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

By Kevin Pezzi, MD

A smart student looking for ways to boost her chance of becoming a doctor

Q: Hello Dr. Pezzi, my name is Melinda. I'm a junior in high school, and look forward to someday becoming an ER physician. I've done my research, mind you, so I know what I'm going into. I've read countless books written by ER physicians, interns, nurses, etc. (including your book!), and I volunteer in the ER at my local hospital. I have a 3.97 GPA, and will be applying to Duke as my first choice, among others. All this may make it seem like I have it all together, but really I'm freaking out. I don't think I'll have what it takes to make it in med school. Sure, I have a high GPA, and am taking college-level courses now, but I feel like it's not enough. I know you've been asked this question many times, but what more can I do to get ready? And before you even suggest it, I'll let you know that I've already read The Memory Book by Lorayne and Lucas (really useful tip, by the way). Anything you can tell me will be appreciated more than you can imagine!

Thanks so much for your web site. It's been a great resource!

Become an ER doctor or other physician by studying hard!
Studious student

Answer by , MD: Hi Melinda,

First, I would like to reassure you that people who make it into medical school are often apprehensive about whether or not they are doing enough to prepare for their future. The ones who don't worry are less likely to be accepted and, if they do somehow get in, less likely to become good, thorough, conscientious doctors. A bit of anxiety is conducive to performance, so doctors with that proclivity are more likely to perform better than the "what, me worry?" docs. Frankly, if you have people's lives in your hands, you should worry and constantly question if you are doing enough. If you have that trait now, it is likely to continue in the future. Good.

Second, it often helps to get a second opinion. Here's mine. I think that you DO have what it takes to get into medical school. You remind me of how I was in high school, except that your GPA is light-years ahead of my high school GPA.

Now on to the crux of your question. After reading The Memory Book, I recommend spending some time exercising those skills by reading something that is foreign to you, challenging, and lengthy, such as The Merck Manual or Harrison's Principles of Internal Medicine. Concurrent with that, I'd read the dictionary, write, and invent. Regarding the latter, many people assume that all the good ideas have already been thought of. Nothing could be further from the truth. Almost every day, I am amazed by various products that were evidently designed by engineers with a pathetic absence of common sense and logic.

I would also recommend learning to program computers. In general, the brain is stimulated by novel challenges, and programming will give you many such opportunities. Even experienced programmers can be stumped by trying to figure out the best way—or any way—to do something. It's easy to formulate an objective; that is, what the program should do. It is an entirely different matter to conceive of how to make a computer do what you want it to do. Even Bill Gates never mastered this. Some people view his recently announced retirement plans as a natural segue, but I think they are more of a tacit capitulation acknowledging the fact that he and the company he created don't have what it takes to master something that should be logical and hence controllable. By all accounts, Gates is an intensely—even obsessively—competitive man, yet his technical legacy will be that he's left us with exasperating third-rate software even though we've given him the riches of hundreds of kings. Not an equitable quid pro quo, in my opinion. You may not earn more than the King of Software, but you can certainly outperform him.

(text continues below this relevant complaint)

UPDATE: I had this and dozens of other files open while later preparing an answer for another student. I left to have my morning cup of tea, and returned a minute later to find my computer rebooting. WTF? After Windows reappeared, it informed me that my computer rebooted to finish installing updates. There was no advance warning, as there usually is, informing me that my computer will reboot in “X” minutes, giving me an option to delay that; this rebooted without warning.

Now who on Earth would think that is a good idea? The folks at Microsoft, too many of whom seem bereft of common sense. However, even Google—virtually a synonym for brilliant innovation—can't master even the basics.

For example, when I receive an order via Google Checkout, it informs me as soon as the order is initiated, but not when the order is complete (credit card authorized, etc.). There's no set time between order initiation and completion, so once I receive the initial e-mail from Google notifying me of the order, I must repeatedly check to see when the process completes. This isn't just a waste of time, but an utterly obvious one. Their lack of respect for user time is also evident in how they fail to provide a yearly tax data summary. That is easy to program (I could do it), which would take one of their programmers less than a day to do it. If they did that, it would save potentially millions of users the need to manually review all order data at the end of the year. Hmmm, a few hours of Google programming time versus millions of hours of user time wasted every year . . . why don't they do it? They either don't give a hoot, or are too obtuse to appreciate the need.

Just like Microsoft. If they had a smidgen of common sense, their OS would know that rebooting when the user is busy isn't a good idea. One of my bosses with access to my educational records said I had an IQ of 160, but I've had so many problems with Microsoft products that I could fill a very thick book describing them. Altogether, I estimate they wasted one year of my life. We've given them gold that made their big shots richer than kings, and what did they give us in return? Poorly conceived, poorly implemented products that waste our time and engender needless stress. However, I'm not the only one to express exasperation over Microsoft usability; it infuriated Bill Gates, too.

The point of these complaints? There is always room for improvement. Now, to continue from where I left off . . . .


PS: Which of my books did you read? True Emergency Room Stories ? If so, did you see the new (free) book that I published a few months ago? It is entitled Love & Lust in the ER. As its title suggests, it primarily pertains to ER cases involving love or lust.

Q: Dr. Pezzi,

I would just like to thank you for how quickly you replied. The fact that you cared enough to write back helps perhaps even more than any advice you may give me. I actually called a doctor last week who agreed to be interviewed, and still have not heard from him, so thank you, again, for being so caring.

As for your opinion that I have what it takes; thank you. You have no idea what it means to receive that kind of compliment. Sure, I get awards and congratulations on my achievements and grades, but receiving one from someone I look up to as much as I do you greatly surpasses that. So thanks again (and I'm sure I'm nowhere near the way you were in high school).

As for the advice you have given me regarding what I should do to get ready, it makes so much sense. I'll be sure to start those soon, although right now I'm bogged down with schoolwork.

I do have a few more questions to ask you, though. And by few, I mean more than few, so brace yourself.

First of all, I'm taking Anatomy and Physiology right now. I have a really high grade in the class, but only because I've read so many books on these topics. When I'm actually presented with the material in class, I have no idea how to approach it. What study tactics did you use to study for science classes?

A: One of the challenges to learning anatomy is the similarity and overlap of the facts, which can lead to those facts becoming blurred and confused with one another. Probably the best example of this are some of the back muscles, the origins and insertions of which differ only slightly. Keeping all that info straight can be challenging. As you know, it may seem straightforward as soon as you read one fact, but after reading a dozen similar facts, and especially after the passage of time in which you've learned countless other things, that once-straightforward fact may become lost in a sea of information. One of the best ways to prevent this is to use memorization techniques from The Memory Book. I didn't use that for everything—usually just the info I thought might otherwise become jumbled in my mind.

Q: And what would you suggest for a procrastination problem?

As a young man trying to study,
my mind would often wander and
focus on other things, such as women.

A: I think that it is helpful to look at the root cause of procrastination. If you dig deep enough, most procrastination problems are traceable to the mind's affinity for pleasure. Actually, most human behavior is rooted in the desire to maximize pleasure. I love learning more than most people, but even I can list hundreds of things more pleasurable than curling up with a ten-pound medical textbook. And even for those of us who truly love medicine, there is another innate human affinity: the desire for variety, the spice of life. There's lots of variety in medicine, of course, but that variety pales in comparison with the variety in the "real world." So does the brain prefer variety or lots of variety? The latter, of course. That is why the brain often prefers procrastination to studying, because the joy of studying is usually dwarfed by competing pleasures. Or someone might try to study, but find his mind daydreaming about more pleasurable things. For me, that was snowmobiling, electronics, and women, of course. My concentration was abysmal—except when I focused on snowmobiling, electronics, or women. Then my ability to concentrate was flawless. Thinking of all the thousands of hours I've spent contemplating those three topics, I cannot recall even one instance in which my mind wandered and I began daydreaming about, say, the origin or insertion of some friggin' muscle. There is an important lesson here. Most people—even ADDish people like myself—don't suffer from a lack of concentration, but from an inability to direct the mind to focus on what it should concentrate on rather than what it wants to concentrate on.

Once you understand this, it's not difficult to find a way to end the procrastination by making studying more enjoyable. I discuss various ways to do this in some of my books, such as Fascinating Health Secrets and even The Science of Sex. In the latter book, I don't discuss studying per se, but I do discuss ways to increase concentration and pleasure. While sex is partly physical and partly mental, all perception of libido and pleasure is solely within the brain. There are several ways to heighten that pleasure, but I'll mention only a few in this message because it would take too long to recapitulate what I wrote about the other methods.

My problem with procrastination and poor concentration ended my first year in medical school during the neuroanatomy unit when I began using caffeine, which I'd previously ingested perhaps only once or twice in my life. Hence, being essentially a virgin to caffeine enabled me to reap the benefits it gives to new users. The problem for most people is that they begin using caffeine when they're children and don't need it, so the potential benefits are wasted. When those kids get older and need a mental boost—say, in college or medical school—caffeine won't do much for them because the body has long ago become habituated to caffeine. That permanently alters the brain so the positive effects of caffeine will never be as dramatic as they once were. Hence, I implore everyone to avoid caffeine until you truly need it. Don't use it as a quotidian recreational beverage!

If a person is not a caffeine virgin, is all hope lost? No, because there are other convenient ways to affect the neurotransmitters affecting concentration and pleasure, such as by consuming fava beans, choline, ginkgo, or flaxseed. Everyone's neurochemistry is slightly different, so people differ in their responses to those substances and the doses required—just as people respond differently to various psychotropic medications, of course. I discovered many things that increase my concentration and pleasure, and even some that magnified my creativity or happiness.

Now to tie all of this together. The brain isn't particularly choosy about the type of pleasure it experiences—it just wants to experience pleasure, period! Give it some pleasure by using one of my tips, and it won't protest if you want to spend the day engrossed in studying something that would otherwise be insufficiently exhilarating to permit protracted concentration or to fend off the urge to procrastinate.

Q: Second, I just have a couple specific questions. What did you major in in college?

A: Zoology.

Q: What college did you go to?

A: Michigan State University for undergrad; Wayne State University School of Medicine for you-know-what.

Q: What college would you suggest?

Morose college student?
College costs can wipe the
smile off anyone's face!

A: I have good news for parents facing astronomical fees from the big-name schools: Don't waste your money. Once you get to a certain level of academia, what matters most is the student and his desire to learn, not the university he attends. For example, Michigan State and Wayne State are not as illustrious as The University of Michigan, Harvard, or Yale, yet on standardized tests such as the MCAT and the medical boards I beat almost all of their graduates. When taking my medical board exam, for example, I knew the answer to almost every question as if I'd studied that material five minutes ago. Thus, I think that Wayne State did a good job educating me (but, being the perfectionist that I am who is constantly seeking to make what's good even better, I can think of many ways to improve medical education).

Graduates of the best universities are smarter and more knowledgeable than graduates of the worst universities, but most of those differences are attributable to the fact that the best universities generally attract smarter, more knowledgeable students who are more studious and more intensely focused on their futures instead of engaging in a nonstop four-year frat party.

I've heard students from illustrious universities griping about how infrequently they see the famous profs they're paying so much for. All too often, those famous profs are off doing whatever it is they enjoy doing . . . which is, apparently, not teaching. Instead, they leave that to their teaching assistants, or TAs as they're called. The TAs at the big-name schools are not better teachers than TAs at average universities, but you'll pay much more for them. If such consumer deception were tolerated in the automobile business, people purchasing a Mercedes-Benz would get the Mercedes ornaments but ride around in a Chevrolet.

Q: I'm looking at Duke right now, and I'd like to go for undergrad at a school that has a med school, but I'd like a second opinion. Hearing one from a seasoned doctor means so much more than my school counselor.

A: Most Admissions Committee members care about your qualifications for becoming a good doctor, not if you attended "their" university for your undergraduate work.

Q: That's it for now, though I'll probably think of some more questions to bug you with. :-)

Thanks again for everything; you have no idea how much you've helped me thus far.

By the way, how would I approach computer programming? Should I get a manual? A Programming for Dummies book?

A: I began with PHP for the World Wide Web by Larry Ullman, and I've since read a few dozen others on PHP, Javascript, CSS, and other topics. Incidentally, Larry is (like me) one of the few authors who respond to many reader questions.

Q: And which edition of The Merck Manual do you suggest I buy first? Home edition? Diagnosis and Therapy?

A: The latter that is intended for physicians.

Q: And how do you suggest I read it and The Principles of Internal Medicine? In chronological order?

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A: The Principles of Internal Medicine, although longer, is probably a better book to start with.

Q: I guess I lied about the "no more questions" :-)


P.S.: Yes, I read the free book, and enjoyed it. I actually used it as my procrastination-from-homework book, although that was probably not its intended purpose. :-) I haven't read the True ER Stories, though. Where can I get it?

A: It's now FREE from my web site:

P.P.S.: So sorry for the long letter. I'm sure you have better things to do :-)

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