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By Kevin Pezzi, MD

Increasing intelligence, memorization, and creativity (Part 2)

by Kevin Pezzi, MD

See part 1 of this dialogue if you haven't already read it.

Q: I staved off from reading your response and finally read it today. Well I guess devoured would be a better word. I have more questions for you. Here goes:

I need more info on emotionally augmenting learning. You said DON'T just memorize Fact A, B, etc. Then how do you do it? You speak of personalizing it, but in what way?

Imagine that this model was a relative of one of your ER patients. Would you want to let her down, or impress her with your brilliance?

Answer by Kevin Pezzi, MD: To personalize information by emotionally augmenting it, don't attempt to memorize the fact in isolation. For example, if you study the treatment for a given disease or condition, don't just read that the treatment is "X" (e.g., 100 mg of cardiosomething IV). Instead, imagine that you have a real patient with that problem, such as a cardiac arrhythmia (abnormal heart rhythm). The patient has a name, a face, and relatives in the waiting room who will be thrilled to hear that you, the astute young ER doctor, saved because you knew the treatment. Now imagine that one of those relatives is Katherine Heigl, the stunningly beautiful blond actress who plays Dr. Isobel "Izzie" Stevens on ABC-TV's Grey's Anatomy. She just happens to be single, and is soooo impressed that you saved her relative's life—all because you knew the treatment for it was 100 mg of cardiosomething IV! Now imagine that you forgot the treatment and lost the patient, so you're now sheepishly informing the relative's family that the patient died from the arrhythmia. Ms. Heigl asks what type of arrhythmia it was, so you tell her. Her countenance immediately changes into one of scorn, and she asks, "What? You didn't know that the correct treatment was 100 mg of cardiosomething IV? I'm just a doctor on television, but even I know that!"

By conjuring up such a scenario, you've done two things. First, you've forced yourself to recall it and repeat it. Students often read something, think they've memorized it, but later forget it because it only "kinda" sunk in or was confused with some other tidbit of information. Second, you've emotionally augmented the info by personalizing it. You've attached emotional importance to it—both positive and negative, in this case. You don't always need both, but I included the positive and negative outcomes for illustrative purposes.

Q: When you crammed in one night for chemistry is this how you did it? I mean come on inorganic chemistry is supposed to be the toughest premed course, right? How in the hell is that possible? Was a solid foundation of the hard sciences already in place?

A: Actually, that was organic chemistry, not inorganic chemistry. Organic chemistry is often viewed by premed students as a man-killer, the class that separates the men from the boys. Many people with aspirations of a medical career see those dreams dashed when their organic chemistry grades are not what the Admissions Committee expects of doctor-caliber students. Knowing this, many premed students voluntarily change their career plans after receiving a poor grade in organic chemistry, rather than devoting more time to a career that seems doomed.

Not Katherine Heigl,
but a 12 nonetheless

In any case, how did I skip most of the class and cram just before the final, absorbing enough to get a 4.0? (Incidentally, that was on a 4.0 scale. I've heard of some schools now using a 4.5 scale. What's next? Instead of rating appearance on a 1 to 10 scale, will the Katherine Heigls of the world now be 12s? What's the point in tweaking such historically well-entrenched scales?) Two factors contributed to my ability to compress a semester's worth of organic chemistry into such a short time. First, because of my earlier efforts (all of this brainpower-boosting stuff is synergistic, you know), learning was immeasurably easier than it once was. Instead of stumbling over elementary facts and being called "slow" by my sixth-grade teacher, I could now conceive 25-step organic chemistry synthetic pathways in my head in a flash. (Probably faster than my 3.2 GHz computer, which can take 20 seconds to open a simple e-mail message in Outlook Express, thanks to Bill Gates and his brilliant programmers.) Second, I emotionally augmented that learning. Every fact I learned was the one that would keep me from becoming a doctor if I didn't learn it. So I did.

Q: I realize that memorizing numbers can be quite difficult because just like the letters of the alphabet they are intangible and you can't grasp them. I however strongly feel that memory is my problem. Do you just look at something and remember it?

A: Sometimes, but not always. Some facts needed techniques from The Memory Book so that I wouldn't confuse that information with similar (and often overlapping) related info. This overlap of info can otherwise become bewildering during medical school. I illustrated this in my www.ERbook.net site in the topic labeled "Med school: Why is it so tough?" Here is a link to that page.

Q: Finishing in the top 1%, memorizing 100 words a day, cramming in one night for a final and earning a 4.0 are all amazing memory feats. I am missing something here, Dr. Pezzi. I see the two points in most things. My problem is connecting them. Could this be a factor? I see the complexities but easy things elude me.

A: Interestingly, my older brother once said the same thing about me. Calling me the "absent-minded Professor," he said that I could master the difficult information, but not the easy stuff, such as finding my car keys or having the slightest clue about how to respond when a woman said hello . . . could be why I am still single! :-)

Q: What it comes down to is the "how." I see the "what" but the "how" eludes me. You said that it was how you applied yourself. That is what I want to mimic. The cognitive mirroring that you spoke of. I have begun to adopt this, especially mirroring David Friedman, son of Milton Friedman a Nobel Prize winner, as well as other economists by applying economics to things that most people don't deem economic (sex, drugs, etc).

A: Have you read Freakonomics: A Rogue Economist Explores the Hidden Side of Everything? That does the same thing. I also recommend a related book, More Sex Is Safer Sex: The Unconventional Wisdom of Economics.

The crux of cognitive mirroring begins with an understanding of how some other person (who is typically bright and hence worthy of emulation) connected the dots or took various bits of information and arrived at a certain conclusion. Neither the input (the "various bits of information") nor the output (the conclusion) are what's really important in this process. The important point is how he arrived at that conclusion. He might explain it, or it might be apparent from analyzing the input and output. The next step in cognitive mirroring is replicating that "thought function," so to speak, in the future when confronted with a similar case. The final step is integrating the "thought functions" of many brilliant people.

Q: I really impressed myself with a truly original thought and application just the other day. If I could mirror you, the benefit would be enormous. The economic way of thinking coupled with the way you think would be one hell of a learning tool that few could match. The words you use in many of your books left me scratching my head and further exacerbated my feeling of stupidity. I have since learned them.

I need this whole memory thing really driven home. I don't want to be one of those doctors with a shitty GPA that just so happened to make it. That is much akin to taking out all the border pieces of a puzzle and putting them together. That is just barely scraping by. I would fear for patients. You on the other hand have the completed the puzzle. That is what I want. I want above and beyond. The ratcheting down of medical students scares me. Knowing you can be a doctor and not knowing an answer—that is scary!

On to another subject. When I speak I often have a retardation of verbal expression.

A: Don't be too hard on yourself, because that is very common. Almost universal, in fact. Some of this stems from social anxiety, which antagonizes clear thinking. One of my friends knew both President Clinton and Vice-President Gore when they were in office, and she sat in on many of their meetings. She told me that Gore was, contrary to popular opinion, actually more intelligent than Clinton. Her analysis meshed with what I read about Gore in some mainstream source (Time magazine, I think), which discussed how Gore was brilliant with small groups but became awkward, stiff, and seemingly less intelligent as the group size increased. Had he not possessed that manifestation of social anxiety, he likely would have been elected President.

People often marvel at the eloquence of various celebrities. In truth, much of that eloquence stems from the aptitude of clever writers and lots of editing to delete all of their flubs. If the average person could edit his or her life so that others would see us only at our best, we could all shine.

Q: When I write it just comes to me naturally. The interaction with other people gets my heart racing, sweating and most important my ears turn red in some situations. When I leave work and know I am going to school, boom my ears turn red. I have tried sucking on ice and placing it on my ears but the effects don't last. I have to walk onto campus sometime. I won't even be nervous but somehow almost subconsciously it just kicks in. Would alcohol, perhaps one beer help?

A: I definitely would not recommend alcohol for that situation. A beta-blocker (such as Inderal) is a much better choice, especially when used in conjunction with systematic desensitization.

Q: Yes, you discussed that in Fascinating Health Secrets. Should I ask my doctor about that drug?

A: I would. Just be leery (and run like heck!) if he wants to prescribe some "catchall" overused drug like Prozac.

Want this free book? Contact me.

Q: As a side note would not a doctor question me if I came in asking about a beta-blocker, more or less telling him I need it?

A: Not likely in this case. Doctors sometimes respond negatively when a patient suggests both the diagnosis and treatment, especially when that treatment is an overhyped, overpriced drug that appears every five minutes in TV commercials, or if it is the patient's "pet" narcotic. However, Inderal and drugs like it are not the type of drugs that patients usually request unless they have a darned good reason for wanting them. Furthermore, the drug is usually given in a low dose for a brief time, which minimizes the risk of side effects yet can still be powerful enough to cure your problem.

Q: Science has never been a strong point of mine. In fact I don't really remember any of it. Taking chemistry and the like is pretty terrifying. My brother is at Purdue and he is struggling in chemistry and he graduated in the top 25 in his high school. He is a smart kid. If I can't master the easy subjects (philosophy, etc.) and get As in them, how in the hell could I with little training master the most basic elements of a medical education in the hard sciences? Is this just more unnecessary whining? Is the only thing involved more elbow grease?

A: Not effort per se, but directed effort. By that, I mean following the path I've outlined in my web site, books, and in my responses to you. Many people work hard to become doctors yet fail because they follow the old educational pathways instead of capitalizing upon various ways to augment brainpower and hence facilitate learning.

As I mentioned in my preceding response to you, teachers don't do a great job teaching. They help students become more knowledgeable by focusing on facts, but do nothing to help students become more intelligent. In the United States alone, we pay untold billions of dollars every year for this antiquated, third-rate educational system. Perhaps some progressive school district, university, or state might someday hire me to implement my educational methodology to increase intelligence and creativity. However, to fully establish all of my educational goals, I would need to be Secretary of Education. I could ensure that all students are taught by the very best teachers while saving tens of billions of dollars per year. Many students who now dread school would then relish it. However, the government and universities are entrenched bureaucracies whose monopolistic power makes them indifferent to reformation.

Q: Can you recommend books to read based on my situation? You mention inventing on numerous occasions. Yeah, right. I don't know how things work so where do I start? Wiring, circuits, Electricity for Dummies?

A: In my opinion, electrical engineering is a good adjunct for stimulating the brain. There are a bewildering number of chips (integrated circuits or ICs) available, each with its own potential utility for various applications. When you want to achieve a given result, it can be a good mental workout to think how to achieve that effect and choose the best ICs for it. Of course, ICs are just part of the equation. Operative circuits often require other components, such as resistors, capacitors, inductors, diodes, discrete transistors, and other devices.

For example, when I designed and built a copying machine from scratch, I first thought of how to detect the image on the source page. Then I thought of a circuit to drive my printhead so that it could reproduce the source page. To make those two basic circuits work together, I needed another circuit that integrated the functions of the other ones. Thus, electrical engineering involves both logic and creativity coupled with the requisite knowledge. This might seem intimidating, but it is MUCH easier than you might imagine. A good way to begin is by reading the "circuit scrapbook" books by Forrest M. Mims III. Connect the parts and—voilà—you have a working circuit. You might want that circuit by itself to do something, or it may be just one of the building blocks in a larger circuit.

Q: Should I read a medical dictionary?

A: Yes.

Q: If so, which is better: Dorland's or Stedman's? I have heard Stedman's is better as it has all the pronunciations.

A: My Dorland's includes pronunciations, but I have an old edition. If you can, get both. Just like with a regular dictionary, it is often helpful to look at two definitions, one of which is usually better and more complete.

Q: The only book I haven't read that you recommended is Zen and The Art of Motorcycle Maintenance. I know, I know—anything but a book about Brittany Spears, right? Is it just pick up any book containing useful info and read?

A: No, because there are too many informative books and not enough time to read even 1% of them. Hence, it behooves you to be selective.

Q: Like medical terminology, etc. Overall is it better to concentrate on my current course related material?

A: Yes, but it is better (time permitting, of course) to supplement that with additional reading on a variety of topics.

Q: I am finding my personal reading time disappearing. You worked two jobs, fixed your jalopy of a car on occasions to get to school, and still had time to study and read all 200 of your magazines and countless books no doubt. Talk about time management! How in the hell did you do that?

A: By minimizing the 1001 things people do that fritter away their time. When I look at various people, including some of my successful friends, I am utterly amazed by their inefficiency. Even when I do things at what I think is a very leisurely pace, I can often get ten things done in the time it takes them to do one thing. Our world is filled with distractions. Do not succumb to them! Here are a few:

• iPods: Who needs 'em? I enjoy good music, but I think that the affinity for iPods is going way too far. To some people, an iPod is as vital as their left ventricle. Intelligently used, music can be an adjunct for enhancing brainpower, but overexposure to music is a good way to block out deep thinking—the kind that sharpens the mind. Having an iPod glued in your ears hours per day is a great way to become a zombie or automaton instead of a smart doctor.
• Cell phones: Some studies suggest that cell phone usage may impair learning. Even if that proves to be untrue, cell phones are a monumental waste of time. What important speech do they communicate that went unsaid before the advent of cell phones? Most cell phone conversations amount to yapping about trivial subjects, not relaying vital information. Couldn't the billions of hours spent talking on cell phones be put to better use? I think so. Sure, we all have wasted hours, such as standing in line or driving. Must those hours be filled by talking on a cell phone? Why not do something useful, such as inventing or otherwise thinking? According to Adam Penenberg, “about 250 million Americans are on the Internet, and spend an average of 23 hours a week online and texting, with 27 percent of that engaged in social media.” Yikes; there goes American prosperity. According to Vlad Martynov, “the typical user picks up and activates their smartphone more than 150 times a day.” That's bad news: Frequent Cell Phone Use Linked to Anxiety, Lower Grade, Reduced Happiness in Students.
• Television: Yes, there are a few educational shows on TV, but there is far more utterly worthless trash. I'm amazed by the millions of people who spend countless hours watching others live their lives on various reality TV shows. It's a pathetic reflection on our culture. If you want to become smarter, sit back, put your feet up, and think. Really think for hours about challenging topics. Most people shortchange the time they devote to thinking, with the result that their thoughts are squeezed in between cell phone calls or yet another must-have iPod song. Result? Their thoughts are superficial and inchoate.

Q: Isn't it pointless to read a medical dictionary, Gray's Anatomy, Harrison's, etc. if you aren't in medical school?

A: Not if you want to become a doctor. The conversion from layman to doctor takes more than four years. The earlier you begin, the better.

Q: You mention sleep as essential to health and memory but how can you sleep with all that reading, studying, and memorizing to do? Your mind is simply amazing. How much did you sleep anyway? I can only assume that you didn't!

A: I slept the usual 8 hours or so until I entered medical school and began studying/working 110 hours per week. I would never recommend intentionally cutting back on sleep to maximize learning. Sleep is integral to learning and memory. I wish the Grand Poo-Bahs of the medical world would accept this reality.

Ironically, people who need to learn the most (medical students and residents) are often the ones who get the least sleep because they work so many hours per week: 110 in my case years ago, and now often "only" a legislated maximum of 80. That is still excessive, because that 80 hours/week is hospital time, not including reading and studying time.

Speaking of entrenched bureaucracies with monopolistic powers that makes them indifferent to reformation, as I was a few paragraphs ago, reminds me of the medical education system in the United States. This is basically a legalized form of slavery in which teaching hospitals get a source of cheap labor (medical students and residents) that they exploit for their own economic benefit. The goal of the medical education system should be to produce the best possible doctors, but it is instead driven by greed. The tacit message is that, "We have the power, so you will do what we say, or else." In other words, it is the arrogant old "my way or the highway" thinking.

Q: Regarding smart drugs: you mention taking caffeine. That was fine in your situation as you never had caffeine before medical school. Come on now Pezzi, I have eroded away all the caffeine receptors. Too much soda pop and coffee for that to have any affect on me. The full effect is already gone. I cannot take advantage of that as you did. My parents raised me on caffeine!

Which foods
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You probably know
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A: I also now get little boost from caffeine, but ginkgo, choline, lecithin, flaxseed, creatine (surprisingly), and some other OTC substances can still deliver a pronounced mental boost.

Q: Inventing: I knew this would come up! I also know you help people out. I do not really want to have you invent something for me, nor do I really want you to build my idea. Perhaps we could flesh something out. My problem is where to start coupled with not knowing how things work. For example, I have a portable DVD player and the screen went out. I thought about taking it apart fiddling around with it perhaps trying to fix it or do something with it but the label about getting the shit shocked out of me is scary.

A: I like to build things from scratch, not tinker with gizmos made in China. I don't even attempt to fix a phone or VCR. If it dies, I buy a new one. They are so inexpensive that it is not worthwhile to fix them. However, I do disassemble and "gut" them to extract parts that might be useful in making a new project. It's not dangerous if you know what you're doing, but if you don't, the warning labels are best heeded. The most dangerous things are capacitors, which can store a potentially injurious charge even if the device is unplugged.

Q: There is a magazine called Make, which shows how to make certain things.

A: Make is a GREAT magazine. I subscribe to it and highly recommend it. I can't think of a better magazine to help get one's mind in gear.

Q: The newest issue is about hacking plants where you take one plant and graft it to another. I realize this isn't inventing but it is making, so could it perhaps lay the groundwork for understanding that leads to inventing?

A: Yes, it's a start. I can't recall the first circuit I built, but it was something very basic, such as a two-transistor radio receiver. If you knew what I am working on now, your jaw would drop.

Q: If so, I would like to work with you on inventing something. Perhaps that would lay the groundwork. Now what that would be I have no idea. You throw me an idea, I have no idea what to do with it, I give up and pay you to make it and I claim that my superb intelligence has led me to invent automatic cards for stool hemoccult testing! See how nicely that works?

A: I have countless ideas. Some are simple, while others are so complex that even major corporations wouldn't attempt them. In fact, I'm now working on two such ideas. My problem is that I will never have the time to develop all of my ideas, so I am open to a collaboration of sorts. I'll need to scan my invention synopsis (which is now approaching 500 pages) to select some good candidates.

BTW, not all inventions relate to tangible things. Others are just useful processes or techniques, some of which don't require any scientific training, yet can still be challenging enough to exercise your mind. For example, imagine that you are on Flight 93. Try to think of a plan to neutralize the terrorists and come home alive instead of nose-diving into a field in Pennsylvania. I hate to be a Monday-morning quarterback, but it is apparent to me that the passengers on that flight did not think of an obvious way to neutralize the terrorist's weapons. Perhaps they might have thought of that had they not spent so much time calling relatives to say (over and over and over, from what I read from numerous sources) that they loved them. That's fine, but wouldn't it be infinitely preferable to come home alive and tell them that in person?

Or consider the massacre at Virginia Tech. As an inventor and outside-the-box thinker, I know there were three tragedies that day. Everyone knows about one of them: the shooting. What were the others?

• Something the victims failed to do that could have saved many lives.
• What the police should have done besides cowering behind trees and cop cars.

Are we living in the Stone Age or the 21st century? Come on, police, get with the program! Furthermore, while I greatly respect the courage of what some victims did in trying to block the shooter's access to their rooms, I am saddened that no one thought of much better ways to neutralize him. In less than ten seconds, I conceived at least four ways to do that. Now five . . . and six . . .

If Bill Gates doesn't want to buy the "it will change the world" hardware/software gizmo that I am now developing (see * below), perhaps he might consider hiring me through his charitable foundation to help students become more intelligent and creative. In this case, a bit of creativity could have saved many lives.

* Microsoft should buy it, according to something that Gates said. In a discussion of missed opportunities during a televised program (Buffett & Gates Go Back to School) in which Bill Gates and Warren Buffett responded to questions from students at the University of Nebraska - Lincoln School of Business Administration, Gates said, "In Microsoft's case, the biggest mistake is where we miss something that's coming along that's going to be huge. We don't want to have anything that comes along, some breakthrough . . . that we haven't gotten the best people in and are putting that together with the work we're doing, so it would be missing something like that that would be our worst mistake."

Well, Mr. Gates, I have something that is a huge breakthrough, potentially more popular than the Internet, and something that more people will find an indispensable part of their lives. It can be used alone or in conjunction with computers and the Internet. Everyone can use it, from young children to old folks, including the myriads of technological Luddites who can't, or won't, program a VCR. Here's your chance to out-innovate Google.

Let me tell you, if none of the dozens of "smarter than the average bear" students and professors involved could think of how to stop the rampage by that whack job, then perhaps there is merit to my contention that iPods, cell phones, and other "I want to be an automaton" devices hinder our thinking more than we would like to admit. By the way, Bill, don't try calling my cell phone. I don't have one.

Q: I believe that is all for now. On a personal note, I really want to thank you. What you wrote was more than just a pat on the back. Truly it was a light that was shone in a dark area. I only saw black in my future. Not the depressing black, but black in the sense that I couldn't see myself succeeding, especially as a doctor.

A: I once felt the same way. Me, a doctor? Difficult to believe. The people destined for medical careers were the smart kids, such as the children of doctors that I knew. Their parents could afford to give them competitive advantages that were a pipe dream to me, but you know what? I kicked their butts in college, on the MCAT, and in medical school. They were probably getting shiny gold stars and accolades such as "Johnny is such a good student!" while my sixth-grade teacher was calling me "slow" and probably thinking that I had less chance of graduating in the top 1% of my class in medical school than he did for dating a Hollywood actress or Playmate of the Year.

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