I would like some information on
being an OB/GYN, and what's required. You will help me in my future career
goal by answering. Thank you! Ana
believe that people who've been falsely accused should not just slink away once
the ordeal is over. That makes it too easy on the mudslingers.
Attorneys have made careers out of being irresponsibly on the offensive, knowing
that they can usually get away with slander because their victims are too meek
to do anything except defend themselves. If someone faces an unjust
allegation, what is called for is not just a defense, but also a punitive
offense. Bullies aren't dissuaded from pummeling people who put up their
arms to shield them from blows; they're dissuaded when someone turns the tables
on them and punches them in the nose. Figuratively speaking, many
attorneys need a good punch in the nose, and Dr. Clark decided to do just that
by writing a book to expose how some attorneys in Michigan will sue without
cause if they think they can extort money. Attorneys have learned that
such extortion is more profitable than robbing banks, and it carries a veneer of
legality so those thugs can continue to ride roughshod over justice without many
repercussions. However, as I've said before, I think the heyday of getting
away with such extortion will end in the not-too-distant future. Some
doctors are suing attorneys for legal malpractice (I tried that, but my attorney
dissuaded me by saying that it is almost impossible to successfully sue for
this), and others are writing books as I and Dr. Clark have done. Sooner
or later, I predict that a doc won't stop with such measured responses.
He'll knock on the attorney's door, and go postal on him. The legal system
could avoid this crude Smith & Wesson way of getting even by providing us with
justice in the courtroom: if we're falsely accused, let us have a fair
shot at suing the careless and unprincipled attorneys. However, the legal
system is one in which legislators (primarily attorneys) write laws that make it
easy for their brethren to plunder at will with virtually no fear of
retaliation. Those laws are interpreted by judges who are also attorneys.
Do you now realize how one-sided this system is?
When I was in medical school, I recall listening in utter amazement to classmates describe how they decided to specialize in something that was lucrative, such as ophthalmology, only because it was lucrative. I thought (and still think) that this is a dumb reason to do anything. I just wanted to do something that was tolerable, helpful to others, and provided me with enough money so that I could buy a tractor, a snowmobile, and lots of parts to make various gizmos. Considering that I was willing to spend my life saving lives and helping untold numbers of people while making sacrifices such as giving up holidays and time with my family, I don't think that I was asking too much in return. I treated many patients for free not because I was a dreamy idealist but because it was the right thing to do and how I'd want to be treated if I were in their shoes (the Golden Rule). Thus, I entered medicine with a reasonable idea of what constituted a fair exchange between myself and society. I was smart, responsible, exceptionally diligent, and willing to sacrifice some of the best years of my life so I could spend 110 hours per week training to become a doctor. I'm certainly not perfect, but society would have to look long and hard before it would find a better candidate to become a dedicated doctor. Perhaps that is why I graduated in the top 1% of my class in medical school, and why my residency director once claimed that I was the smartest resident they'd ever had in their ER program. I am not mentioning this to brag; I am mentioning this to point out that there aren't many candidates who were more promising than me. Patients should realize that it is in their best interests not to make the practice of medicine so noxious that people like me are so disgusted by it that we walk away from our careers.
A few years ago a local businessman mentioned how he was troubled by a numb finger. He said that he'd cut his finger some time ago, and went to the local ER (the place I once worked) to have it repaired. The ER doc asked him if he could open and close his fist, and when he could, the doc just sutured his wound and reassured him that the ability to open and close his fist meant there was no internal damage. Did this doctor graduate from medical school, or just Romper Room? Anyone with an MD after his name should know that finger strength and sensation are entirely separate. Every such injury demands a thorough examination, and that includes assessing sensation. I tested this man's sensation by doing a two-point discrimination test (in which the ability to perceive skin contact from two points is tested as the distance between those points is varied), which is the same test I would have performed in the ER. Any competent ER doc would do the same thing. But not this doc, who was filling my shoes or trying to after I walked away from my medical career so society could shower its gratitude on someone else. I am not perfect, but I am smart and diligent enough not to make such an inexcusable error. I've previously documented cases in which less thorough doctors have made errors that did everything from kill patients to rob a young child of one of his eyes. So while I am far from perfect, I am thorough enough so that these tragedies could have been averted if I'd treated those patients. Consequently, I contend that society is paying a price for making some dedicated and diligent doctors say "to heck with medicine." If that happened to me (someone who was once as dedicated to medicine as a person could be), it could happen to anyone. Even you, Ana. We're all human, and we want to be treated with fairness. When we're subjected to injustices, it is natural to rethink whether it is wise to subject ourselves to possible future mistreatment. That is why Dr. Clark stopped seeing new patients, why I quit working in the ER, and why hordes of obstetricians would rather be unemployed than delivering babies. We're not cruel, and we're not blind to the patients we're neglecting. I still care about patients, and would gladly treat many for free if I did not have to risk a shakedown from an attorney. I truly enjoy helping people; to me, it is one of the most rewarding things in life. But society has turned its back on doctors and trivializes their desire for justice, so we've turned our backs on patients and said good-bye to medicine. This isn't good for doctors or patients, but it is great for attorneys. When will voters realize this?
A second opinion on the palatability of practicing medicine
A few days ago I heard radio talk show host Dr. Dean Edell discussing how most medical students in the United States are now female. Is this cause for celebration? No, explained Dr. Edell, because those women are just filling a vacuum left by men. He mentioned how most practicing physicians in the old Soviet Union were female. Why? Because it was a great job? No, because there were more desirable jobs for men. Dr. Edell then said that medicine in America is in many ways a "lousy profession." Dr. Edell was so disgusted by it that he walked away from his practice and segued into being a talk show host. Unfortunately for today's students, practicing medicine is now far more noxious than when Dr. Edell quit.
If I were married and had kids (as do most ER docs), I would still be practicing emergency medicine. That career wouldn't be any more tolerable, but like most people who are forced to do unpleasant work to support their families, I'd do it. Sans student loans and a mortgage, I suspect that far more ER docs would skedaddle. In view of this, you shouldn't look at the numbers of still-practicing ER docs and conclude that it couldn't be that bad of a job. Trust me, it is.
If you want yet another opinion, listen to what Dr. Voelker said. He read True Emergency Room Stories and then ordered a second copy of it from Amazon.com's Marketplace. I e-mailed him to ask if this was a new order, or perhaps a snafu from Amazon repeating the first order. He responded:
"Yes, it's a new order. Having been a residency-trained, board-certified ER doc for 22 years (one of the first), I wanted to keep the first one for myself, and loan out the second to various people, including one of my fighter pilots who is going to attend med school and wants to be an ER doc despite my dire warnings. Great book!!! Your writing sounds exactly like many of the "sermons" I've been giving for years. Your use of the exact same language was uncanny. I've experienced almost everything you've written about in the book in my 26 years of ER work. Thanks for putting it in writing so I can tell people to read it if they want to know what my life is like. Thanks again for the awesome book."
William Voelker, MD, MC (FS/VFC-13) USNR, FAAEM
Responding to a reader who thinks that I could have done a better job
Intro by Dr. Pezzi: I sporadically receive abusive and obviously unsolicited e-mails from a person who both idolizes me and loathes me because I can't, and won't, reciprocate any personal interest. A few days ago she sent me an e-mail in which she questioned whether she were mentally ill, then today she sent another strange missive in which she opined that I did a good job with the technical aspects of working in an ER but that I could have done a better job leading the nurses. I do not know why this person feels qualified to judge me, considering the fact that she has no medical training, is unemployed (yet receives money from her rich Hollywood parents), and spends most of her life literally holed up underground living in a fantasy world. You might wonder why I would waste my breath responding to these rants, but she pays me for the answers. So I did. I won't bother you with the others, but this one is worth reading.
A: Could I have done a better job? Certainly. If an ER doc worked just one shift in his career, armchair experts, such as yourself, could look back at his myriad actions that day and, with your amazing 20/20 hindsight, judge which were perfect and which were not. After thousands of shifts, many of which were worked while being utterly fatigued from chronic sleep deprivation such as what I endured (or tried to) for 16 years, mistakes were inevitable. I'm human, not an indefatigable robot.
Sponging off your parents and being unemployed as you are gives you the ability to do nothing, and therefore to never do anything wrong. The rest of us, who actually do things, take the risk that our human imperfections will sometimes ensure that we slip up. I am reminded of this quote from Theodore Roosevelt:
"Far better it is to dare mighty things, to win glorious triumphs even though checkered by failure, than to rank with those poor spirits who neither enjoy nor suffer much because they live in the gray twilight that knows neither victory nor defeat."
I don't think that working in the ER is grand enough to warrant the "dare mighty things" bit, but we do sometimes "win glorious triumphs" when we save lives and otherwise make a big difference in people's lives.
I will now
address your assertion about the nursing leadership. First, judging from
what you said, I think you based it on some of my stories describing contentious
interactions I had with nurses. Let me point out something that should be
utterly obvious: Turn on the news, and what do you see? Bad news.
Why? Because when things go OK, it's not news. When a gasoline
tanker truck delivers its fuel to a gas station and the driver goes home and
enjoys a meal with his family, it isn't news. But if that tanker explodes
into a fireball on a freeway, it's news. Get the picture? So when I
wrote about my interactions with nurses, I usually wrote about the newsworthy
ones. If a nurse did his or her job, is it worth writing about? "I
ordered an injection, and the nurse correctly gave it." Spellbinding!
But if a nurse gave the wrong drug or otherwise made a mistake, that is
newsworthy. When nurses made mistakes (and especially when they tried to
defend their indefensible errors!), that can be legitimately criticized, and I
did that. What you don't know is that most of the "nurse interaction"
stories to which you refer happened at one hospital in a circumscribed period of
time in which the "nurse problem" was at least partly traceable to an abominable
nurse administrator (since fired, thankfully) and her pathetic lack of
management skills and common sense. However, even at that hospital there
was a core group of good nurses (primarily consisting of older experienced
nurses) with whom I had excellent relationships. In fact, the head nurse
on my shift told me how confident he was in my leadership skills. Having
said that, he segued into a discussion of how alarmed he was by the lack of
leadership evinced by another ER physician in my group. That's a story I
will leave for another day.
That nurse was clearly marching to the tune of his own drummer, or Jack Daniel's, or some mental demons that made him do bizarre, inexplicable things. I tried to lead him, but dealing with boozing GM-rejects who needed detox and probably psychotropic medicine is just too much to ask of a doctor working in a busy ER. That nurse needed a pink slip, not leadership. In the ER, I did not have the time to deal with nurses who needed such basic remediation. However, from your unique vantage point (I'm now speaking just to the person who posed this question to me), I can appreciate why you may think that tolerance should have no limits.
In my opinion, the good nurses didn't need much leadership. They knew what they were doing, and they did it. They didn't need me to hold their hands. Legally, they just needed orders, and I gave them. Incidentally, the experienced head nurse on my shift said that I was the best diagnostician he'd ever met . . . and trust me, that nurse knows far more about my ER performance than you could ever learn from reading my stories in which I have for the most part intentionally selected the ones in which things did not go well. Some of the less experienced nurses had to get more reassurance from me and ask me more questions, which I was happy to give since that was part of my job. No one is born experienced; we're all rookies at some time. Well, those of us who actually do things. Ahem. However, some nurses needed an unreasonable amount of leadership. Besides the aforementioned boozer, there were others, such as one nurse who followed me around like a puppy and asked so many questions that I thought she either had a crush on me, or she did not know very much. According to what some nurses told me about her, she recently graduated from nursing school at the top of her class but yet had no confidence in her skills so she asked me countless questions in order that she could document "Dr. Pezzi said this . . ." and therefore absolve herself of the need to make judgments. A good ER nurse can and does make countless judgments on her own without pestering the ER doc with hundreds of questions per day. If every nurse did that, the ER would come to a standstill.