Some of my: Inventions | Magazine interviews | Sheds | Favorite ER memories

Information for people contemplating
a career in emergency medicine and
other medical specialties

By Kevin Pezzi, MD

Update 2021: Addressing the epidemic of burnout, depression, and suicide in medicine

I developed this site many years ago to help those aiming for medical careers achieve their dreams, but did not adequately emphasize that interest in medicine and aptitude for it are not sufficient reasons to pursue that goal. As documented by some of the references listed below (and countless others I could add), the medical profession is plagued by an epidemic of burnout, depression, and suicide, the best antidote for which is a stark dose of reality in which people honestly admit why they are drawn to medicine.

I know many doctors but can't think of one who would continue working if paid what average Americans make: now (2021) roughly $25 per hour. In contrast, I would have a difficult time listing all doctors I know who hate medicine and barely tolerate it because they are well-paid. Thus people who enter medicine are less likely to love it than to torment themselves by being trapped in pressure-cooker careers plagued by burnout, depression, and suicide.

Bitterly regretting that career choice can be prevented by pondering other motivations. Do you like people — really? Americans have such a low threshold for hatred they commonly dislike others with different political beliefs, as if that should be a sin in a nation that supposedly embodies freedom. As difficult as it is for Americans to genuinely like and respect one another, that difficulty is magnified when dealing with patients who are frequently more cranky, demanding, and self-centered than ever, according to what I hear from nurses who haven't yet found a way to escape that profession.

I did a reasonably good job of conveying that unfortunate reality in prior books and websites because I believe that the medical profession is best served when people enter it with both eyes open, fully aware of what they are getting themselves into.

However, most of the fault goes not to patients but to doctors who have masterfully equated healthcare with what they do, which largely boils down to prescribing drugs and performing surgery. Doctors give lip service to prevention yet ignore over 99% of possible preventive measures as well as countless ways to help people feel better physically and mentally, performing better in school and on the job.

For example, more than a few pediatricians have patients who struggle in school and even more with dreams but not the intellectual capacity to achieve them. If asked to provide specific actionable advice, most pediatricians could recite only obvious tips of limited effectiveness, explaining why we have lots of pediatricians but also lots of people who cannot transform themselves from poor students to superb ones, as I did.

This is one of many examples illustrating how the medical profession routinely — not just occasionally — fails to optimally help people live better lives. For those who genuinely care about others, it can be very upsetting to eventually realize that all of the years spent in training leaves them woefully equipped to give people what they deserve.

While some doctors are so misled they still believe that the path to health is paved with pills and surgery, others are awakening to the reality that we need a new approach, much better for patients and practitioners as well as everyone sick of paying through the nose for healthcare that rarely delivers the best health. I spent years proving this beyond a reasonable doubt by writing a book, now well over 3300 pages and growing daily, presenting incontrovertible evidence that we need a new medical specialty more cognizant of how health is affected by the lives people lead at home, in their yards, cars, at work and elsewhere.

This immersion, and consequences from it, are barely acknowledged by primary care physicians who just scratch the surface in helping people dodge possible threats to their health and happiness. The nascent concept known as the exposome partially encompasses the focus of my book, which also illustrates that physicians commonly ignore research conducted by university-affiliated scientists and published in reputable medical journals.

I am addicted to reading the medical literature and spend several hours per day doing that, 365 days per year, collecting so much figurative gold I can't understand why all doctors aren't equally obsessed with learning. One obvious impediment is time, because most doctors are so busy working they don't have enough time to learn what they should know, which is considerably more than that taught during medical school and residency.

Many primary care visits involve patients who don't feel good psychologically, seeking advice from doctors who themselves are miserable. Similarly, patients who should lose weight are often counseled by doctors who need to lose weight.

Early in my medical career, I was so fat I couldn't see my feet when I stood up, but I lost that weight and for decades afterward maintained a waistline of 29 – 32 inches without starving myself or exercising as much as I should, with the time for that frequently robbed by my magnetic attraction to medical and science journals along with spending many thousands of hours focused on developing new innovations, one of which was inspired by a kid who bullied me in elementary school.

One day I had a flash of insight and prototyped it to test my concept, finding that it could safeguard people from physical bullying — children and others, including people like my Mom who was pounded by my father until her bones broke. She saw a doctor and received the usual care but no effective advice on how to protect herself from my father the thug.

Patients commonly receive other inside-the-box treatment omitting what they need most. Consequently, when I visit the upscale yuppie town I shop in, even before the pandemic I rarely saw anyone who appeared both happy and healthy. Since virtually all those folks have doctors, thinking people are bound to wonder why doctors aren't doing more for them. Because the docs don't know, because their training equips them to prescribe drugs and perform surgery, not deliver optimal health and happiness, which generally are as elusive to doctors as everyone else. Long before I was born, “Doctor, heal thyself” was a common theme, yet the message still hasn't gotten through to most people in the medical profession.

This article typifies the obtuseness of the medical profession: Irregular sleep schedules connected to bad moods and depression, study shows: The more variation in wake-up time and sleep time, the worse mood and more chance of depression symptoms in study of first-year medical residents.

The fact that sleep is essential to physical and mental health is hardly new news, yet one of the most salient features of medical education is sleep deprivation and frequently changing sleep schedules. The need for sleep falls somewhere between Captain Obvious stuff and “duh!,” so chronically trivializing the value of sleep (as leaders in medical education have done) is about as daffy as shooting people and then wondering why they bleed.

Yet this is only the tip of the stupidity iceberg, because there are countless other ways in which medical educators are dunces in health. Another way in which they strike out is not beginning medical education with tips relevant to health, such as teaching them to eat food conducive to brainpower and then implementing that by having medical school and hospital cafeterias serve fare that best serves health. Instead, in every of the many hospitals I ate in, the food was ordinary, optimized for taste, not what is best for bodies and minds.

I understand that people are addicted to the pleasure of eating (I am, too), yet that fondness need not be a perpetual noose around our necks because I eventually discovered how to change flavor so healthy, convenient, and affordable food can taste like the yummy stuff we crave. If my innovation were commercialized, it would transform healthcare by obviating the need for much of it, because many health problems and premature graves are figuratively dug by forks and spoons.

Before conceiving that idea, I succumbed to food addiction, becoming so fat I dreaded what I saw in the mirror. Bad food and other triggers eventually sent me into Class IV heart failure, where I hovered for years, affecting me physically and mentally (it's easy to spot the crap I wrote back then), but I bounced back so well I can shovel my 400-foot driveway and enjoy it, or do what I did yesterday: spend an hour walking up and down a steep hill in deep snow and wish that I had more free time to continue that.

So if I can come back from the brink of death, why can't more doctors help more patients achieve similar recoveries without drugs (that often trigger nasty side effects) and without bankrupting them with healthcare that is often more expensive than it is effective? Because most doctors are dunces in health.

PS: I can talk much faster than type, so I now write using Dragon NaturallySpeaking, speech recognition software that sometimes works superbly but other times mangles text in bizarre ways. Thus if you spot a typo, please tell me about it.

“The tragedy is that everyone thinks they already have goals. But what they really have are hopes and wishes.”
— Brian Tracy in The Power of Discipline. This dovetails with an article (Children overcoming adversity) that said, “… contrary to prior belief, children in difficult situations need to do more than dream of a happier and successful future self: They need a strategy for becoming that person.”

You want to become a doctor. I want to help you achieve your goal.

I don't think that you will find anyone more qualified than I am to help you become a doctor, because I did it, against all odds. In sixth grade, my teacher said that I was "slow," and I struggled my first two years of high school. I felt lucky to receive Ds in some classes that I should have flunked.

Then everything changed. I earned virtually all As my last two years of high school and throughout college. My college GPA and MCAT scores were so high that I was the one person my medical school accepted per year with only three years of college. I did so well in medical school that I was elected to Alpha Omega Alpha (the med school equivalent of Phi Beta Kappa) after my second year, and graduated in the top 1% of my class.

Studying to become an ER doctor?
Future ER doctor?

I 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. The director of my residency program once commented that I was the smartest resident they ever had, and one of my former bosses told me that I was the smartest doctor he ever met. Aren't these implausible accolades for someone who once was a class dunce?

I was not born with that aptitude. I learned how to expand every facet of brainpower from intelligence to creativity, and I can show you how to do the same thing. You will learn more from me than you could from people who were born on third base, yet act as if they just hit a triple. Being dealt four aces doesn't necessarily make one a great poker player.

I achieved this intellectual metamorphosis from dunce to doctor without any tutors, prep courses, or much help from my family. If I can do it, you can, too, because you're probably brighter than I was. The problem is that 99.99% of teachers succeed only in making their students more knowledgeable, not more intelligent or creative. "Slow" kids like me usually fumble through the system and emerge from it without anyone doing anything to materially augment their brainpower. Hidebound by centuries of antiquated teaching methods, today's teachers cannot transform "slow" kids into ones who ace medical school, like I did. Hence, it frustrates me when I hear politicians and teachers' unions suggesting that the primary way to improve education is to increase funding for it. Hogwash.

Although I was trained as an emergency room doctor, most of my advice is applicable to other medical and surgical specialties as well as other careers requiring superb intelligence or creativity.

In addition to presenting tips to enhance your academic success, I will give you an insider's view of what it is like to be an ER doctor. You will learn the pros and cons of a career in emergency medicine while you are being educated, entertained, and often surprised by a very candid doctor who never pulls a punch.

I spent years developing a similar site, www.ERbook.net, which also focuses on emergency rooms and ER as a career. That site needs an aesthetic makeover, but its extensive question and answer pages provide information that you won't find elsewhere. I will post all new topics on this site in its question and answer section. I am willing to answer questions that I have not previously addressed, but please first check both sites to see if I already discussed that matter.

I firmly believe that since I overcame many obstacles yet succeeded, you can do it, too. If you read some of the difficulties I faced (here and here), it will erase any doubts you may have about whether you can become a doctor or other professional in a challenging career. You can, and with my help, you will.

I helped many people succeed, such as a struggling student depressed about his abysmal grades that seemed to shatter his dreams of becoming a doctor. He is now a brilliant medical student. Another person was trapped in a dead-end job, convinced she didn't have The Right Stuff to become a doctor. With my help, she did; she is now a professor at the medical school I attended (Wayne State), and she is chair of her department at a hospital in the Detroit Medical Center. I gave yet another person the boost she needed. She is now a neuroradiologist, medical school professor, and president of a prestigious medical organization. Note the pattern: not only did I help them, but I helped them become outstanding.

If you want to wear a white coat and earn the right to be called a doctor, the time to start is now. Ready? Let's go.

“Who are we to worry about, or compare ourselves to, others’ dreams when we can't even execute on our own?”
Michael Lazerow

“Too many of us are not living our dreams because we are living our fears.”
Les Brown

“Build your own dreams, or someone else will hire you to build theirs.”
Farrah Gray

“The best time to plant a tree was 20 years ago. The second best time is now.”
Chinese Proverb

“Nothing in the world can take the place of persistence. Talent will not; nothing is more common than unsuccessful men with talent. Genius will not; unrewarded genius is almost a proverb. Education will not; the world is full of educated derelicts. Persistence and determination alone are omnipotent. The slogan "press on" has solved and always will solve the problems of the human race.”
Calvin Coolidge, President of the United States 1923 – 1929

“As we look ahead into the next century, leaders will be those who empower others.”
Bill Gates

Notes/Thinking of becoming a doctor? Get a second opinion.

  1. $1 million mistake: Becoming a doctor
  2. This is the personality trait that most often predicts success: conscientiousness. If you don't have it, you won't be a good doctor, no matter how smart you are or how much you know. Here's a true story that illustrates conscientiousness.
  3. Personality outsmarts intelligence at school: Conscientiousness and openness key to learning
  4. Grit better than GRE for predicting grad student success
  5. If you want to become a doctor, what I'm holding should scare the living daylights out of you: an amazingly thick brochure of the 11th annual Non-Clinical Careers for Physicians conference. Now ask yourself: if being a doctor is such a desirable profession, why on Earth is there a demand for an expensive course that teaches ways to escape clinical medicine?
  6. How Being a Doctor Became the Most Miserable Profession: Nine of 10 doctors discourage others from joining the profession, and 300 physicians commit suicide every year. When did it get this bad?
    Comment: In 1980, my older brother presciently realized that medicine was bound to become a very noxious profession, so he warned me to not go into it. I didn't listen, making the single greatest mistake of my life. Unfortunately, medical school admissions committees are just as foolish as many applicants in assuming they should become doctors if they like science, excel in it, aren't allergic to hard work, and can't think of anything better to do. Wrong! Medicine can be a fabulous profession for some people, but when you're young, it isn't easy to predict what you'll be like when you mature.

    Secondly, the optimism of youth blinds medical students and wannabes into thinking they will magically escape the myriad drawbacks of medicine, such as ones presented in that brilliant article and ones I presented in the past few decades, but figuratively closing your eyes and hoping for the best won't deliver it. To dodge problems, you must focus on them and intelligently plan ways to circumvent them.
  7. Scientific American: Doctors and Suicide: The rate among students, residents and physicians is significantly higher than average—but so-called “wellness initiatives” can help
  8. Suicide rate higher than average for female clinicians
  9. Medscape National Physician Burnout & Suicide Report 2020: The Generational Divide
  10. Medscape: My Millennial Doctor Peers Think They're Walking Into a Crisis
    Excerpt #1: “[referring to a young orthopedic surgery colleague who decided to quit practicing medicine] Overall, he felt that medicine was a sinking ship on which doctors were losing autonomy quickly and that this was a path leading straight to burnout.”
    Comment: He is correct. Going into medicine was unquestionably the worst mistake of my life. Medicine has some obvious attractions but drawbacks most doctors discover too late, analogous to marrying a beautiful woman and then discovering things about her that make you want to run away from her as fast as you can.

    Every so often I hear from doctors saying I shouldn't discuss those drawbacks because "we need good people in medicine." True, but the best way to get them is to deceive them so they don't know what they're getting into? Does. Not. Compute.

    I prefer your the honest approach so students considering that career have a more balanced perspective of what awaits them instead of relying on pollyannaish blind faith that, when shattered, too often leads to burned-out doctors providing second-grade care. And that is the best way to get good people in medicine? Hogwash!

    Secondly, frank discussions of the drawbacks of medicine are beneficial because not everyone hates the same things, thus warts-and-all portrayals of what medicine is like are more likely to result in the next generation of doctors being better suited for the sorry mess of what medicine has degenerated into.

    Thirdly, some of those drawbacks can be avoided or minimized if doctors know about them in advance instead of blindly encountering them later, after it's too late.

    Excerpt #2: “On average, one doctor a day in the United States ends his or her own life. Physicians commit suicide at a rate twice that of the general population, and over 1 million patients will lose their doctors to suicide every year. … Physician suicide is heartbreaking and screams crisis. … Many physicians are crying for help and nobody is listening. Some sadly feel that the only way out is to end their lives.”

    Comment #2: The best way to analyze this topic is to generalize it, exploring one of its ultimate roots: poor education. It's not that doctors are dumbbells (clearly not); it is that our educational system has too much chaff and not enough wheat.

    In retrospect, there was plenty of time for teachers and professors to educate me and others so we could better avoid and deal with frequent (in many cases almost inevitable) problems encountered during our personal and professional lives. There must have been time for that because there was lots of time for teaching fluff I didn't need, such as mythology, music, and creative writing (the latter gave me an opportunity to showcase my ability but did nothing to appreciably amplify it).

    All that math I had — its raison d'être didn't add up: all of the math I needed as a doctor could have been shoehorned into a very short math class or, better yet, two weeks of self-instruction: the time it took me to learn computer programming on my own, beginning with knowing virtually nothing about it (not even the basics of HTML) to programming an interactive website (MySpamSponge) coded in PHP and MySQL. Thus it wasn't that I needed years of math classes; my teachers and professors needed them to justify their paychecks. Ditto for most of my other education.

    I had this crazy idea that I would encounter crazy people only in clinical situations. Wrong; the world is so teeming with them I met some while dating, others at work and elsewhere in the real world, just as others do with many of us unprepared for how to best deal with them. That would have helped my father, too, who was murdered by someone he met from a personal ad.

    Everyone dates, works, and buys or rents a home or apartment along with countless other aspects of adult life that teachers and professors typically ignore or give short shrift to. Sidetracked by teaching what we don't need, there's too little time to teach what we do.

    Everyone also tries to stay healthy. You might think that I, having graduated in the top 1% of my class in medical school, would have been an expert in health, but I then knew so little about it I made many preventable mistakes and paid the price for them. After decades of studying health (as opposed to medicine, which is based on the fantasy that the optimal path to health is paved with pills and surgery), I now realize that what almost everyone does is analogous to walking blind through a minefield, encountering dangers that could have been avoided. With health unquestionably the most precious thing we have, being so ignorant of it because educators have other priorities is simply unconscionable.

    Depression is depressingly common, affecting most people to varying degrees at some point in their lives and often throughout it, and with almost everyone not feeling as good as they could. If doctors could solve that problem, they wouldn't lead the league in terms of suicide — but they do.

    After many years of giving in to my addiction to reading research (usually spending at least several hours per day doing that 365 days per year), I learned tips worth their weight in gold relevant to almost every aspect of health, including depression. I could teach a one-hour class summarizing what I found, which teachers and professors could transmit to their students, but too many of them are too busy teaching fluff to teach what we need for better lives and careers.
  11. Medscape: What Is the Cost of Physician Burnout in the United States?
    Excerpt: “… the suicide rate among physicians tops that of combat veterans.”
  12. Study finds 80% of medical students feel low sense of personal achievement: Research on burnout at osteopathic medical schools also finds 17% report high levels of depersonalization
  13. Med Student Mental Health 'Crisis': Experts Urge Nationwide Action
  14. Physicians Experience Highest Suicide Rate of Any Profession
    Excerpt: “… 50% of 2106 female physicians who completed a Facebook questionnaire reported meeting criteria for a mental disorder but were reluctant to seek professional help because of the fear of stigma.”
    Comment: I've spent many more years learning health than I did learning medicine that ignores or gives scant attention to key aspects of health. Consequently, doctors of medicine often cannot help themselves get and stay healthy, just as they are (obviously) failing to optimize the health and happiness of patients.
  15. Taking education too far: An episode of Full Measure with Sharyl Attkisson (Cram Culture) discussed South Korean after-school academies called hagwons extend education so “many kids study 9-15 hours a day, seven days a week.” Not surprisingly, “in 2014, South Korean children were found to be the least happy in a study among developed countries” and in 2013, “suicide overtook transportation accidents as the leading cause of death for young Koreans.”

    Life is best when it is balanced, with plenty of time for friends, family, and fun. Despite my education, this basic lesson did not sink in until too late. As a result, I was an academic star but a personal failure—frankly, a self-centered asshole in some ways. This happens to many doctors. We enter medicine with the best of intentions, get beat up and burned out by the system, and gauge our happiness by the size of our paychecks. Of course, money cannot buy happiness, as evidenced by those South Korean suicides of children who could have had bright futures in a prosperous and burgeoning nation.

    People need time to stop and smell the roses, put their feet up, enjoy life and all that it has to offer.
  16. More Than Half of General Surgery Residents Think About Quitting
    Comment: Mentioning the drawbacks of medical careers and how most doctors eventually regret choosing them is essential so students make the best possible career choices for themselves and society. While being a doctor is often very stressful (except for the cushy specialties), the rewards can be priceless.

    I saved many lives as an ER doc. I vividly recall one “save” because I went out of my way and risked my future to save the life of a young black man I knew I couldn't bill. I left the ER (and my malpractice coverage) to run upstairs for his code, which was being botched by the residents responsible for his care. At that facility, a teaching hospital, ER doctors covered the ER only and were supposed to stay there, which I typically did because it was usually so busy I had no other choice.

    But one uncharacteristically slow night I heard a code called overhead and decided to go even though I realized I could have been sued for everything I had and would ever earn had the patient not lived, and I knew the dismal odds: 85% of patients who code in hospitals die. Knowing this, American doctors don't step outside the scope of their practice and malpractice coverage to save lives they have no responsibility for.

    On the street, Good Samaritan laws give some protection to doctors who go out of their way to help, but that'd be a tough sell in a hospital in which I took over a code the residents were running. The second I entered the room, both residents said “Dr. Pezzi!,” clearly surprised and happy to see me. A somewhat officious (but just doing her job) nurse asked me to spell my name during the code, which she wrote in the medical record detailing the code—thus I knew I'd be named in the lawsuit if the patient died. Families often understand the death of elderly folks but are hopping mad when young people die, so I was treading on very risky waters.

    I've never heard of another doc exposing himself to so much potential liability with nothing to gain, but I put that patient's welfare ahead of my own—and I feel very good about that, and also about turning that into a teachable moment because the residents were making a mistake they didn't realize, so if the patient died (which he would have, had I not arrived), they would have learned nothing and chalked up the death to being just another one in that miserable 85% statistic.

    With odds like that against me, and with leaving the ER being so medicolegally risky, the “save” was all the more gratifying. Other occupations don't give people equal chances to save lives, so before you reject medicine, consider what you're giving up. Not only did I save his life, but also the lives of the children he likely had afterward, and the lives of their children, and on and on. Ten thousand years from now, many people will likely have lived but wouldn't have had I not saved the life of their predecessor.

    In medical school I was taught to treat every patient like a sibling. I didn't always do that, but I did in this case, and I'm darn proud of it. You'd be, too.

    “To do more for the world than the world does for you — that is success.”
    Henry Ford

    I relish the “saves” but rue the ones I couldn't, such as my Dad who was murdered and dumped in a swamp, or a classmate executed by her husband, who reportedly spaced shots to her head by 20 to 30 seconds so the relatively wimpy .22 bullets gave her enough time to suffer horribly—and she did indeed, as she stumbled out of her home to drop dead in her snowy front yard less than a year after marrying him.
  17. Five things to know about physician suicide
    Excerpt: “Increased suicidal ideation begins as early as in medical school, with nearly 1 in 4 students surveyed reporting suicidal ideation within the last 12 months.”
    Comment: Proof that medicine is a sick profession. Is it plausible to presume that people so troubled can optimally help patients? Physician, heal thyself.
  18. 11 stupid ways smart people sabotage their success
  19. Why Physicians Won't Unite to 'Rescue' Medicine
  20. Sell Yourself, No one Else Will
    Comment: This commendable LinkedIn article is applicable to life in general, not just business careers. One quibble: the author, Bryan Lovgren, seems not to appreciate the benefits of what he terms “a self-deprecating mentality.” There's real-world and scientific evidence that the optimal catalyst for success is appearing to the world as if you have a big head but secretly doubting your ability so you wake up every day with a fire in your belly compelling you to do something great to prove your worth. You can go a step further and utilize social rejection, which is incomparably effective.

    Had I not possessed a self-deprecating mentality, I likely wouldn't have become a doctor and surely would not have graduated in the top 1% of my class, nor would I have subsequently accomplished goals that make medical school seem like a walk in the park. Once I can reveal the inventions I have up my sleeve, their benefits to billions of people now and forever will underscore the upside to thinking so little of yourself it fuels a perpetual quest to improve.

    The complacency of narcissists stems from inflated self-assessments that undermines the incentive to prove themselves because in their minds, they have nothing to prove: they think they're great, so there's no need to do anything more to justify it. Parenthetically, that is one reason why narcissists often excel only in careers in which appearance (not just physical appearance) is key, such as politics or the myriad silver-tongued talking heads on television who often have high IQs but achieve almost nothing tangible.

    Henry Ford said, “Don't find fault, find a remedy; anybody can complain.” It is so easy for TV's talking heads, and other functional idiots in general, to complain about others, but inherent in their criticisms is tacit boasting they have better ideas and solutions. If so, where are they? None of the narcissists on TV have a plan better than mine: a way to give more to those who receive benefits from government while draining less from taxpayers, simultaneously strengthening the social glue that binds us together: rich, poor, and in-between. I was tired of the malignant divisiveness that increasingly fractures America, so I did something about it.
  21. Babies can learn that hard work pays off: Infants try harder after seeing adults struggle to achieve a goal
    Comment: Worth pondering.
  22. What triggers a high-school student to suddenly drop out?
    Comment: My urge to drop out of high school was motivated by a fondness for easy. I wanted the easy way through life, and my freshman/sophomore courses—although standard—were too hard for me to mentally digest. Our affinity for something often reflects our aptitude for it and whether it's easy or hard. At that time, I excelled in eating cookies, popping pimples, mowing lawns, and lifting weights, not thinking, studying, or taking tests. So my bright idea was to drop out, work on an auto assembly line, and keep pumping iron. Then everything changed after I stumbled upon ways to boost brainpower.
  23. Majority of US physicians say they're burned out or depressed
    Comment: Nearly two-thirds! Now think: how can docs unable to help themselves with something so basic help patients with such common problems? They usually cannot, except with drugs that are often expensive and frequently loaded with noxious or risky side effects. Let's face it: the you-have-a-problem, you-need-a-pill approach to “healthcare” (ahem!) is misguided.
  24. Why Do Female Physicians Keep Dying By Suicide At Mount Sinai St. Luke's Hospital? In the span of two years, three women — two physicians and one medical student — died by suicide while at Mount Sinai St. Luke's Hospital.
  25. Medical student's death highlights high rates of physician suicides
    Comment: After Kathryn Stascavage jumped to her death, the Icahn School of Medicine at Mount Sinai responded in part by putting “a moratorium on inducting medical students into Alpha Omega Alpha, a prominent national honor society.” This is like canceling the Olympics because most people aren't world-class athletes. In other words, it is ridiculous, bound to be ineffectual, and evidence that medical education leaders don't understand roots of burnout.

    Being inducted into Alpha Omega Alpha did nothing to shield me from burnout. To the extent that it depressed doctors who didn't make it into Alpha Omega Alpha: well, that's life. Unlike the Lake Wobegon effect (a.k.a. illusory superiority), named after Garrison Keillor's fictional town where “all the children are above average,” not everyone can be at the top of their class.

    The pain of failure, or not succeeding as much as you wish, can provide a burning desire to burn the midnight oil (work hard) and work smart to succeed. Working smart is one of the primary lessons conveyed in this website and some of my other publications. Being more intelligent and mentally efficient enables greater success with the same input of time, so students who aspire for excellence have an incentive to read what I've written.
  26. March 31, 2021: Nursing graduate students report high levels of stress, anxiety, depression: Nearly one-quarter of survey respondents at CU College of Nursing report struggling with stress, depression and anxiety; almost one-quarter more score within area of clinical concern
  27. Three quarters of Americans concerned about burnout among healthcare professionals
    Comment: 100% should be.
  28. March 23, 2021: Global health care worker burnout is high and 'unsustainable'
  29. April 21, 2021: Survey of 3,536 healthcare workers suggests 67% are suffering burnout
  30. Let’s talk about female physician suicide
  31. Enough Talk: Preventing Burnout During Medical Training
  32. 5 Surprising Causes of Burnout: Are you stuck in a job so demoralizing or stressful, you look at Sisyphus and think, “That doesn't look so bad.” The Savvy Psychologist explains 5 surprising causes of burnout
    Excerpt: “The last symptom, depersonalization, is being cynical, critical, and resentful with co-workers and clients. If you frequently mutter, ‘What is with these people?’, ‘Idiots!’, or any number of NSFW labels, you may be on your way to depersonalization.”
    Comment #1: Sisyphean tasks are laborious and futile.
    Comment #2: Sentiments common in medicine.
  33. Three factors could explain physician burnout
    Excerpt: [quoting Dr. Andrew G. Alexander] “Doctors now spend more time with electronic health records than they do with patients. Electronic health records were pushed by the government at great expense and without regard to the effects upon patient or physician health. Go into any hospital and look for the nurses and the doctors. You will find them sitting in front of computers. They are not happy, and their patients are not healthier.”

    Comment #1: But in the land of the once-free, American politicians don't care. There is nothing inherently bad about electronic health records (EHRs); I programmed my own in the 1980s and loved using that system. EHRs can do more than document what was done; properly conceived and implemented, they can turn average practitioners into superior ones routinely delivering topnotch care while saving money and time. But EHRs are often developed by people who need more training, intelligence, and creativity. Garbage in, garbage out.

    Comment #2: Another factor responsible for burnout is doctors feeling trapped: after investing the best years of their lives and a small fortune into becoming licensed doctors, human susceptibility to the sunk-cost fallacy leads to them escalating and perpetuating their commitment. I decided that I did not want to become a doctor after my first year of college, but not wanting to waste that year, I continued on, applied to medical school, graduated, and worked for years in a job I generally hated. In retrospect, it shouldn't have taken a year to realize that college and I were not a great fit because while I love learning, I HATE sitting in lectures, studying, and taking exams even though I excelled in them; with my five-minute max attention span, trying to pay attention longer than that was sheer torture.

    This is one reason why I envy people with circa-$12/hour jobs in retail, light manufacturing, or whatever: if they don't like their job, boss, or co-workers, they can easily find another that also requires little or no training or investment. They're free, which is priceless.
  34. April 27, 2021: EHR usability issues linked to nurse burnout and patient outcomes
    Comment: EHR = electronic health record.
  35. Primary care physicians experience more burnout and anxiety than other health professions: New George Mason University study examines rates of anxiety, frustration, and other behaviors connected to burnout among health care professionals in primary care
    Comment: Unsurprisingly.
  36. January 12, 2021: High levels of clinician burnout identified at leading cardiac centre
    Excerpt: “More than half the clinicians surveyed at the Peter Munk Cardiac Centre reported burnout and high levels of distress …”
  37. Stress from using electronic health records is linked to physician burnout
    Comment: I developed a way to make electronic health records fun yet much better at delivering superior healthcare at affordable prices.
  38. Electronic Health Records and Doctor Burnout: They have legitimate value, but we physicians entered the profession to connect with and help patients—not stare at a screen
  39. Electronic Health Records Need a Shot in the Arm
    Comment: This article discusses how “artificial intelligence in the form of machine learning … might be able to help overcome the obstacles encountered with EHRs [Electronic Health Records] and unlock their potential for making predictions and improving patient care.” Indeed it could, and eventually will, but to maximally realize that potential and to achieve it as soon as possible requires input from physicians who can think logically and know how to embody that logic in computer algorithms.

    In the 1980s, I programmed (in BASIC) the venerable Tandy 100 and 200 laptop computers to implement emergency department electronic health records, which worked superbly, saving me lots of time. With modern computers, I could save even more and make the system significantly more powerful so average practitioners could deliver better care than professors of medicine, and I could do that along with eliminating the clunky computer interface that drives a wedge between doctors and patients.

    Let's back up a moment and reflect on the ultimate root of this problem: with so much money thrown at it and with so many lives at stake, why on Earth is it taking so long to develop EHRs that doctors love and respect instead of resent? Because the companies developing them don't know how to find the best talent, nor can LinkedIn find them: its networking method, like other such sites, simply puts a digital veneer on antiquated practices — there is no brilliance separating the wheat from the chaff, so while you can find programmers competent in, say, PHP and MySQL, you have a snowball's chance in hell of finding the absolute best, not only technically competent but those capable of thinking in code to optimally solve the problem, in this case implementing EHRs that save lives, money, and time.

    Employers give lip service to meritocracies yet don't know to ideally winnow the stack of applicants, so feebly unable to find the best they substitute other criteria, such as political correctness and appearance — believe it or not, but appearance discrimination is rife, explaining why companies are much more likely to fill a position with someone with a beautiful face than a beautiful mind.

    Ironically, computer technology should make it much easier for the cream to rise to the top. I developed such a system and offered it free to LinkedIn years ago, proposing that in a PM to one of their big shot leaders who asked to connect with me (and did) but seemingly had overly thin skin in terms of tolerating my critique of what LinkedIn does wrong, including its numerous bugs but especially its glaring omission of features that would make that site vastly more powerful. Consequently, he didn't even want to see my demonstration of that technology.

    Consequently, as Isaac Kohane, computer scientist and chair of the department of biomedical informatics at Harvard Medical School, said, “Medical records suck.” They still suck and will suck because EHR market leaders Cerner and Epic, and others, don't know how to find the best minds.
  40. March 30, 2021: Yoga only goes so far: How overhauling patient records can curb physician burnout: Wellness programs for health care workers emphasize self-care; they're overlooking a huge contributor to burnout: Patient records
    Excerpt: “Judges don't do court stenography. CEOs don't take minutes at meetings. So why do we expect doctors and other health care providers to spend hours recording notes — something experts know contributes to burnout?”
    Comment: Because the healthcare system is poor at solving problems; this is just one of many examples. Medical records software need not be painful to use because the one I programmed in the 1980s was a joy to use, and I could now make it even more fun — a real blast, in fact — as well as rewarding on both personal and professional levels. I conceived ways to do that roughly a decade ago while working for an innovation think tank co-founded by an ex-Microsoft top executive. To make a long story short, they did not back me to pursue that innovation, saying it wouldn't be patentable, yet its algorithms likely could have been patented and its extensive database content would unquestionably be protected by copyright. Years later, medical records software companies have nothing remotely comparable.
  41. April 6, 2021: Burnout urgently needs robust research
  42. Isolation and Burnout in Physician Culture: Innovative Solutions
    Excerpt: “Burnout is reaching epidemic proportions across medicine.”
    Comment: Yes, and I predicted it decades ago—plenty of time to do something about it—and proposed solutions, but the medical profession is better at whining about problems than solving them. The central defect isn't a lack of brains but lack of a spine: the very nature of medical training inculcates reverence to authority, even when that is based more on being pusillanimous than being correct. Having raised chickens, I see behavioral parallels between doctors and chickens, who are often needlessly fearful, find comfort in flocks, but reflexively cower in the face of danger. Most chickens.
  43. Multimorbidity leads to general practitioners suffering burnout: The risk of general practitioners (GPs) suffering burnout increases with the number of patients with complex medical histories
    Comment: Physician assistants (PAs) and nurse practitioners (NPs) inadvertently contribute to this problem because they generally take more of the easier cases, leaving doctors with a greater percentage of the challenging ones. I enjoyed the most challenging cases in the ER, but who am I to dismiss their potential toll? I became a poster child for burnout, recovering only when I left medicine. When you're young, it is often easy to trivialize the effects of stress, which slowly erodes the emotional reserve buffering us from life's ups and downs.
  44. What Happens to Your Body When You’re Burnt Out
  45. Medical students, burnout and alcohol
  46. Humiliation tops list of mistreatment toward med students
    Comment: I somehow escaped that, but I witnessed other classmates being humiliated, such as when a professor of surgery would routinely take us—third-year medical students at the time—into a hospital meeting room, close the door, and grill us with one question after another. If anyone paused before responding, didn't know their stuff, or couldn't express it in grammatically correct sentences and paragraphs without saying “um ”or “uh,” they'd be sharply criticized and sometimes subjected to The Mother of All Humiliations: when the surgery prof would SLAM his fist on the table so hard it shook, and with his neck veins popping out further than I'd ever seen, he'd SCREAM in their faces, “You're too dumb to be a doctor!”

    And you know what? He was correct; some med students are indeed too dumb or too lazy to be doctors. He was also wise enough to realize that public humiliation is the best motivator, with research now substantiating its efficacy. Painful? Yes, but not nearly as painful as when those students become doctors who know too little and put too many people into the grave too soon.

    As a medical student, I worked 7 days per week, every day of the year, from early morning until late night, studying, studying, and more studying. I didn't waste half the day, as students reportedly do now, frittering away time on social media; I put my nose to the grindstone and worked hard because I knew patients would one day count on me to keep them alive. The surgery professor knew that, too. People who want to slough off should go into something like politics, where they can bamboozle voters into thinking they have bright ideas when all they have is charm and Hollywood looks. And ego.

    The docs with marginal mental qualifications—say, the ones who graduated in the bottom half of their class—should be turned into nurses or PAs.
  47. Starla Fitch MD: Don’t let your babies grow up to be doctors
    Comment: Don't judge a book by its cover, nor an article by its title.
  48. Ped EM docs at risk for developing compassion fatigue, burnout, low compassion satisfaction
  49. The ugly side of becoming a surgeon by Miko
    Comment: This very poignant, heartbreaking story is one of the ultimate stories of medical burnout.
    Related:
    (a) Exhausted surgeon dismissed as an 'emotional female'
    (b) Stress-free training may enhance surgical skill
    Comment: Researchers found that “the best way to train surgeons is to remove the stress of residency programs and make surgery a hobby.” I agree. I enjoy performing surgery and various procedures such as spinal taps and inserting central IVs, but I and other medical students frequently loathed training under surgeons who seemed less concerned with teaching than acting like egomaniacs who think the world is a better place the more they abuse people. I don't recall any abuse directed at me, but surgeons threw so many temper tantrums I was constantly on edge, worrying I would be their next target.
    Other research has shown that a bit of stress is conducive to learning, but the ambient stress in medical school is way above that as a baseline, so amplifying stress can be very counterproductive.
  50. More than 70% of young oncologists in Europe suffer symptoms of burnout
  51. Physician Burnout Climbs 10% in 3 Years, Hits 55%
  52. Mayo Clinic: Physicians and burnout: It's getting worse
  53. Physician burnout costs the US health care system approximately $4.6 billion a year
  54. Burnout and scope of practice in new family physicians
  55. Physician burnout: Resilience training is only part of the solution
    Comment: Resilience training? Why not fix the problems?
  56. Medscape Lifestyle Report 2016: Bias and Burnout
    Excerpt: “This year's Medscape survey, echoing other recent national surveys, … strongly suggests that burnout among US physicians has reached a critical level. … the highest percentages of burnout occurred in critical care, urology, and emergency medicine, all at 55%. … In this year's Medscape lifestyle survey, as in previous years, more female physicians … expressed burnout than their male peers …”
    Comment: Decades ago, I began writing about problems affecting doctors I knew would catalyze burnout and hence harm them and patients.
  57. Combating Physician Burnout: Tactics and Strategies for Easing Burnout
    Comment: With physician burnout being so prevalent, the problem obviously isn't the doctors but the profession and how it is caught between a rock and a hard place.
  58. What medicine can teach academia about preventing burnout
    The medical programmes we see in our training as physician-scientists are becoming more progressive and supportive of students. Here’s what academia can learn from them, say Yoo Jung Kim and Erik Faber.
  59. New study highlights prevalence of PTSD among obstetricians and gynaecologists
  60. Chance of depression in new doctors depends on where they train: Survey of first-year internal medicine residents shows those in programs with longer hours, less faculty mentoring & more research focus had higher depression scores
  61. British pilots score high on burnout scale -- but still perform well
  62. One in four new doctors may be depressed, and their patients may suffer because of it
  63. “… Dr Pam Wible reports that 75% of American medical students and residents are taking stimulants, antidepressants, or other psychiatric medications.” (source)
    Comment: Nothing says SOMETHING IS SERIOUSLY WRONG WITH THE MEDICAL PROFESSION more strongly than that. Ironic that people purportedly so adept at healing cannot heal themselves; the fact they take such crap highlights their ignorance of better alternatives. I got sick of that nuttiness many years ago and left medicine, likely for good. One root of the problem is that doctors are poor at solving problems. The medical profession was besieged by a perfect storm of government meddling, insurance companies and hospital administrators usurping ultimate decision-making, and attorneys blind to most cases of malpractice who see it in Technicolor when it simply doesn't exist. Today's practitioners pay for the spinelessness of past generations of doctors.
  64. Days after I posted the above:
    NYU Resident, Medical Student Die by Suicide 5 Days Apart
    Comment: A psychiatry resident!
  65. Female Docs Afraid to Admit Seeking Mental Health Care
  66. Despite millennial stereotypes, burnout just as bad for Gen X doctors in training
    Comment: The COVID-19 pandemic is trapping doctors in a previously unimaginable pressure cooker seemingly engineered as an ideal recipe for producing burnout.
  67. Hire a 'Burnout' Officer to Help Physicians: Report
    Excerpt: “To combat the crisis of physician burnout, every major healthcare organization in the United States should appoint an executive-level wellness officer …”
  68. Burnout Rises Above 50% in Some Specialties, New Survey Shows
  69. Burnout Starts Early, Especially in Some Specialties
  70. Facing Burnout the First Year of Residency
    Comment: Most people who aspire to become physicians excel in answering questions. Here's one for ya: why, really, do you want to become a doctor? And another: do you really know what you're getting yourself into?

    Medicine is a great career for robots, not for people who wish to fully maintain their humanity. It took many years after leaving clinical medicine to undo some of its effects, some of which I fear are indelible. Abuse a dog, and it may never be the same again; abuse a person, ditto.

    A key to constantly evolving into a better person is to be kind to yourself and live a balanced life, which is virtually impossible if you put patients first and keep your nose to the grindstone constantly learning.

    By the way, doctors are kidding themselves—and essentially defrauding their patients—if they think the spectrum of learning during medical school and residency are sufficient fundamentals upon which to optimally augment patient health. I've spent more time before and after medical school learning crucial facets of health ignored by healthcare practitioners, and the deeper I dig, the more I realize I am nowhere near close to identifying all of the myriad factors that unquestionably impact health. Within the past year, for example, I added more to one of my health books, expanding it from 550 pages to now over 1400 and constantly growing, with it densely packed with information I would have figuratively given my right arm to know decades ago.
  71. Association of Clinical Specialty With Symptoms of Burnout and Career Choice Regret Among US Resident Physicians
    Comment: 45.2% of second-year resident physicians reported symptoms of burnout; career choice regret occurred in 14.1%. In my experience working with more experienced ER doctors, virtually all regretted choosing a medical career.
  72. This surgeon loves her job. But it's killing her. She quit. She didn't love her job; she hated it.
  73. Burnout, depression can affect ophthalmology residents, study finds
    Comment: Interesting because ophthalmology is considered one of the cushier specialties.
  74. Professional Loneliness and the Loss of the Doctors’ Dining Room
  75. Sam Sinai, PhD student at Harvard University: Why I became a computer scientist instead of a doctor
  76. Med Student Suicide, Depression: National Response Needed
  77. Depression, anxiety high in graduate students, survey shows
    Comment: Gee whiz, I wonder why? Might a balanced life be important to physical and mental health?
  78. New doctors' intense and changing schedules take a toll on sleep, activity and mood
  79. Workplace stress can take a toll on your brain surgeon, too: A new study by the Keck School of Medicine of USC finds that two-thirds of neurosurgeons experience burnout during training
  80. Ending Resident Suicides Starts With More Humane Training
  81. UA study reveals Arizona EMTs face 39-percent greater risk of suicide
  82. National study confirms nurses at higher risk of suicide than general population
  83. April 14, 2021: Suicide among female nurses is double that of the general female population
  84. Do doctors have the worst job in America?
  85. Why Doctors Are Drowning in Medical School Debt: A resident physician investigates the causes of skyrocketing tuition
  86. Physician burnout in small practices is dramatically lower than national average
  87. Medical errors may stem more from physician burnout than unsafe health care settings
  88. Changing diagnosis codes will challenge emergency medicine
    Comment: American doctors are besieged with challenges faster than they can adapt to them; this is just one of the many problems they face. If you read between the lines, a clear message is evident: if you want a reasonably stress-free life, medicine isn't the career for you.

    better than being a doctor
    Surmounting the inherent challenges of medicine should be enough, but for American docs, the nightmare is just beginning. My advice? Read my LinkedIn article $70,000 per year, start now (its title was intentionally understated; you could earn more than most physicians and surgeons). Then put your feet up and really think about what I said and whether you want to beat yourself up to get “MD” after your name, or whether you want comparable income much sooner with markedly fewer hassles.

    The alternative career options I suggested are less prestigious, adding yet another benefit—that will seem like a non sequitur unless you've read my article on how social rejection boosts motivation to excel in extraordinary ways. If you are truly smart enough to be a good doctor, you can do much more to help folks by inventing solutions to problems. People could be considerably happier and live more enjoyable lives but the joy they could have is robbed by problems that just pile up: the bane of the modern world that's bubbling with apps but not good ideas.

    Good ideas solve problems in novel ways. For example, I wanted something better than antibiotics (I mentioned their numerous drawbacks in Best Shark Tank Product Ever?), so I created devices that cure certain infections much faster and more reliably than antibiotics and sold that technology to a friend of Bill Gates who owns a company that also invested in some of my other ideas.

    I've used my germ-killing devices for years to knock out infections that antibiotics do little or nothing for. It's never failed, and along the way I found that it works better than anything else to control a very common problem and seems to rapidly accelerate healing of chronic wounds. While that device is good, it doesn't begin to get my pulse racing; what I'm working on now will make your eyes pop out, solving what is unquestionably one of the biggest problems in the world in very surprising ways.

    Thus more people should be doing what I'm doing. If they did, we'd need markedly fewer doctors, and people would be healthier, happier, smarter, and more attractive with more free time and more money to spend on fun instead of healthcare that's bankrupting us but not making us very healthy.
  89. Emergency care doctors not getting sufficient 'down time', new study shows
  90. Road To Nowhere Part 1: Negative Outcomes On The Path To Discovering A Post-Medical Career
  91. How to be a Real Emergency Physician: An Open Letter to the Recently Graduated and the Seasoned Veteran
  92. 6 MDs Who Quit Clinical Practice and Never Looked Back
  93. When a Physician Leaves, We All Lose
  94. The Loneliness of Being a Physician
  95. Employees of medical centers report high stress, negative health behaviors
  96. Medical students become less empathic toward patients throughout medical school
  97. Doctor Achieves Lifelong Dream of Quitting Medicine Forever
    Comment: Satire, but if most doctors could feasibly leave medicine, most would in a heartbeat. Being a doctor is one of the best jobs in the world, with priceless rewards (not money, BTW) but more pain and stress than anyone should have to endure. If someone inflicted comparable misery on you, it would be a felony.
  98. Over 40 percent of GPs intend to quit within five years: New survey
  99. Should Physicians Educate Patients via Social Media?
    Comment: Medical ethicist Art Caplan, Ph.D. says yes. I said yes decades ago.
  100. 'I've Had It With Medicine!' 16 Options for Second Careers
    Comment: Make that 17: inventing. :-) I can't prematurely disclose what game-changing ideas I have up my sleeve just to appease skeptics and small-minded folks imbued with a crab mentality who don't think there will ever be another Steve Jobs, but when my prototyped and proven inventions are marketed, I will succeed in helping billions of people now and in the future in addition to making my investors fabulously wealthy.

    My LinkedIn tagline has the seemingly audacious claim that my big ideas “could make my investors richer than Bill Gates and Warren Buffett combined.” That seems like a pipe dream, and had someone told me five years ago that I'd soon have ideas that valuable, I would have laughed. But after decades of trying to come up with even a single big idea, I quickly had a small flood of them, some of which do things that seem utterly impossible, yet I know how to make them practical and easy to produce and use.

    I will enrich my investors while saving consumers a boatload of money. To understand how that's possible, history gives other precedents for how significant innovations can create vast fortunes while benefiting consumers. My inventions will make people happier, healthier, and more attractive; they'll save time and energy, and give more pleasure than you ever thought possible.

    I never intended to address drug addiction, but as a fortuitous side effect of one of my inventions (not its primary application), some people addicted to drugs or at risk for that will instead use my product so they could, if they wished, experience rapturous pleasure every waking minute of their lives, without harming their health or society, as the repercussions of drug abuse do. Yup, I turned even a frigging side effect into a miracle!
    The moral of the story is that if you truly want to help people, as most people say when they want to become doctors, you might do enormously more by not practicing clinical medicine. The catch is that there's a well-worn path to becoming a doc. It's arduous, but the road map is clear: just follow the directions and — presto! — you'll arrive at your destination if you have The Right Stuff: enough mental horsepower and figurative gas in your tank.

    Unfortunately, the path is much less clear on how to become an inventor with moonshot ideas that pan out. Going from dunce to doctor, as I once did (see above) was a breeze compared with the difficulty of morphing from a doctor to an inventor with ideas that solve some of mankind's most pressing problems and help companies leapfrog ahead of their competition.

    In this and my other ER site, I gave various tips for augmenting intelligence, most of which are easy though not always quick. Many of my serendipitously discovered tips for boosting creativity are even easier (though so abstruse virtually no one knows them), but some of them require sacrifices few people would endure. The latter are the ones likely most responsible for my big ideas, but without such breakthroughs, you can still make a decent living and help people by inventing. So before you commit to a medical career, consider inventing. Had someone given me that advice when I was young, they would have done me a huge favor.