1. The importance of self-confidence for doctors—and the danger of arrogance
2. Accurately assessing your ability
3. How to truly succeed, not just make it
Q: Is it important for doctors to be self-confident?
Answer by Kevin Pezzi, MD: Self-confident, yes; arrogant, no.
Picture this: Paramedics rush a critically ill patient into the ER. Several nurses immediately gather around and begin routine interventions. Then they look to the ER doctor, who is frozen in fear, trembling, staring: the deer in the headlights look.
Trust me, the last thing ER nurses want is a doctor shaking like a leaf, otherwise frozen in panic. They want a doc who knows what he is doing and has enough self-confidence to take charge of the situation and be the captain of the ship. That's his job.
I assumed all ER doctors invariably did this, but a nurse told me about how one of the ER physicians in my group would react when faced with seriously ill or injured patients. I put 2 and 2 together, recalling the booze on his breath and his curious habit of almost constantly sucking on strong breath mints—undoubtedly in an attempt to camouflage the odor of alcohol. Then there was the little metal flask he'd sometimes sip from. Mouthwash, he said.
Bullshit, I thought. Who on Earth swallows mouthwash? And who but a grizzly bear with rotten teeth has breath so bad they need almost nonstop breath mints and mouthwash?
Halitosis in an emergency department is as irrelevant as passing gas in a septic tank or a zit in a morgue. With so many other noxious smells and so many more important things to worry about, intensively treating bad breath is hardly essential—except in a pathetic attempt to hide his affinity for liquid courage.
Why he drinking was hardly a mystery: to mitigate his anxiety to the point he could think and act instead of freeze. However, there are clearly better ways of dealing with the anxiety of treating patients on the verge of death.
For instance: A gorgeous and evidently blind nurse I knew from the hospital called and asked me for a date.
No, I responded.
Oh, she's a lot of fun on dates, and we'd have a great time, she promised.
My answer was still no.
She called the next week and did an even better job of selling herself.
More calls from her, and more refusals from me, for months.
I wasn't in the mood for dating; I was in the mood for thinking of how to improve the success rate of cardiopulmonary resuscitations (“codes”), which averaged less than 5% for patients taken to an ER for cardiac arrest—what we called outside-the-hospital arrests (OTHA). In other words, over 19 out of 20 OTHA patients ended up in the grave.
I was utterly devastated by the first patient I lost as an attending ER physician during a code. I was depressed and literally felt as if I'd been punched in the gut, but that sensation persisted for two weeks, erasing my otherwise nonstop appetite. I spoke with my boss about the case, expecting that he would criticize me, but instead he just chuckled and said that I'd followed the ACLS guidelines, so what's the big deal? Patients sometimes die despite our best efforts, he said. Get used to it.
I couldn't get used to it because, deep down, I didn't think I did everything possible to save that patient. I suspected at the time, and later knew with certainty, that I had to go beyond ACLS if I wanted to save more lives, so I did.
You could read every textbook and journal of emergency medicine and cardiology and still strike out 95% of the time. There was no inside-the-box magical answer for how to significantly boost that success rate, but losing that first patient motivated me to say “no” to the gorgeous nurse and instead find a way to save more patients—and I did.
While working in a busy ER that handled codes every day, I've gone over 18 months without losing one patient while other ER docs put patient after patient into the ground. My self-confidence in handling codes improved so much that I'd sometimes stick my nose into a code and run it even when I had no obligation to respond, such as in a hospital in which inpatient resuscitations were usually run (and botched) by the medical residents. (Yes, they need to learn, but I reasoned they could learn more from me than they could by letting another patient die, which usually taught them nothing except how to fill out a death certificate.)
I suppose most ER doctors get all the confidence they need by passing the ACLS and ATLS courses, but I wondered how anyone could be confident of handling codes in which 95% of patients ended up in a grave. By not allowing myself the pleasure and contentment of self-confidence until I could do much better, I truly had reason to be so self-assured, and patients had reason to smile. Instead of rotting in the ground, they could go home and resume their lives, often having a chance to live another half-century or more.
People often confuse self-confidence with arrogance, but they are hardly synonymous. As I explained in responding to a reader who accused me of being arrogant, pride means “pleasure or satisfaction taken in an achievement” or “a sense of one's own proper dignity or value; self-respect” while arrogant means “making or disposed to make claims to unwarranted importance.”
Self-confidence means “confidence in one's abilities,” not one's imagined abilities. Healthy self-confidence arises from a justified belief in oneself and freedom from doubt, not from arrogantly thinking one is good, great, or capable when one is not. The desire for self-confidence impels mentally healthy people to do things to earn that self-esteem, while others take a shortcut and think they're hot stuff even when they are not. That's arrogance.
There is a world of difference between arrogance and self-confidence. Arrogant ER doctors pat themselves on the back for being great even when their patients die, while justifiably self-confident doctors don't feel good until we can do much better. The self-confidence I possessed was earned by turning down chances to date a hot nurse so I could instead put my nose to the grindstone and go in overdrive while other docs figuratively rode on cruise control.
Considering the above distinctions, patients are well-served by self-confident doctors, but are imperiled by arrogant ones. Since the difference between self-confidence and arrogance can mean the difference between living and dying, does anyone really want a modest doctor? If you or a loved one had one foot in the grave, wouldn't you prefer a doctor with a bit of an ego as long as that was justified by his or her abilities? When I am old and in danger of dying, I hope the modest doctors stay far away from me!
Ben Franklin pondered whether people who feel good about their modesty truly are modest (they are not, he concluded), and whether feigning the supposed virtue of modesty was preferable to feeling good about one's achievements. In the end, he thought the modesty game was not worth playing; he was a superior individual, so why try to hide it or pretend otherwise?
Rather than guzzle Jack Daniel's whiskey or whatever booze was in that silver flask, the trembling ER doctor mentioned above should have sought a more adaptive way to become self-confident. Had he done that, many people who went to their graves could now be enjoying a beautiful summer day.
The stress of being an ER doctor in a busy, high-acuity emergency department is almost unimaginable. We tried to recruit ER specialists from Lansing (Michigan), but even though they had years of experience working in emergency departments filled with gunshot victims, heart attacks, and other typical ER cases, they were so shocked by the stress of working in my hospital that most quit in the first week in spite of the excellent pay and benefits that included nurses and other staff who made most Hollywood stars look like Plain Janes.
It is one thing to have a patient's life in your hands, but when you have dozens of patients at the same time, many screaming or crying or just acting out in uncontrolled borderline ways (see 15 Minutes in the Life of an ER doctor), and you need to be in ten or more places at once, and sometimes need to run three codes at the same time . . . well, that's stress.
Codes are rarely as neat, clean, and simple as what you see on TV or what is depicted in the ACLS course, which isn't adequate to prepare healthcare practitioners to successfully treat most cardiopulmonary arrests. The one thing most docs botch is not figuring out and treating the underlying cause of the code. The frigging heart never stops because it was deficient in epinephrine or some antiarrhythmic agent, so giving those things is usually ineffective. Hence, it is not surprising that most codes fail.
Running codes as I did required a mountain of self-confidence because I went beyond the relatively simple recipes (so to speak) in the ACLS cookbook. Most doctors just follow the ACLS script without sweating the details that can make a big difference, but I sought to identify and treat the underlying problem. To do that, I could not rely on lab or other tests, because I needed to implement therapy stat—within seconds. That required educated guessing. As it turned out, every such guess I made was correct, but had I been wrong, I would have made a malpractice attorney very happy and rich. From a medicolegal standpoint, it would have been safer to follow the ACLS cookbook and leave it at that. If the patient died, well, too bad.
If your Mom were being coded, you'd want a gutsy, self-confident doctor who cared more about saving lives than worrying about lawyers. Motivated by a burning desire to save every life and not just go through the motions, I made some risky decisions (such as by treating hyperkalemia when I thought the potassium was high but not knowing it, because if I waited for a lab test to prove it, it would be too late to do any good) that required self-confidence in my diagnostic ability, not just ACLS skills. It usually isn't too difficult to make a diagnosis when a doctor has enough time and is aided by lab and other tests along with a review of the patient's prior medical record, coupled with history from family members and knowledge of the patient's current medications. However, in many codes, there is no accompanying family, medication list, or even a name; temporarily, they are just John or Jane Doe.
What doctors running codes need is a crystal ball. We don't have one, of course, so we stick to standard ACLS or we have the self-confidence (and knowledge that justifies it) to go beyond it. Isn't the latter much better?
What doctors need is an ACLS+ or Beyond ACLS course. If medicine would step out of the Stone Ages, it would be easy to determine who is qualified to teach such a course: simply keep track of a doctor's code success rate, as baseball does in computing batting averages. With most doctors batting .050 (saving only one patient in 20) and me batting as high as 1.00 (saving every patient in hitting streaks that lasted as long as 1½ years), it would be easy to select the far-right tail of the Bell curve. In other words, forget paper qualifications and look at a doctor's code track record.
Besides that complexity, codes can be tough because a patient may have a short, bull neck and a volcano of puke obscuring landmarks during insertion of an endotracheal tube. Or finding a vein may be difficult because the patient is morbidly obese or a junkie. And on and on.
Many doctors have good reason to be modest. They do what other doctors do, strike out 19 times out of 20 when handling codes, and say “yes” when gorgeous nurses call for dates.
Clearly, self-confidence that is earned and justified is preferable.
I wasn't always self-confident even when I knew my stuff. For example, during a college organic chemistry exam, I froze in fear, unable to answer any question. Then, about ten minutes before the time was up, I regained my composure and flew through the test, on which I earned a 4.0 (“A”) by getting almost every question correct.
A lack of self-confidence can impair performance—whether on an exam or asking a pretty girl for a date—by triggering anxiety that clouds thinking. Research has shown that a bit of anxiety or a bit of self-doubt can improve performance, but too much has the opposite effect. Total, unquestioned self-confidence is usually undesirable because when people are fully confident in victory, they often don't give it all they've got. Even when I was self-confident in my ability to save patients, I never went into a code thinking it would be a breeze. It takes a lot of dysfunction to stop a heart, and quickly undoing those problems is very challenging.
The damaging effects of arrogance (an unjustifiably lofty opinion of one's abilities) are manifest in a popular premed forum populated by too many people who are dripping with excessive confidence in their ability to get into medical school and excel once there, for the few of them who actually are accepted. When I think of them, one word pops into my mind: cocksure.
cocksure (adjective): A condition of extreme (sometimes foolish) confidence; to be outlandishly and completely sure; too certain; feeling perfect assurance despite inadequate grounds; arrogantly overconfident.
Cocksure people are more likely to possess a constellation of other negative qualities. Too often, they're brash, cheeky, impertinent, insolent, and impudent.
In short, they are full of themselves and have big heads without any rational justification for why they think so much of their ability to get into medical school. Consequently, most of them do not succeed. Although it is easier than ever before in modern times to get into medical school, too many of these cocksure students swing and miss at the MCAT, organic chemistry, or college in general. Instead of having M.D. after their names, they get to go through life explaining why they were premed but didn't make it. I'm sure they have plenty of excuses, but I faced a mountain of adversity (some so painful I refuse to mention it) and succeeded in spite of facing one stumbling block after another. Since most people don't face even half of those challenges and most are smarter than I once was (my sixth-grade teacher was not wrong when he called me “slow”), most students who want to become doctors should do even better than me—but they don't. Why they fail is obvious: their overconfidence leads them to not try as hard as they should.
While it is easier than before to get into medical school, getting in and truly succeeding (not just passing) is hardly a walk in the park even though they are now competing against others who fritter too much time away on Facebook, listening to music, texting, and yapping on cell phones. The few who become doctors are destined to be ones who send 19 of 20 patients they code into their graves. They think they're good enough, and I think they're delusional. If their patients could speak from the grave, they would not be thrilled with the results of their treatment, especially if they knew the doctor deemed golfing, boating, traveling, and dating more important than thinking about ways to improve the success rate of codes. Becoming an excellent doctor requires a number of unpleasant sacrifices, but those sacrifices are less noxious than what patients endure when doctors can't help them. By putting myself in their shoes, I knew their suffering and death was considerably more important than dating a stunning nurse who claimed to be a great kisser and loads of fun on dates.
Self-confidence was never my goal. Instead, it was just a byproduct of doing what I should have been doing, such as mastering how to save more patients in cardiac arrest.
Researchers found a connection between overconfident students and low reading comprehension. People who read my book on boosting brainpower will learn thousands of things, including how confidence and stress can help or hurt academic performance, and how to find the best levels for them. Too little stress, and they won't give a 100% effort (or even realize what that is); too much, and they will choke under pressure. Overconfidence prematurely silences stress, which is as maladaptive as silencing a fire alarm before the fire is extinguished.
It isn't easy for ER doctors to be self-confident
If you've read my books that present unusual emergency room stories, you know that ER doctors must handle cases that cannot be solved or handled using standard medical knowledge in lectures, textbooks, and journals. Thus, it is impossible for an ER doctor to be fully self-confident in terms of assessing his or her ability to handle every situation that might arise in or near the ER (I've been called on to determine what to do with people stuck in elevators or who collapsed in a parking structure). If he is, that is more likely arrogance than self-confidence.
Consequently, ER doctors with a realistic sense of their abilities often feel anxious to some extent. For example, one of my smartest bosses (I'll call him Bob) told me he would feel nauseated beginning about three hours before the start of every shift in anticipation of the stress he would soon endure in the ER pressure cooker. Any ER has the potential to be stressful, but we worked in an emergency department in the 95th percentile for acuity, located in the most litigious county in a very litigious state.
Translation? Doctors could be—and were—often sued even when they did everything perfectly, not just adequately. (Physicians are supposed to be insulated from malpractice lawsuits if they do what an average practitioner of their specialty would do, not necessarily what a topnotch practitioner would do. However, in their eagerness to buy another vacation home in Colorado, lawyers will sue even when doctors perform flawlessly, knowing that a bad outcome [often inevitable even with the best care] motivates insurance companies to make generous settlements offers, fearing that a sympathetic jury will award even more.) That county was so litigious that I wasn't very surprised to learn when Bob confided in me that he was sued multiple times in one week!
Contrary to what you might think, Bob was not incompetent, but rather one of the brightest and most knowledgeable ER doctors I ever knew. He was a rocket scientist in comparison with other ER doctors who were never sued. The difference? They had warm, fuzzy personalities and were great at schmoozing, not diagnosing or treating. Even in litigious areas, treating patients with kindness, not aloofness, prevents many lawsuits. Bob had a very traumatic childhood that left him with emotional scars that decimated his potential to be a people person. He clashed with nurses, administration, too many patients, and even other ER doctors—but he knew his stuff. However, that knowledge wasn't enough to insulate him from malpractice suits and anticipatory anxiety about what he would soon face in the ER.
If I can do it, you can, too
One of my primary goals in writing about brainpower is to instill the conviction in my readers that if I can do it, you can, too. My sixth-grade teacher ridiculed my intelligence, and I faced challenges that would make most people give up, yet my performance in college and medical school left almost everyone in the dust even though they had higher innate IQs and fewer stumbling blocks.
Why couldn't the naturally brilliant rich kids whose parents sent them to the best private schools trounce me academically? As they were taking MCAT prep courses and getting advice from expensive tutors, I was mowing lawns and working dangerous, hellacious jobs to pay for my education, which was so expensive that it sometimes left me no money for food. I'd occasionally go weeks without even one proper meal, yet all of the rich kids with all of their advantages couldn't beat me.
Because they never learned to really try.
Because they listened to tutors who hadn't discovered my dunce-to-doctor secrets for amplifying brainpower.
Because they were overly confident in their ability to succeed.
Because they often didn't even know what it means to succeed—confusing just making it with success. Patients who are coded know there is a world of difference between just making it and success, because there is a world of difference between life and death.
Most doctors could replicate my success in coding patients, but once they get M.D. after their names, too many are too busy living the good life instead of studying, and too many think they're doing enough by listening to the American Heart Association, the organization behind ACLS courses, tell them how to treat patients with cardiac arrest.
After my last shift working in the high-pressure ER mentioned above, the head nurse on the night shift (my usual shift) took me aside and said that he would really miss me, and that I was the best diagnostician he ever met. Frankly, that surprised the heck out of me. I knew my code success rate was far above average, but I figured I was as lost as other ER doctors when it came to diagnosing other patients.
Correctly diagnosing patients in a busy emergency department is not as easy as it may seem. For example, many elderly patients have vague, nonspecific complaints, such as saying they are weak or “just don't feel good.” They could have cancer, heart disease, a stroke, one of many possible endocrine disorders, depression, anemia, pneumonia or other infection, dehydration, poor nutrition, carbon monoxide (or myriad other) poisoning, drug side effects, and countless other problems. Many patients do not have old medical records, and even if they are available, there is rarely enough time to do more than glance at a few pages. Many elderly folks have hearing impairments or other conditions that negatively affect communication.
ER doctors often have less than 15 minutes to take a medical history, examine the patient, order and interpret tests, x-rays, EKGs, check orthostatic changes in pulse and blood pressure, do a rectal exam checking for blood, speak with the family, talk with the patient's doctor or the one on-call for him or her, arrange admission or write discharge orders and prescriptions, order and arrange follow-up testing, answer questions from the patient, write out the medical chart, and then dictate it. Fifteen minutes to do all that leaves almost no time for diagnosing. Finding the true diagnosis requires doctors to consider alternative diagnoses and to rule them in or rule them out—much easier said than done in a busy ER in which dozens of patients and nurses may be clamoring for the doctor's attention at a given time.
Most students who aspire to become doctors should be able to leave me in the dust, but they don't. Most had a huge head start, but ended up far behind, because most never had a realistic assessment of their ability.
After reading this article, it should be obvious that it is important to accurately assess your ability. Underestimating it can decimate your self-confidence, perhaps leaving you choking under pressure like the ER doctor mentioned above who used booze to mitigate his performance anxiety. Overestimating your ability can make you slack off when you should be in overdrive.
Accurately assessing your ability is very adaptive in an evolutionary sense. Before humans had guns and bombs, they had to size up prey and other opponents. Could they take them on and win, or might they be injured or killed in the process? Thinking they could do something they could not rapidly ended many lives, taking myriad overly confident cavemen out of the gene pool. However, the overly timid ones—the ones who could but thought they couldn't—were more likely to starve and less likely to impress a potential mate, so they were also removed from the gene pool.
The survivors were the ones with the most accurate perceptions of their abilities. Those survivors became our ancestors, so humans generally have a reasonable sense of their capabilities—or they did until recently when our culture made many people feel great even when they were not even average. When those people hear my if I can do it, you can, too message, they assume they can do it without doing what I did.
Unless you are naturally gifted and born with a nose-to-the-grindstone attitude, you won't achieve what I did unless you work hard and discover the secrets to augmenting brainpower. Some of them are arduous, while others are quick, easy, and even pleasant. Not everyone possesses the supreme dedication it takes to become a topnotch doctor, so the less determined folks are sure to omit the arduous steps—but why on Earth would anyone not use the easy ones?
One possible reason is that the doctor wannabe deems it more important to spend money on cell phones, iPods, designer clothing, partying, and other frivolities than my book on boosting brainpower, which everyone should read. Even if you are very smart, you could be even smarter, more creative, and more productive. The boost in IQ and memory will help you save more lives if you become a doctor (with 19 out of 20 codes failing, there is tremendous room for improvement).
Every doctor needs more brainpower. When I think of some of the seemingly smartest and best qualified doctors I've seen as a patient, it is clear they are part sages and part out-of-their-league quacks who don't know what the heck they're doing.
For example, to treat the objective tinnitus that severely disrupted my sleep for years, an ENT surgeon proposed cutting the tendon to the affected muscle or putting me on nightly Valium the rest of my life to suppress the rapid muscle spasms that shook my ear drum (creating noise I couldn't mask even with a white noise machine on full volume). After years of this, the affected muscle hypertrophied as other muscles grow from intense exercise. As that muscle grew stronger, it contracted ever more forcefully, so I no longer only had noise that awoke me almost every time I entered anything more than a light sleep, I had an impossible-to-ignore sensation of what felt like an enraged wasp or hornet in my ear canal, madly thrashing its wings to escape. Bzzzz, bzzzzzzzz, bzzzz, bzzzzzz, bzzzzzzzzzz, bzz, bzz, bzz, bzzzzzz—it'd go on for hours, every night, every week, every month, every year for years.
All the supposed experts, and even the American Tinnitus Association, had no good solution. Who solved my problem? I did by making simple changes to my diet. Why didn't the experts know that tip that helped me and my brother (who has the same problem)? Because they didn't know enough, despite office walls plastered with impressive degrees, awards, certifications, licenses, and credentials.
Enhanced brainpower can help you perform better in virtually any occupation, even ones that seem mentally easy. For example, almost anyone can install plastic slatwall, but piece-to-piece size variations, inability to plaster over joints and mistakes (as is done with drywall), and difficulty getting the slats to match up when installed around a door or window give even professionals gray hairs and results that often look amateurish.
When my brother entered the slatwall business, I helped him do various jobs. By doing that, I thought of how to solve virtually every slatwall installation problem, sometimes conceiving of new procedures and sometimes inventing new slatwall installation tools.
Why didn't people who installed slatwall for years think of those things? I met some slatwall pros when I accompanied my brother as he spent a day talking to folks who charge an arm and a leg for a franchise selling and installing their brand of slatwall. The slatwall in their office appeared to have been installed by a drunk who didn't give a hoot about how it looked—very odd for a company with impressive (Photoshopped?) advertisements. They had none of the slatwall tools I invented and made, which seemed utterly obvious to me . . . but obviously not everyone.
NOTE: If you cannot afford my book on boosting brainpower, have your school, university, hospital, or company purchase an institutional license.
Every hospital I worked in or have seen is filled with insufficiently intelligent workers who make plenty of mistakes that cause patients to suffer or die. A local hospital that claims to be one of the top 100 hospitals in the country makes so many mistakes, such as killing one of my friends, that I don't have time to write about them all even though the mistakes I learn about are likely less than one of every 1000 mistakes they make.
I was so incensed by one of those mistakes that I spent months years ago as an investigative journalist digging into the hospital award business since that hospital loves to boast about its awards. The awards I investigated were, I concluded, just cleverly obfuscated scams in which hospitals would indirectly purchase awards to make them look good, and to help their brass justify ever-larger salaries and bonuses for themselves.
Rather than wasting money on such nonsense, hospitals who truly care about patients should purchase an institutional license for my book on boosting brainpower so their doctors, nurses, and other staff can do things other hospitals only dream of, such as saving almost every patient in a code (as I did) instead of sending 19 of 20 to the grave.
Most hospitals won't purchase my book even though it could do infinitely more good than awards about as meaningful as those in Cracker Jack® boxes. Why? Because they are arrogant and know much less than what they think they do, or should. This is a symptom of a larger problem: Most people, corporations, and other institutions are more concerned with having an image of excellence than excellence itself.
Arguably the primary problem with the United States is that its excellence did not match its image of excellence. Much of it was just smoke and mirrors coupled with bubbles that burst. In the late 1980s, when America was riding high and seemingly destined to be the world's economic superpower in perpetuity, I predicted that we would face nightmarish financial problems in the future. We are, and they've only just begun.
The solutions proposed by our brightest politicians boil down to: Let's inflate more bubbles (even though they are bound to burst), renege on our promises and obligations (even though many are legally binding contracts), create more money out of thin air (even though that dilutes the value of existing money and effectively robs people), blame the other party, cross our fingers, and hope the shit won't hit the fan while I'm in office.
Most Americans are too stupid to realize that our politicians don't know what the hell they're doing. Research has shown that in the past 50 years, American voters chose the Presidential candidate with more hair. That's either one heck of a coincidence, or proof that meshes with other research demonstrating that voters prefer candidates who are taller and more attractive.
One might think that our present economic problems might compel voters to end this beauty contest, but the current Republican front runner looks like a hunk but earned only a “D” in college economics. Republican hunk #2 owes his success in large measure to a huge head start he received by having a rich and politically powerful father. I am often accused of being a Republican, but such candidates fill me with dread, not valid hope for a brighter future.
However, American economic problems are not solely the fault of our leaders; they resulted from us collectively resting our laurels, glorifying all the wrong things (such as beauty instead of brainpower, and celebrity instead of substance), and focusing more on the image of excellence than excellence itself.
This isn't the time or the place to propose a comprehensive solution, but one obvious remedy is for us to spend less time harping about the flaws in our leaders and fellow Americans and spend more time improving ourselves. I did that by transforming myself from dunce to doctor. If other Americans replicated my intellectual metamorphosis, our economic problems would be solved. We could leave China in the dust, pay our debt and other bills that seem almost mathematically impossible to repay, and give our children a brighter future than they ever imagined. To achieve that goal, we don't need pixie dust, we need to read my book on boosting brainpower.
Let's turn off our iPods, cell phones, TV sets, and stop dancing with the stars so we can be stars. If we individually pursued excellent with vigor, we could collectively catalyze greatness in America, which is just the sum of its parts.
- Failed College Dreams Don't Spell Depression, Study Finds based on Is There a Downside to Shooting for the Stars? Unrealized Educational Expectations and Symptoms of Depression (The author of this paper said, “My previous research showed that teenagers are increasingly unrealistic about what they will be able to achieve.”)
- Educators Should Encourage College Students to Shoot for the Stars, Study Suggests
Comment: After many years of corresponding with thousands of students, I've learned that a lack of self-confidence is surprisingly common, while arrogance isn't uncommon. Self-confidence is good, while arrogance is bad. The distinction between the two is muddled in the minds of many; I discussed this in an article on my other ER site.
- Looking forward to the 24th century: Cardiac arrest remains a deadly problem -- but for different reasons from today
Comment: Dead wrong. I developed two ways to remove the time pressure in cardiac arrests. I haven't released this technology because I'm working on better inventions, but even if I don't get around to it, I forecast that someone else will replicate my breakthroughs well before the 24th century.