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

Can intelligence be improved? Yes. Learn from someone who did just that.

Congratulations on your high MCAT score!
He aced the MCAT and got into med school . . .

Update: The student who submitted these questions was once floundering in an academic sense, but later scored in the 95th percentile on the MCAT exam and was accepted into a US medical school. He occasionally calls, impressing me with his mental activity that is two notches above most med students.

Q: Writing to you has proven to be most difficult. I managed to stave off writing for over a year now because I was ambivalent about receiving answers to my questions. First, allow me to say that I have read every bit of information on your site and purchased three of your books (The Science of Sex, True Emergency Room Stories (now available as a free download), and Fascinating Health Secrets). I mentioned this because I am not one of those lazy troglodytes who write to you without checking to see if you already answered a particular question.

Answer by , MD: I appreciate that, because I have indeed previously answered most questions that I receive. I spent years writing to provide information to help people boost their brainpower, health, and sexual satisfaction. I want to devote my time addressing new topics, not ones that I previously discussed. I am amazed when students write to me saying they desperately want to become a doctor, yet obviously have not read much of what I wrote about that profession and my tips for increasing intelligence and academic performance. I would have killed for such a resource when I was young, but the Internet did not exist then. Granted, it will take weeks to read everything, but if someone is too lazy to do that, he or she does not have the necessary drive to become a doctor. Clearly, you do, so I admire your ambitiousness.

Students studyingA note to everyone who wishes to become a doctor or to augment intelligence and creativity: I will post all new topics on this site, but I strongly encourage you to also read my site because it contains information that I will not repeat here.

Q: Being a budding young economist, I know the value of things. I realize the enormous opportunity cost of you taking time out of your day to answer questions. I wish to say right now that I will pay you, whatever the price may be, because I believe that you hold the means that I need in order to reach my goal. I shall digress no longer and give you my story.

For me, getting into medical school has seemed like a dream. Those thoughts come from my past, which continues to haunt me. Only three and a half years ago did I start to really care about expanding the confines of my mind. In high school I only cared about smoking dope and popping pills and this heavily affected my grades, save for English, which I somehow always managed to get an A.

I attended college but dropped out due to the pregnancy of my girlfriend. I escaped with two Bs and a D in Japanese. I never thought I would return to college. Now that D continues to haunt my GPA.

A: First, don't fret about one D. My college GPA, although very high, could have been even higher were it not for a D that I received in a college chemistry lab. That D resulted from the fact that I stopped attending the class and dropped it, but, because of some bureaucratic snafu, the fact that I'd already taken one test in it and accumulated enough points prevented the registrar from dropping that course from my transcript. Incidentally, I dropped that class after I changed my career plans from medicine to the CIA . . . and of what use is chemistry to a CIA agent, I wondered? In any case, one D cannot significantly lower a GPA by the time you apply to medical school. At worst, the Admissions Committee member who interviews you may ask for an explanation of the aberrant grade. In my case, that grade was buried in a sea of 4.0s and was never mentioned.

Q: For me there is still a glimmer of hope. That hope is of course you. Your candid demeanor has given me insight into the way you think and shown me that perhaps it is possible to improve intelligence and memory. I have read three books by Harry Lorayne including The Memory Book, Super Memory Super Student, and Page-A-Minute Memory Book. I have seen my memory improve. Sometimes without a mnemonic I am able to remember things. However I do have difficulty with the substitution words. The examples that he uses just seem to be too easily broken down into tangible things. Following your advice, I have been reading the dictionary and vocabulary books daily. I have already developed a rapacious appetite for reading. Still I find the task of remembering 100 new words a day to be difficult, because of my struggle with the substitution word mnemonic. Yet I know my memory must be good because to show off at work I memorized a 50-digit number in under 10 minutes.

A: I doubt that most medical students could replicate that feat, which is impressive, so I think that memory will not be the limiting factor thwarting your medical career.

I have a few more comments on memory:

1. In the past year, I've read various studies showing that the longevity of long-term memories is strengthened if the memory was acquired at an emotionally stressful time. Notably, most of this research is directed toward the negative consequences of such memory potentiation (such as in PTSD, where the abolition of a memory is desirable, but often next-to-impossible to achieve), but I think that the findings are more universally applicable. Specifically, I believe that a mild undercurrent of anxiety is generally conducive to memory formation and retention. Interestingly, and not surprisingly, some drugs that reduce anxiety also impair memory — not a coincidence, in my opinion.

If a person with aspirations of a medical career does not already possess that requisite degree of anxiety, it is easy to recruit it. When I applied to medical school, being anxious came natural to me and many other pre-med students. The competition was tougher then, college grade inflation was years in the future, and being a white male put two strikes against me. I read several horror stories of white males with high GPAs who were nonetheless rejected by medical schools; Alan Baake's case is the one most publicized, but there were (and are) countless others. So I went through college thinking that some minor misstep might end my career plans. Indeed, my lab partner in medical school had a high GPA (3.7-something) from the University of Michigan, yet even he was rejected the first year he applied. I knew one person who applied ten times before he was accepted! So, as I studied in college, every day and indeed every hour I never forgot those daunting facts.

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2. Once you get into medical school, there are countless things you can do to enhance the stress-induced potentiation of memory. DON'T just try to memorize Fact A, then Facts B and C. Think that you have a patient who might die if you forget that fact. Or imagine that someone will eventually ask you a question that can only be answered if you know that fact. It might be an attending physician when you are a medical student or resident, or just someone at a party some day. You wouldn't believe the diversity of questions that doctors receive. Friends, and friends of those friends, ask me questions about everything from neurology to pediatrics to internal medicine to gastroenterology to dermatology to psychiatry to infectious disease to anesthesiology and lots more. As you memorize things, think of how embarrassed you'd be if you could not answer a question. You won't remember everything using this (or any other) technique, but you'll do better than the folks who robotically try to memorize things without personalizing the eventual personal import of that information.

A significant portion of the brain is devoted to emotional circuitry. Traditionally, this is blithely ignored by educators and students, who seemingly assume that the straightforward "just the facts" approach is all it takes to master a subject. Yes, it CAN be done that way, but why not capitalize upon the benefits of emotionally augmenting learning? Evolution (or God) has wired our brains so they never forget things associated with powerful emotions. Cavemen who forgot that saber-toothed tigers are dangerous were promptly removed from the gene pool. Emotions exist for one reason: because they conferred a survival advantage to people from prehistoric times to the present. Anyone who wishes to maximize their intelligence and academic performance must know that emotions are not a frivolous, inconsequential, and hence dispensable element of the mind that can be insouciantly ignored. Emotions are intertwined with, and can be used to augment, higher cognitive processes, including the ones that will get you into medical school and make you into a topnotch physician.

3. There are different types of memory, and not all of them involve what most people would term "memorization." For example, there is relational memory, which really separates the men from the boys in terms of intellectual achievement. Relational memory is the ability to make logical inferences from disparate pieces of information, or in more colloquial terms, to figuratively put 2 and 2 together. In other words, it is the ability to see the "big picture," forming relationships among perceptually distinct items. Relational memory is a key underpinning of the process of integrating information in which previously unrelated facts are related or bound together (I discuss this in my site).

Want this free book? Contact me.

Relational memory depends in part upon transitive inference, which is the ability to deduce a relationship from a series of items that were learned separately. For example, if A > B, and B > C, then by transitive inference you can deduce that A > C. From school and other sources, you may have been taught only the first two facts, but you can know more than what you were taught because of insights gleaned from transitive inference.

Relational memory is closely associated with abductive thinking: the creative process of generating novel ideas about what could be and reflecting on them. Abductive thinking is critical to spawning the fresh approaches that underlie inventing and scientific breakthroughs. If you consider the dictionary definition of genius (extraordinary intellectual power especially as manifested in creative activity), you may realize that differences in relational memory and abductive thinking are what separate true geniuses from the hordes of people who can memorize lots of information and regurgitate those facts during exams, yet cannot use that knowledge to create new ideas, things, or processes. Thus, while prolific inventors and innovative scientists often know much more than others, what gives them the ability to create is less a function of their extra knowledge than it is their ability to use their relational memory and abductive thinking to innovate. Therefore, innovation is the crux of what separates geniuses from people who are merely quite knowledgeable.

“Creativity is intelligence having fun.”
Albert Einstein

I recently watched a program entitled "Battle of the Brains" on The Science Channel in which several supposed geniuses proved to be remarkably inept in solving real-world challenges that called for out-of-the-box innovative thinking. From this show and other sources, I think that the definition of genius is shifting from "one who excels in IQ tests" to "one who excels in creatively solving problems." Thus, ingenuity (defined as inventive skill or imagination; cleverness) is central to genius. In fact, I contend that exceptional creativity is a much better marker for true genius than, say, memorization, in which one is merely mimicking or parroting (or "regurgitating," as we used to say in school) facts.

One reason that I exhort students to invent is because this stimulates their relational memory and abductive thinking, which, in time, amplifies it, thus making them truly smarter and a step closer to being a bona fide genius. Superior relational memory, but not necessarily abductive thinking, is necessary to become a first-rate physician. You DO want to be one of the topnotch doctors, don't you?

Unfortunately, most teachers and professors know more about Paris Hilton than they do relational memory and abductive thinking. The vast majority of students graduate more knowledgeable, not smarter. The tragedy is that they could learn even more AND be smarter, if their teachers weren't so hidebound.

There's nothing like
a good night's sleep

Sleep strengthens individual memories and helps knit them together, or integrate them. Therefore, do not shortchange yourself in the quantity or quality of your sleep. (I discuss sleep in Fascinating Health Secrets and The Science of Sex.) Additionally, another crucial requirement for maximizing relational memory and abductive thinking is to give your brain some downtime to digest everything, integrating your recently acquired knowledge with older info. Many people never give themselves, or their children, enough time to think. Parents often believe they are doing their kids a favor by shuttling them from soccer practice to band practice to yet another time drain that prevents children from putting their feet up and thinking. I don't advocate such regimented activities because they hinder intellectual development if overdone, as often happens.

Q: Perhaps due to low self-esteem I always feel like a dunderheaded dolt.

A: I was plagued by low self-esteem, too. I thought that I stood a snowball's chance in you-know-where of being accepted into an American medical school, so as a Plan B option I investigated the possibility of attending an Italian medical school (encouraged by my Italian aunt, and their "you're in if you've got a pulse" admissions policy). Even when I was accepted into an American med school, I was still convinced that I was bound to flunk out. That conviction did not abate until some time in my second year, after I'd scored at or near the top of my class on every exam, even trouncing people with Ph.D.s in the subjects we studied, such as biochemistry or pharmacology.

Q: My feelings of inferiority flare on many occasions, such as when reading about a boy who graduated with a 3.8 in high school and vowed to become a doctor after the death of his father. These are the type of people I am competing against.

A: There will always be such people, but, in general, today's premedical students don't possess the same ferocious, single-minded burning desire to get into medical school as was common when I applied. This isn't some fantasy by an old codger reminiscing about the way things were back in the old days. I could cite many facts in support of that opinion. Besides that, the Admissions Committee person who interviewed me basically said that I'd live, eat, and breathe medicine every waking hour of every day, weekends and holidays included, until I learned enough to be called a doctor so that people could trust me with their lives and the lives of their loved ones. He did say that I could go on one brief date per week, but other than that, it was medicine, medicine, and more medicine. What do today's medical students do? I've seen professional students fritter away time in ways that were unthinkable to me. Some spend hours yapping every day on the phone, surfing the web (and not for medical info, either), or even posting their picture on HotOrNot to see how attractive they are. In the years that I've known and corresponded with countless medical students, I've witnessed a distressing decrement in the intensity with which medical and other professional students approach their training. Heck, I even dated one a couple of years ago, who couldn't make it through a day without spending one to three hours on the phone with me discussing things of Earth-shattering importance such as the cute things her dog did or how a neighbor in her apartment was hitting on her. Um, aren't there more important things to do, like study?

Some med students*
post their pictures
on HotOrNot

This ratcheting down of medical student intensity is bad news for their future patients, but good news for medical students and prospective medical students. Medical students are graded on the curve, so if the trend is for med students to slack off, they can slack off, yap on the phone, log onto HotOrNot every hour to check their rating, and still pass because more than a few of their classmates are equally frivolous in apportioning their time and priorities. Thus, it is easier to get into medical school, and easier to stay in. One downside to this abatement of intensity is that it might reduce the "will I make it?" anxiety that can, as I mentioned above, be used to promote memorization.

Q: If I can't memorize 100 words how do I expect to gain acceptance into medical school? I can't help but think though that the seed is there. Reading your personal stories such as your mind wondering while studying (in medical school no less!), working two jobs and being considered a dolt while you were younger gives me hope. There are many parallels in our lives. Looking upon my high school transcripts, I am quite frankly appalled. It is riddled with Cs, Ds, and Fs.

A: I received some Ds in my first two years of high school that should have been Fs. High school teachers sometimes give passing grades just to get kids out of their class. That was obviously the case in some of my classes in which I learned virtually nothing. When I would try in those classes, I'd look at the material, become frustrated because it seemed as clear to me as hieroglyphics, and then skip the next few weeks of class so that I could ride my motorcycle during school hours and feast on junk food such as Mickey's Banana Flips from the local 7-11 store. At one point, plagued by its difficulty, I considered dropping out of high school. If someone told me that I'd eventually graduate in the top 1% of my class in medical school, I would have deemed that to be preposterous. I wasn't headed for medical school at that time, I was headed for being a shop rat. Indeed I was a shop rat for a while, but I learned how to reinvent my mind from one that was destined for failure into one that achieved things that I—and my teachers—once thought were impossible. My point is this: if I can do it, you can, too.

Q: Has my vehement pursuit of knowledge truly increased my IQ? I really want to argue with you on this point. Could it be nature and not nurture that ensures intelligence?

A: Both do, but I think the degree to which nurture can amplify intelligence has been trivialized because very few people know how to catalyze this intellectual metamorphosis. Educators think they're giving their students optimal educations, but they are sadly mistaken. They use antiquated techniques that do not provide the necessary stimuli to increase intelligence. Take the one thing they do best—focusing on regurgitation of information—and ask yourself if they even do a good job of that. Do they? In all of my years in school, the process of memorization was never addressed. Sheesh, it's no wonder that they also never broached subjects that were like hieroglyphics to them, such as the cognitive mirroring process that helped me transform from an academic loser into an academic winner.

Interestingly, this upsurge in achievement was not limited to school performance. In high school, my only notable nonacademic talents were skill in mowing lawns and a phenomenal ability to scarf down hundreds of Christmas cookies. Oh, I did a good job of cleaning out the garage, too.

Many doctors know medicine and nothing else. I couldn't begin to tell you how many docs I've heard saying that they cannot do anything outside of work beyond screwing in a light bulb, as if that were a badge of honor! Once I began doing things outside of medicine, I found that I could—often the first time I tried something—do things better than the old pros. For example, the first shed I built was so cute that it could have graced the cover of Fine Homebuilding magazine. Two years ago, I built a shed shaped like a lighthouse with enough conical, cylindrical, and hemispherical surfaces (and their intersections!) to make the project a pipe dream even for experienced professional carpenters. Incidentally, the shed was built strong enough to survive a recent tornado totally unscathed, even though nearby hardwood trees almost 3 feet in diameter were uprooted while others were snapped in two (update: two of my sheds are featured in a book entitled Shedworking). The first robot I made (a robotic lawn mower) was built from junk parts during the summer vacation between my first and second years of medical school. Its performance was head and shoulders above that of the robotic mower made today by a multi-million-dollar corporation, even though mine was constructed decades ago in my spare time when I wasn't mowing lawns to make money.

I could fill a few books just synopsizing some of the other things I've done outside of my medical career, and if you've read through all of my web sites, you've seen about 1% of the things I've made. Someone who truly cares about education—such as Bill Gates—ought to study how I transformed myself from a failing high school student to someone who aced medical school and developed diverse abilities that seemingly came out of nowhere and trumped what corporations with huge research teams could do.

Remember that I was once on the fast track to nowhere. My sixth grade teacher thought so little of me that he called me "slow" in front of other students as he looked at me with a countenance that telegraphed his contempt and disappointment. Therefore, if nature and not nurture is the predominant determinant of intelligence, how could I have evolved so radically? I was deemed "slow" by a teacher but later became, according to a physician that I worked for, "the smartest doctor I ever met." That transformation cannot be explained by nature. Actually, nurture is not the best way to label the alternative explanation, since nurture is defined as "The sum of environmental influences and conditions acting on an organism" and "To foster the development of. To educate; train. To help grow or develop; cultivate, nourish, patronize, encourage, forward, guide, nurse along, promote, further, advance." The common denominator in those definitions suggests that nurture is something done to the recipient, not done by that person. Thus, it is an external stimulus, not an internal one. Consequently, the whole "nature versus nurture" controversy totally misses the mark in terms of identifying one of the major determinants of intelligence, creativity, and demonstrated accomplishment. Accomplishment is given short shrift as a measure of intellectual ability, being perennially overshadowed by readily administered and scored things like IQ tests. In my opinion, the latter are convenient markers for intellectual potential but are not good predictors of accomplishment that requires brainpower. This reminds me of various women I've met who claimed to have IQs of 150, yet accomplished nothing that could not have been achieved by women with average IQs.

Q: Perhaps you never applied yourself early in life and later did.

A: While I never made any determined effort to improve my brainpower when I was younger, I think that is also true of most kids. I did very typical things: hang out with my brother, play baseball, lift weights, listen to the radio, watch TV, mow lawns, and think about girls. It is true that I later applied myself, but that's also true of many people as they mature and buckle down. In fact, I knew people who buckled down much earlier than I did, and yet I did much better than they did in college, medical school, and on the MCAT and IQ tests. Therefore, it wasn't so much the fact that I applied myself as how I applied myself. Many others were just as studious as I was, or even more so, yet their intelligence and creativity improved incrementally, if at all.

Q: The results are quite obvious and seem to be too astronomical a leap given the amazing feats that you accomplished and continue to do so. Yet I believe that I am experiencing the same thing. Can this truly be? According to some of the research that I have done on psychometrics there seems to be agreement that you can raise your IQ but by only 15%. Incidentally, your diatribe about Marilyn vos Savant brought a smile to my face. So what if they are smart, because if they are doing nothing with it, then what is the point?

A: Exactly. What good is an aptitude for IQ tests if that intelligence never accomplishes anything notable?

Q: Do you now understand the gist of my situation? I waited over a year to write you as I believe that you will be the final nail in the coffin, to finally get me to realize that I need to put to rest this deciduous dream and move on to something else.

No matter what is said I still would like to thank you. The impact that you have had on my life is immeasurable. I now read the dictionary and the book by Professor Sheehan that you recommended. I have developed a rapacious appetite for reading. I am quite fond of anatomy books now, which is the direct opposite of what I used to be. I would read personal stories of doctors and how to gain acceptance into medical school (I have in fact read almost the entire gamut of such books, including the ones you reviewed) but would put off reading the anatomy books as they were intimidating. I have a bottle of piracetam but am unsure of when to start taking it. Do I start now or after my failure to get into medical school?

A: Piracetam is only an adjunct to augmenting intelligence. I transformed myself from dunce to doctor without it. In fact, the only so-called "smart drug" that I used regularly was caffeine, which I began using my first year in medical school.

Q: I obtained your ER book through the used book section on Amazon. I had to wait quite a while for a used copy to appear. It is autographed to Charlton Heston. I don't know if that was why the book was $75 or not . . .

A: I was surprised to see used copies of my book priced that high, but I suppose that is just a reflection of the laws of supply and demand. The supply dried up after I decided to not reprint the book (e-book copies are always available from me), so with constant demand, the price rose. Like many other authors, I once welcomed as a great sales channel, but I later tired of their petty policies that made it all but impossible to profit from book sales. Actually, their behavior went beyond mere pettiness to something that I felt constituted blatant fraud, and dealing with them is like dealing with any big bureaucracy: a futile waste of time. Their responses to me were imbued with an iniquitous arrogance that I found repulsive. The big secret in the book industry is that most authors never make any money. The profits go to the bookstores and sundry middlemen.

Q: . . . and it didn't quite matter to me as I wasn't paying for the autograph; I just wanted your book. I doubted the validity of the autograph until I noticed he uniqueness of the signature. I found a validating comment on the page in which you give the answer as being Al Gore on one of the last pages. It says that you don't much care for Gore but you had a friend who knew him and said that he was a health nut. I just thought it perplexing to have a book that was autographed to Mr. Heston.

A: The autograph was legit. I sent copies of my books to Charlton Heston, and he sent me a cordial letter of thanks but was later diagnosed with Alzheimer's disease—possibly explaining why the book ended up on Amazon's Marketplace.

Q: Thank you for the rapid response. What would you recommend that I do? Give up my dream of becoming a doctor, or keep pursuing it?

Whether you want to be a
singer or a doctor, the key
to success is to never give up

A: I would not advise giving up. Much of my success is attributable to the fact that I possess a "never give up" attitude that keeps me working at full steam long after others have given up. Any time your brain seems to desire capitulation because something seems too arduous, DO NOT THROW IN THE TOWEL! Keep focused and pressing forward. Your mind will eventually "get it" and solve the problem. In the process of doing that, it will learn an important lesson. Whatever the impediment was that once stymied you, the next time you face the same or similar circumstance, the solution to the problem will come to you in a flash. Even major goals, such as medical school acceptance, are really nothing more than the successful attainment of numerous preceding smaller goals. That is often true of many accomplishments, such as my lighthouse shed. I've never seen Norm Abram, the master of intricate projects, undertake something so involved as the lighthouse shed, yet I don't see any reason why an average person couldn't do what I did. The shed was built from thousands of parts that I designed and built, any one of which could be made by anyone with the proper knowledge, skill, and—most importantly—determination to make that part. Repeat that process thousands of times, carefully assemble the pieces, and—presto!—the shed is finished. The real key was determination, not knowledge or skill. The skills were ones that virtually anyone could do, such as, "Pick up saw. Move saw to board. Cut on line." The trouble is that most people are reluctant to undertake a project that is even one-hundredth as involved as the lighthouse shed. Instead, we buy mass-produced merchandise that is inferior in quality and less diversified than handcrafted items. Ergo, I believe that what most people lack is not intelligence or ability, but stick-to-itiveness: an unwavering perseverance.

One of the sheds designed and built by Dr. Pezzi.
More pictures of it

I will now briefly revisit two topics mentioned above as well as on my web site:

1. Memorizing words is important, but using them in context is equally important. Unless you socialize with Mensa members, you cannot use uncommon words without leaving your listeners in the dust. Furthermore, conversational English naturally tends to be less formal, less well structured, and less intellectual than the written word. Thus, I highly recommend writing, and lots of it, intended for a smart audience. When you write, your brain is forced to make numerous word choices from synonyms with slightly different definitions. Analyzing those nuances and choosing the best word for the context is a great mental workout. Most people write simply, with predictable results: they get no benefit from writing.

2. I highly recommend inventing as a means to fuel intellectual growth. If you truly invent something, you've conceived of something that has eluded the billions of people who lived now or in the past. Some inventions stem from eureka revelations, but most originate from a careful analysis of a problem and a proposed solution. "Straining your brain," as I call it, is vital to expanding brainpower. If you invent, you will strain your brain.

UPDATE April 2014: Here's research substantiating that (which I wrote a decade ago): Strategic thinking strengthens intellectual capacity Excerpt: “… we found that it was not learning new information that engaged widespread brain networks and elevated cognitive performance, but rather actually deeper processing of information and using that information in new ways that augmented brain performance.”

Q: I thank you with the utmost sincerity. I personally don't believe that you will ever be able to understand how much you have done for me. You have without a doubt become my exemplar. You are a true hero to me. I thank you dearly. I only ask that you not include my last name if you post any of this since I realize that it is now your property.

A: I appreciate your kind words. I generally don't publish the last name of anyone who submits questions. Incidentally, in case anyone is wondering about my rights to publish what you submit: that is a necessary quid pro quo that creates an incentive for me to respond to you, and one that I mention on my contact page and elsewhere. I've spent countless hours answering questions. Some of you are considerate enough to pay me, but most of those payments are not enough to fully compensate me for the hours I put into this endeavor. I need to post your questions and my responses to help others, thus amplifying the value of what I write, which may now help thousands of people, not just the one who submitted the question. If you don't want me to publish something, either don't submit it to me, or pay for a private response.

Continue reading part two of this dialogue

Back to the main Question & Answer page

* Not this model, of course!


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