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

By Kevin Pezzi, MD

1. Physician income versus lifestyle
2. The surprising income of an ER doc
3. How ER doctors earn their money
4. My life: from the ER to (almost) Hollywood
5. Inaccurate public perceptions
6. Improving the mind in more ways than one
7. Life advice worth its weight in gold
8. A true story that will make your heart race

Q: Hey Dr. Pezzi,

I'm a 4^th year medical student in the midst of interviewing for a residency spot in Emergency Medicine. My decision to go into EM was a recent one, one that I had changed from Plastic & Reconstructive Surgery. Some of the major factors that drove me to EM over Plastic Surgery were: the people in EM were way cooler and way more down to Earth than plastic surgeons. There was virtually a lack of ego relative to the surgical fields. The variety was great and kept me interested, especially as one who loses interest in repetitive work so quickly and frequently. And finally, the lifestyle of having no pagers, not being on call, and working your 8–10 shifts a month seemed way more conducive for me to pursue my myriad outside interests even as an attending.

With that said, I am not having any doubts. BUT, I sometimes ruminate about how different my future would be like as a Plastic Surgeon instead. You seem to have lived a very rewarding and interesting life as an ER doc, but did that come at the expense of taking a relatively HUGE pay cut compared to being an orthopedic or plastic surgeon? I definitely don't think that ER docs make chicken scratch salaries, because I know the pay is great, but compared to the potential earning capacity I could have had as a plastic surgeon, I'm curious as to how big that difference really is? Do plastic surgeons still make the millions of dollars as they used to before the big markets, like NYC and LA, became saturated with them? I've also heard from plastic surgeons and non alike that the stereotypical, wealthy plastic surgeon is actually very rare and that some surgeons are actually getting paid way less than they had originally expected due to the current recession we are in and as our nation begins to transition to a more universal, less-specialty-reimbursed healthcare system. What are your thoughts?

Answer by Kevin Pezzi, MD: The best way to answer your question is to rewind the film reel of my life to the day a plastic surgeon I knew from residency stopped by my home to look at it, which I'd recently listed for sale. He and his wife really liked it; their baby had no comment. :-)

Just one problem: As much as he and his wife wanted my home, he couldn't afford it.

A few years before, when I applied for a mortgage, the agent asked my monthly income. I answered her routine question, which prompted her to direct her gaze from the paperwork in front of her, to me. She paused for a second, peering over the top of her glasses, grimaced as if she were sucking on a lime sprinkled with battery acid, then said in a snotty tone, “I didn't think ER doctors made that much.”

The look of disgust on her not-very-attractive face made her even less appealing. Was she jealous, or just outraged that someone who worked in a busy pressure-cooker emergency department wasn't on food stamps?

Who knows? Or cares? Like other salespeople, mortgage brokers are supposed to feign a veneer of pleasantness and tolerance for their clients, but instead of getting the usual transparent act of niceness, I got a brazenly challenging agent with an axe to grind.

Lucky me.

In the past month, earning the $15,000 (adjusting for interim inflation, it'd now be $24,000) that sent her head spinning in the early 1990s, I'd saved countless lives, including some people other doctors thought were goners. I'd treated people with heart attacks, strokes, seizures, diabetic comas, automobile accidents, gunshot wounds, and assorted bar fight injuries. I'd delivered babies, held the hands of grandmothers, examined rape victims, and put a smile on the faces of kids who entered the ER crying inconsolably. I'd read x-rays and EKGs, interpreted thousands of lab results, started IVs in patients after the ER nurses and IV team struck out on them, performed lumbar punctures (“spinal taps”) on my first attempt even in the most challenging cases, and disimpacted feces: a fancy medical way of saying that I dug poop out of people who were plugged up like a toilet filled with a blob of Silly Putty™ the size of a basketball.

I treated patients with almost every imaginable medical, surgical, and psychiatric diagnosis, and then some. I treated everyone from rich and famous celebrities and sports stars to winos who smelled as if they used nauseatingly cheap wine mixed with vomitus as aftershave that fermented to produce an odor so noxious that it almost made me, strong stomach and all, want to puke. I put up with patients with extensive vocabularies of profane words and a propensity to shout them at the top of their lungs into my migrainous ear with hyperacusis. You're basically a doc now, so you know what that means.

Pain.

For enduring that pain and doing the thousands of things I did in the preceding month, including moonlighting in a hospital clinic, and giving up over a decade of my life years before to become a licensed doctor, I earned every cent of that 15 grand, and I earned the right to not have it questioned by an agent who did a poor job of pretending to be pleasant.

But I digress, as usual, which might be why some folks in Hollywood have contacted me, including a man behind one of the biggest Hollywood blockbusters of all time, who wanted to turn some of my ER stories into a movie or new TV series. I figured out long ago—it really wasn't much of a mystery—that what is particularly interesting about emergency medicine isn't the cookbook stuff, such as “x” milligrams of drug “Y,” even when it's given stat by a breathless doctor flanked by gorgeous nurses—as is usually the case in television depictions of what we do. Instead, what is interesting are the human stories, many of which make TV medical programs seem like fiction, which they usually are, which are never as interesting as reality. Hence the calls from Hollywood to spice up their big screen and little screen offerings.

The last call from Hollywood came from a producer who wanted me to appear in a movie. I viewed the trailer and was surprised—even stunned—by his talent in taking a seemingly impossible subject and injecting it with humor and substance in a way that made me realize I was dealing with a frigging genius. I could be in his movie, rubbing shoulders with celebrities, some so gorgeous and tantalizing that it was hard to say “no.”

But I did, anyway. Other than my one Hollywood friend, who read my first book of ER stories and contacted me because of it, I have no interest in Hollywood, unless the money was sufficiently great to overcome my fear of flying and my distaste for cities that don't permit tractors on their roads. The amount he offered me—zero—seemed to suggest that I'd jump at the chance to spend some time with hot celebrities instead of my rusty tractor and chickens, one of whom seems to think my hand is edible.

However, after being discovered by another genius—that story must wait for another day that will never come—I was already working overtime … incidentally, with none of it in the ER. Career transitions can be good.

However, after reading about a person in my area who was deported, I'd recently begun efforts to help her escape the dangerous border town in Mexico she lived in until she could raise enough money to legally return to the U.S. To help her, I offered to sell my Sea-doo, Ski-doo, and shed, donating 100% of the proceeds to her Operation Save Liz fund. It was the right thing to do—so right I was certain that Hollywood celebrities would jump at the chance to jump on the Operation Save Liz bandwagon and enlist public support to help her.

So as much as I preferred to keep working and feeding my chickens, despite the occasional hand peck, I responded to the Hollywood producer, saying I'd agree to appear in his movie if he persuaded some of his celebrity friends to help Liz.

He never responded, perhaps offended that an ER doctor would ask for something in return. He likely had his plate full, as did I, and the last thing he needed was even more to do.

Well, I tried.

The public seems to think that doctors are miserly moneygrubbers, so the fact that I'd go out of my way to help a stranger, even one who lived in my town, doesn't mesh with that picture. Add in the gross distortions of who I am and what I am like when smeared by people either bereft of intelligence or ethics, and the chasm between that depiction and reality becomes even wider.

Thus I know what Angelina Jolie was speaking of in the November 27^th 2011 episode of 60 Minutes when reporter Bob Simon asked, “The vast majority of Americans know you because you're on the cover of magazines every week and every time they go to a supermarket, they see you. What are they missing?”

Jolie: Um, me. I don't see those things, and I don't know what they are, but I assume—

Simon: (cutting her off) Sure you do, you know what they are.

Jolie: I assume they're not me. They're not who I am, they're not what I spend my day caring about. I find them quite shallow and often very wrong when I do hear about what they are.

Whether one is a virtual unknown like me or a famous celebrity like Angelina Jolie, busybodies with small minds are eager to evince their intellectual shortcomings by discussing us even when they're dead wrong, and their time would be better spent discussing more substantive topics.

As I've become older and hopefully wiser, I've lost most of my affinity for ER stories even though the events I depicted were presented to illustrate compelling ideas. However, that message was lost on many readers who can't read between the lines.

Conclusion? Some people are impervious to the facts. If their small minds are filled with a conviction that doctors have a Scrooge-like affinity for money and contempt for their fellow human beings … well, there is no way to get through to them.

Speaking of aging, wisdom, and money, allow me to address one of your primary questions.

Money? Forgeddaboutit!

As long as you have MD after your name and a license to practice medicine, you won't starve (something I did before I became a doctor) or go homeless. With the basic necessities of life not in question, doing what you love is vastly more important than the ability of an orthopedic surgeon to drive a Mercedes SUV instead of one from the erstwhile Big Three, or to live in a 7000 sq ft home instead of squeezing into 4500 sq ft, six bedrooms, four bathrooms, and a master suite sure to attract women willing to share it … but for all the right reasons? I figured that out before a golddigger pretended to like me long enough that a judge would award her the house plus alimony, but others—from many doctors to Rush Limbaugh—are not sufficiently honest with themselves to understand that the magnetic attraction some women have for them draws them to their wallets instead of their hearts.

You were correct in suggesting that I've had an interesting life, which has been considerably more exciting and diverse than I ever could have imagined, and likely even spicier than you might think after reading the small part of it I revealed online and in my books. If I revealed it all, one might conclude that becoming an ER doctor was the fast track to a fascinating life.

While ER docs do lead high-octane lives, most of them are just filled with stress and too much caffeine in a desperate attempt to sufficiently fuel themselves hoping to meet the demands of the many challenges they face. The calls from Hollywood, the offer to co-host a Discovery Channel health show, the friendship with a mutual friend of Katie Couric who wanted to set me up on a blind date with her—for most ER docs, such offers never come. Heaven knows why so many rained down on me. Perhaps it is because, as the Discovery Channel producer said after reading my Fascinating Health Secrets book, “Dr. Pezzi, there are thousands of books on health, but no one writes like you.”

Or reads like I do. I read about medicine, of course, but also a wide variety of other topics, some of which turns out to be applicable to health or related topics, such as how to boost mood, creativity, or intelligence, though most of what I've learned about those topics resulted from serendipity: fortuitously stumbling upon interesting, useful information. I even found a nifty way to cure writer's block. A tip like that could make a world of difference in the life of a writer, or someone who aspires to be one. However, most people are as unwilling to pay for such info as the aforementioned gifted producer who wanted me in his movie. Now that I'm offering to give free microhomes and other stuff (e.g., firewood and Thanksgiving dinners) to people, I need to make money to support my addiction of helping others.

Another discovery enabled me to effectively squeeze more time into each day, but they all still have 24 hours. Hence, I need to be selective in choosing who I should respond to when my inbox is full of messages from people requesting help about an amazing diversity of topics. Your message resonated with me, so I put aside my almost endless “to do” list because I was eager to help you not make a common career mistake: focusing on money.

Do what you love and what you're especially good at, and the money will come. That's trite but true.

Now that I am delivering life advice, here's a bit more than you asked for: forget about beautiful women. You might be one of the lucky men who finds a hot woman with a great mind and big heart who genuinely cares for others, someone who is down-to-earth, interesting, and fun with a wonderful personality, but statistically speaking, you are more likely to find such gems if they aren't wrapped in a body hot enough to turn heads.

Every time I say something similar, I hear from women who are hot in more ways that one: hot in appearance (or so they claim), and hot under the collar that I would dare suggest something almost every man eventually learns if he has at least a room-temperature IQ. I'm hardly the first, or even the billionth, man to make such a connection. In retrospect, I am surprised that it took me so long to realize that what my Mom said was true. (To understand why it is often true, read about the beautiful woman syndrome.)

I am not as dogmatic as some people think. I truly listen to others and consider the merits of their positions when they differ from mine. When I'm wrong, I readily admit it. I never attempt to be consistent; I attempt to be correct intellectually and morally, and to constantly improve. If I were consistent, my errors of yesterday would become errors of today.

A few months ago, a perceptive and attractive woman wrote to me, disputing that the beautiful woman syndrome is limited to beauties. In responding to her, I realized that she was correct. Our culture often produces people with inflated self-esteem but no rational basis for it. Thus, you might find a Plain Jane convinced she's hotter than Angelina Jolie, smarter than the President, wiser than her parents, and kinder than Mother Teresa. More likely, she's living in a dream world: one you don't want to share. Healthy self-esteem is good, but an unjustifiably big head is not.

I realize that I did not date enough women to draw statistically valid conclusions, but from my limited experience, there was—at least in retrospect—an obvious inverse correlation between pulchritude and pleasant personalities housed in women with big hearts, not heads. Angelina Jolie appears to be one of the exceptions, and I previously dated someone as yummy on the outside as she was on the inside.

Most men aren't that lucky. They go hunting for foxes and are outfoxed by them, playing games they don't even recognize as such, with the Machiavellian foxes devising rules that favor them, all of it getting further and further from what should be the goal: for a compatible couple who genuinely love one another as people (not for their appearance or money) to augment each other, forming a sum greater than the combined parts. When Aristotle said, “The whole is greater than the sum of its parts,” he may very well have been speaking of relationships.

So after forgetting about money, forget about finding a fox. Instead, find your best friend. Beauty can last a lifetime, but considering the junk most folks eat, it usually lasts no more than 10 or 15 years. Let's see: A lifetime with your best friend, or spending your life with a cranky entitled ex-Princess who lost her looks decades ago?

Mmmm, not a tough choice.

Next bit of avuncular advice: don't be “house poor.” I previously discussed this, so I won't repeat what I wrote.

Next tip: Endeavor to treat every patient as if they were a beloved member of your family, and put yourself in their shoes, seeing things from their perspective. If I could cite one thing most healthcare personnel do wrong, this would be it. They often become cynical and burned out, viewing patients as enemies or potential enemies, and the patient encounter as a game they can win by perfunctorily going through the motions. Wrong.

Dead wrong. Patients aren't stupid; they see right through such phoniness.

Give patients a break. If you see a struggling single mother fretting about how she can afford to buy the medicine you just prescribed, give it to her, if you have it in your personal stash. I dispensed so many drugs from the ER that the hospital brass asked me to get a pharmacy license, which I did. If you don't have the drug in your free mini-pharmacy, open your wallet and hand her some cash. You won't starve, trust me, but she might. Before I became a doctor, my family was sometimes so poor that I developed two diseases stemming from nutritional deficiencies, sometimes ate food my Mom found on the side of the road, and sometimes starved, losing so much body fat that a medical student I knew suggested I apply for a job as a surface anatomy model. Consequently, I know what it is like to be very poor, and it's very noxious.

Many of the problems you'll encounter in the ER are not medical problems, or not entirely medical problems. You could do what most ER docs do: shrug your shoulders and say they aren't your problem. That's true, and you have no obligation to give money to folks who need it more than you do (the government does a good job of helping high-income earners do that), but if you truly care about people, the joy of giving will ensure that you will receive more than you give.

My generosity toward patients eventually led to an automobile salesperson to bluntly inform me that I drove a “loser's car,” and she even insulted my shoes. Perhaps because I am so down-to-earth and don't act like a doctor snob, many patients said they felt as if they could tell me anything—even things they'd never told their spouse or the family doc they had for decades—just five minutes after meeting me in a very busy ER! That unpretentiousness may have led to the mortgage broker mentioned above feeling free enough to reveal what she thought of my income, and it likely led to the insults at the car dealership, though the latter was too shockingly offensive to have originated solely from my lack of ostentation and easy-going nature. As I mentioned in a blog posting, that sales person was smoking hot and likely accustomed to saying whatever she wanted to men—and getting away with it. The corrupting influence of beauty, once more.

Next tip, and perhaps the biggest one of them all: Learn the secrets of happiness, including the “Holy Grail of Happiness” tips that can make almost any day a blissful one, with your veins bubbling with pleasure and a burning desire to help others.

Why do most people want to make money? Because buying stuff makes them feel good or, more precisely, they think it will make them feel good. It often does, but not for long. The ephemeral blip of joy is rarely as high or as enduring as they thought it would be. Even most mega-lottery winners return to their baseline of happiness. I've met very wealthy people in the ER who were very miserable, and not just because of their temporary problems.

You're likely wondering why I don't reveal all the secrets of happiness that took me decades to discover (I began discussing this topic in my blog, but have lots more to add, including the big tip). If I did that, 99% of people would just gloss over it. The Internet has produced such a profusion of information that identifying the really good stuff is often difficult. Years ago, after thinking of a perfect way to instantly erase racism, I posted it without fanfare on one of my sites, and later another. No blaring trumpets; no “THIS IS GREAT!!!!!!!!!!!!!” hyping. Its value would be so obvious that touting it seemed as unnecessary as Angelina Jolie stating she was pretty. (If you doubt the need to rapidly reverse racism, read this.)

Another example: People have paid billions of dollars to online dating sites that charge for the privilege of communicating. Posting and searching profiles is typically free, but to make contact, you're got to pay. Until I came along. I thought of a legal way to circumvent this “pay to contact” model, so I created a free site (ContactMeFree.com) that made the Internet truly free on dating and other “pay to contact” sites. No hacking, nothing unethical, just using logic to figure out something that was very obvious to me, but evidently not others. When I revealed the secret and gave Internet users a free online tool to break down what many presumed to be an insurmountable barrier, I assumed folks would tell their friends, and those friends would tell other friends, with viral word-of-mouth testimonials doing all the marketing I needed. “Selling” that site would be as difficult as selling dates with a friendly beauty queen—or so I thought. I've since learned that we live in an inside-the-box world filled with inside-the-box people and inside-the-box ideas. Any truly novel outside-the-box idea, even if its value should be readily apparent, is often missed by inside-the-box people with inside-the-box myopia that blinds them to everything except inside-the-box ideas.

A woman brushing her teeth in the 1800s

Take something as basic as toothbrushing. Seems quite desirable, huh? The first ones to do it were viewed as oddballs and ridiculed. “You're doing what? Why would anyone want to do such a silly thing? Brush your teeth? Ha-ha-ha!”

In the 1930s, Americans wondered why anyone would want to use shopping carts—then a new invention—in grocery stores. Customers were used to hand-held carts. Make them larger, and put them on wheels: two free hands, no gravity constantly tugging on their arms … wow, really obvious benefits, right? However, owners were so exasperated by customers continuing to use hand-held carts that they hired people to push the new carts around their stores. Apparently monkey can't do until monkey sees.

Conclusion? Even for what should be simple, obvious advances, monkey can't put 2 and 2 together until monkey sees it in action, and getting monkey's attention long enough to make him see something can be a problem. That's undoubtedly why many companies hire celebrities to market their products. Good products shouldn't need such endorsements to sell, but companies producing countless products and services know that getting people's attention long enough to impart even simple ideas often takes a celebrity, who often can offer no more than T&A to encourage you to buy whatever is being sold.

I never made enough money to hire a celebrity to “sell” my solution to racism or my free site to make the Internet truly free, so folks ignored them, in droves. Pity them.

ContactMeFree didn't draw enough users to justify the time and expense of maintaining it, so I took it down. There are 24 hours per day, and I have better things to do, such as focus on publicizing my solution to racism, bigotry, homophobia, and other unjustifiable bias. I am patiently biding my time, waiting for the perfect opportunity to promulgate my remedy to this festering problem.

Like kids who want candy, not nutritional advice, adults don't want advice that keeps them from doing what they want to do.

I realize that life advice is generally as welcomed as dietary advice given to kids carrying a big bag of Halloween candy. I rejected the advice given to me when I was young, though I later found that the recommendations could have helped me live an even better life.

However, often the only lessons that really sink in are those acquired in The School of Hard Knocks. Perhaps having the freedom to make mistakes and learn from them is part of what life is all about. Had I not lived in a big house, I would not realize how that can downsize happiness (see my free Microhome Living book and website). Had I not dated some gorgeous women, I would not realize how beauty often carries a hidden price tag. There is no law of biology necessitating a correlation between pulchritude and inflated self-esteem, but the cultural glorification of beauty ensures that those who have it are more likely to have big heads and small hearts that give others big problems.

The common denominator in healthy self-esteem is the ability of the lauded attribute to help others. If you, as an ER doctor, can save more lives and help more people than other ER physicians, you can and should feel very good about that. Your self-esteem hurts no one and helps many in priceless ways. The desire to maintain and increase your self-esteem will motivate you to burn the midnight oil. As some of your colleagues are skiing in Vail or sailing on sunny days, you could be hitting the books, working overtime to become an even better doctor.

This model looks like a clone of a doctor I know, but
as far as I know, this is just a model, not a doctor.

In contrast, the self-esteem possessed by people in love with their appearance helps no one but themselves. I've been with babes when others weren't within earshot, hearing them say things to make it very clear that they thought they were better than others just because they were better looking than others. That gets really old, really fast.

When I think of some of the beauties I dated, I wonder what they did of significance to help anyone but themselves. I did more some days in the ER than they did their entire lives. I excelled in reviving patients who were coding as well as those otherwise on the verge of death, such as a young asthmatic patient rushed to the ER by a deputy sheriff (in that county, the paramedics were deputies) who'd given her various treatments en route to the hospital, none of which worked. I'd seen countless patients with asthma, but no one this bad: she was unconscious, unresponsive, and diffusely a deeper purple than the pen I used to write orders, but I saved her life and she's now probably making lunch for her kids or enjoying the sun on a beach. Ditto for countless others.

Sure, working as an ER doc gave me endless opportunities to help, but I've saved lives when I didn't have my white coat on and otherwise helped people. Did the babes shovel chest-deep snow from the driveway and porch of an elderly disabled person, as I've done? No.

Did they give away free eggs, as I've done? Or free meals, firewood, and microhomes?

Did they pay a programmer in India twice as much as their contractual obligation at a time they desperately needed the money for themselves? I did.

Did they offer to sell their Sea-doo, Ski-doo, and shed to help a deported person reenter the United States? I did.

I could fill a book listing what I've done to help others, but what did those beauties do? Admire their reflections in a mirror? Make others feel bad for not being as attractive? One babe repeatedly told me about her sister's fat legs and other beauty imperfections she didn't possess—clearly she felt superior because she looked better.

Our strange culture is paying a price for its strange priorities. We glorify models, athletes, folks from Hollywood, and assorted celebrities while brainiacs with calculators strapped to their belts are ignored or made the butt of jokes. We know who invented the lightbulb*, but we don't know who invented anything else. We repeatedly fall for politicians who excel in talking, not leading or thinking.

The laws of success are as immutable as the laws of physics. Is it any wonder why America is failing?

All the twists and all the turns in my writing. Desultory? No. While I have a reason for saying everything I include, the manner in which I concatenate it is calculated to help my readers augment their intelligence if they're patient enough to read all or most of my websites and books. I mentioned that goal years ago, attracting the attention of a struggling student who seemed as likely to get into medical school as I would be to get into the finals of the Mr. Universe contest, but that man is now near the top of his class in medical school. I've helped others who already graduated and are now leading successful careers in medicine.

One of my goals isn't just to help people become doctors, but better doctors with more brainpower and compassion. If you've seen what average doctors do, you know why I work as hard as I do to right-shift the bell curve of intelligence.

Contrary to what neuroscientists claimed until recently, intelligence can be permanently improved. Stuffing more information into the brain does little or nothing to boost IQ, just as loading more information into a computer's RAM won't improve its CPU. Just as the latter can be improved by giving it better instructions, giving the brain better operational rules improves its ability to process information and generate new ideas by putting facts together in novel ways that lead to new breakthroughs.

We need new breakthroughs to kick-start our economy. The pace of American innovation once was sufficient to fuel our growth, but our inventiveness has stalled, producing lots of little ideas that don't add up to a hill of beans. In some ways, for all of our supposed progress, we've taken giant steps backward. For example, as I discussed in my blog, the men who built the Erie Canal did so with amazing speed in spite of their lack of technology, completing it at a cost (even after adjusting for inflation) that we couldn't begin to touch in the 21^st century even though we now have huge earthmoving machines that can do more work in a day than a man—or even a man with a horse—can do in a year.

As we ruminate about how all of our giant leaps forward have taken us so far backward, let's ponder something else—something I find utterly fascinating and profoundly important: just as it is possible to boost intelligence and creativity, it is possible to boost other facets of mental functioning, such as empathy.

A Science Channel program (Ingenious Minds) featuring John Robison documented how researchers working with him helped him overcome his Asperger's syndrome, one manifestation of which is limited empathy.

I feel the same way. I never had Asperger's syndrome, but I once had the usual level of empathy—in other words, not much. I cared primarily about myself. Just as Robison was angered by hearing people repeatedly mention things he could not see, I was angered when I'd hear liberals discuss compassion and righting wrongs, which translated into higher taxes or greater national debt, necessitating higher eventual taxes. I'd done far more than my share of giving, and I was tired of conservatives being labeled as cold-hearted if they resisted higher taxation. Give more? Get lost—or so I thought at the time.

Fortunately, as I proved in my blog, it is possible to give more to people in need while lessening the burden on those who give. Since I seem to be the only one who's figured this out, let's call this Pezzi's New Math, giving us a way to have a whole that is greater than the sum of its parts, just as Aristotle said.

Making the net cost of giving less than zero will surely catalyze it. Politicians wise enough to realize this could help everyone—from those on the Left to those on the Right and those in between—while helping themselves achieve the Holy Grail of politics: having a platform that is so clearly superior they have an insurmountable edge in every election, instead of power perennially bouncing back and forth as voters lose faith in the ability of one party to solve problems only to return power to a party that has repeatedly proven they're much better at helping themselves than helping us.

The future of America—if it has one—is to set aside partisan bickering about how to divide the pie, and instead adopt my plan for expanding the pie, making it sweeter than ever yet very healthy.

My desire to give skyrocketed after I stumbled upon a way to amplify pleasure, fun, and happiness. A smart billionaire who knew that secret would give most of his fortune to learn it, because it can do much more than money to give the joy and contentment we all so desperately crave.

Alone or in conjunction with my secrets for happiness, my seemingly pie-in-the-sky solution (of how we could give more to people in need while lessening the burden on those who give) could transform the world. It'd be like a Christmas when gifts cost nothing, so there was no excuse to be a Scrooge.

With such clear benefits made possible by thinking outside the box, we need to stop glorifying inside-the-box thinking. There is no inside-the-box solution that could give virtually everyone the world they'd most like to live in. Instead, Group A fights Group B, trying to carve up the pie so they have more of it. That's not very empathetic. Nor is it very smart now there's a way for everyone to have more.

Small-minded people will surely bristle at the suggestion that a political outsider can present a solution that politicians cannot see, but marked innovations almost always come from outsiders who think outside the box.

An advertising slogan created for Apple Computer in 1997 brilliantly explained how “the round pegs in the square holes, the ones who see things differently” who are “crazy enough to think they can change the world, are the ones who do.”

For all the lip service given to the importance of tolerance, we remain an abhorrently intolerant culture, with many of us eager to pillory others who don't agree with us on everything. If crucifying or picking apart are not sufficient, blatant lies may soon follow.

Example: Mitt Romney wants voters to believe he obviously has The Right Stuff to be President of the United States, yet he told a bold-faced lie in an ad that twisted what Obama said, making him appear to say the antithesis of what he actually said in context. For that outrageous distortion, PolitiFact gave Romney's portrayal its Pants on Fire rating. I agree. I'm no fan of Obama, but I am a fan of fairness and truth.

One of the many pathways to empathy is to suffer what you later lament. If you've been the victim of a malicious distortion, you are more likely to deplore them. Though my empathy was already ascending, it may have gotten a boost from people telling Pants on Fire lies about me, such as claiming I sold something I never did, and suggesting I am tickled pink about the subjugation of Native Americans even though I am part Native American and I had forcefully explained why that subjugation was wrong and why it shouldn't be ignored. What's next for the liars? Claiming that Colonel Sanders wasn't fond of chicken? That Santa hates children?

Teachers and professors need to do a better job of helping students acquire empathy. I've spent more time in school than 99% of the population, yet I saw no conscious effort to impart empathy. Educators evidently think students will soak up optimal levels of it, but that expectation is as realistic as wafting a stalk of broccoli past a child's nose and expecting him or her to thereafter crave its goodness.

Teachers and professors, need I say this? Give a child an Internet connection, and he or she can learn much more from it than from you. Once more than a few parents realize this, they may question why we need so many well-paid educators, and you may be standing in line to apply for work at Wal-Mart or McDonald's. Want fries with your order?

Educators should—but often don't—earn their keep by giving students important lessons they cannot easily acquire on their own. Even relatively advanced topics, such as surgery, can be learned by reading about it. When I was a poor teenager and had one of those faces that looked as if I'd been hit by a shotgun blast or two, I fell head over heels for a down-to-earth and kind yet beautiful cheerleader. With more than the usual teenage anxiety over my appearance, I sought to correct the problem. I did that by reading about skin anatomy and the dermabrasion procedure. Twenty minutes later, with 15 of those minutes spent summoning up my courage, I headed for the garage and picked up the only piece of sandpaper I had. It'd been on the shelf for years and hence was hardly sterile or even clean, but when you're poor and desperate, you do desperate things. I was desperate for Carol to love me, so I sanded the skin off my face, often wincing in pain but never thinking of stopping. In retrospect, I did a better job than most plastic surgeons. I transformed my face with 10 cents worth of sandpaper.

If a poor kid can teach himself something that typically remains esoteric knowledge until it is taught in a hospital to doctors who'd already graduated from medical school, do students really need educators to tell them about history, math, or more basic aspects of science than surgery? I don't think so. The times are changing, educators. Are you?

I wish that some teacher, instead of regaling the class with personal anecdotes about his wife or dog, would have spent that time helping students become more empathic. Teaching empathy is very easy, if you know how.

Next tip: Carefully consider where you want to live. This is one of the biggest career mistakes I made. I lived in a suburban area not because I liked it, but because an ER doc I knew from residency repeatedly called me, asking me to work for him. (Incidentally, he is the one who said I was the smartest doctor he ever met; he isn't the other boss I often mention: the buffoon who would have let a child die had I not taken over the case. The latter boss earned my everlasting enmity by caring more about appearances than saving lives. In another case, he manifested the same bizarre priority by stating that it would have been better to risk the life of a patient just so the doctor could look better. Nuts!)

I want to live where I have elbow room, with enough land on which to drive my rusty tractor and give a great life to my chickens, who I call “my babies.” One of my goals in life is to bring as much happiness as possible to as many people and animals as possible. I can't help the animals I want to help if they're not around.

You mentioned that you “sometimes ruminate about how different my future would be like as a Plastic Surgeon instead.” I thought of you when I read an article, Failing to commit: Maximizers avoid commitment in a way that contributes to reduced satisfaction. The title does not accurately reflect the point I'd like to make, which is better expressed in the ScienceDaily discussion of it: Second-Guessing One's Decisions Leads to Unhappiness, Psychology Researcher Finds.

While most physicians are committed to their specialty choices (since the cost of changing is so high), many docs later second-guess their decisions.

In The Science of Sex, I discussed adaptation and the diminution of joy. Here's my introduction to that topic:

In that book, I also analyzed why more choice can lead to less happiness, kicking off that discussion by writing:

Medical doctors have the same problem. If there were two specialties—medicine and surgery—picking the best choice would be easy, except for folks like me (and likely you) who enjoy both medicine and surgery—something that we, as ER doctors, get to do. One minute, I could be prescribing an overpriced antibiotic for a single mother who can't afford it and, after pulling some cash from my wallet, the next minute I could be cutting open a patient's chest, heading for the heart in a last-ditch attempt to save a life. Exciting, yes, but not as exciting as what I now do.

Having dated an internist (for the uninitiated, that is a physician specializing in internal medicine: what med students often call “eternal medicine”), and having heard her repeatedly vent her spleen on how bored she was with repeatedly seeing the same things (high blood pressure, diabetes, back pain, etc.), I witnessed how that boredom turned into anger that created an urge to mitigate it by mocking her patients, saying nasty things about them behind their backs.

As you likely know, she is hardly alone. Many docs aren't happy with their career choices. I hope to keep you from being one of them, not only for your own sake, but for the sake of your patients. Unhappy doctors leads to less-than-ideal patient care.

My ex-girlfriend the internist thought she was a sage and patients were darned lucky to have her as a doc. In truth, she was smarter and more knowledgeable than an average MD, yet she still had knowledge gaps that penalized patients. All doctors need to know nutrition and environmental medicine, because we all eat and live in an environment that can ruin our lives if we, for example, weld or take a shower, with the former a generally faster way to inhale manganese that can cause problems most physicians never get to the root of.

In my experience, unhappy doctors are content to go through the motions of practicing medicine, doing the minimum required CME but not reading a wide variety of topics that could help them help patients. Consequently, augmenting physician happiness is important, so factors that impact it—such as happiness with specialty choice—is also crucial.

No matter what choices you make in life, there are usually better ones, but by trying to find them, you can undermine your happiness and bypass opportunities that may not be the best, yet may be better for you. If you read my analysis of this in The Science of Sex, you'll understand this paradox.

Here is a real-world example: When I purchased the land I now live on, I hired a builder who evidently thought I was too stupid to realize he substituted the trusses I specified (ones that would have enabled me to have a second story) with ones in which the W-webbing precluded any attic living space. To make a long story short, I forced him to compensate me for cheating me out of the living space I would have had. The compromise we settled on was that he would build a 12' x 16' shed—which, in retrospect, wasn't nearly enough to make up for the loss of having a second story on my home.

Flash-forward a few weeks, and I watched as the excavator dug a deep hole for the shed's foundation. I wondered why on Earth (no pun intended) he was going so deep. He explained the dirt in the top soil layers wasn't adequate for a foundation. OK, fine.

About 6 feet down, he struck a huge mass of telephone wire. That's odd, I thought, because I knew no home had ever been on this land. Telephone wire? Here? That far down? It wasn't anywhere near the buried telephone line on the other side of the road; it didn't make any sense.

My lighthouse shed

That mystery would remain a mystery for years, during which time I dug other holes with my various tractors and eventually bulldozer (the same one that broke my neck, but that's another story). I even leveled a hill, harvesting its dirt to extend another hill, on which I placed my lighthouse shed. In the midst of all this digging, sometimes just a couple of feet down, and other times ten or more feet down, I repeatedly noticed something really odd: pieces of old machinery and even plastic, along with an ancient Stanley hammer and other stuff.

I understand that some people bury trash on their property, but TEN FEET DOWN?

Does. Not. Compute.

Ten feet down in multiple areas?

Really does not compute.

Shortly after I purchased this land, which was heavily wooded in some areas and open in others, I noticed a hunting blind perched in a tree, with a rickety wooden ladder leading up to it. I had better things to do than to investigate that, such as keeping my eye on my unethical builder (I heard that he later lost his building license, which didn't surprise me).

Then, years later, curiosity got the best of me. I was driving a tractor pulling a trailer carrying a ladder that I'd just used to trim branches in a tree near one of my many trails. As I neared the old hunting blind, situated a few steps away from the trail, I decided to use that ladder to climb up to the blind, expecting to perhaps find some old fired cartridge casings.

What I found was something else: a box with a diary in it, discussing his quest to find the gold his partner (in crime?, I wondered) buried here before he suddenly died. The diarist knew the gold was here—but where?

That search seemed to consume him, motivating him to dig holes searching for it.

The diarist, evidently not realizing his grammatical mistake of using multiple exclamation points, detailed the locations of holes he dug searching for “300 pounds of GOLD!!!!!!!!!!!”

Aha, now the holes on my land made sense, with ones marked by the diarist in spots, such as where I later put the 12' x 16' shed, where I'd found junk deeply buried, for a reason I still don't know, but probably just a convenient spot to discard his trash. People who dig for gold, just like everyone else, still have trash to get rid of, and in those days, there was no weekly trash service to pick up his junk. I probably would have buried it, too.

300 pounds of gold is now worth $7.7 million, not exactly a mega-fortune, but enough to live very well without ever working. With that much gold on my property, one might think that I'd spend less time with my chickens and more time with my bulldozer that, unlike most dozers with a front blade, has an enormous front bucket that is great for scooping out and moving literally tons of dirt in one swipe.

So why don't I dig for the gold? First, after breaking my neck with the dozer (not digging for gold, BTW), I don't like even looking at that thing … it just brings back bad memories. I've healed fairly well (not perfectly), and the limitations on what I can't do (at least safely) bother me so much, being the active person I am, that I'd love to sell the dozer AND the land, getting as far away mentally and physically from reminders of that fateful day when the dozer changed my life.

However, even without that mishap (that a seat belt could have easily prevented), I wouldn't dig for the gold—not seriously, anyway. On a couple of occasions, digging for something else (usually to remove a stump or smooth a trail), I went a bit deeper, knowing that I could be inches away from $7.7 million, which is likely still buried here, somewhere.

While my land is very beautiful, it is marred by two power lines, one near the road, and one about one-third the way toward the back, with the back power line owned by a different power company. Angered by how they sent in a massive machine to trim trees, I decided to challenge them on their legal right to enter my property, seeing if they had the papers giving them a right-of-way.

Darn, they did, which they proved by giving me a photocopy of a microfiched document showing how a prior owner (the diarist?, I wondered) sold them the right-of-way for a pittance. No one who had 300 pounds of gold and an ounce of common sense would permit such an ugly right-of-way intrusion for such a small amount of money.

It's very tempting to dig for the gold, but I think I am better off by NOT doing it. I might go outside, fire up the dozer, and find the gold in five minutes, or I might waste the rest of my life doing it. I have ten acres, which is a lot to dig up, even with a bucket-equipped bulldozer. There is probably a fairly easy way to locate it (metal detector or ground-penetrating radar), but I wouldn't feel right taking that money.

About a month ago, I was killing time by the road, waiting for my mail lady to arrive, since I knew I would be getting a large package of fabrics I ordered to make super-thick mittens and a hat. I wanted to save her the trouble of driving up my 400' driveway because a friend's car parked there made it difficult to use the turnaround spot. As I waited, I trimmed small brushy trees by the road. While I did this, I noticed a middle-aged man and two kids intently searching through the weeds by the road, about 200 feet away from me. Slowly, they made their way toward me.

I assumed they were looking for a pet that was struck by a car, or perhaps they lost something, so I asked the girl (the one closest to me) what they were doing. Her father approached and explained he'd been jogging when he found money thickly scattered by the side of the road. He said he stuffed his pockets until they were full and went home to get his children to help him search for more, which he found. He suggested that I might want to help myself to some of the money (he likely said that to mitigate his guilt about entering my property), but I knew the money wasn't mine, so taking it didn't strike me as being the right thing to do. I went back to clearing my brush and waiting for the mail lady with the fabric and Thinsulate™ Ultra insulation stuffed in a Priority Mail box.

If anyone is less idealistic than I am (too idealistic, according to my girlfriend) and don't mind waiting for spring to dig (the winter is rapidly approaching), I'll gladly sell you my property and toss in the dozer. Just be sure to add a seatbelt! I'll miss the beautiful land (except for the frigging power lines), and I'll miss the beautiful smile of my mail lady (whose smile is better than any Hollywood star), but I won't miss the too-frequent reminders of the day I broke my neck. Incidentally, this home is not the same as the one mentioned in the beginning of my response, which feels like I began it a century ago.

Now it's time to see what my babies are doing! :-)

One of my chickens (my babies) with a curious mind, inspecting the dozer and perhaps wondering if she could drive it. My chickens are fascinated by my tractor and bulldozer because they love to hunt for bugs in the freshly-turned soil they churn up.

UPDATE: A reader changed my mind about something I discussed in this article; you can read about that in these topics:

1. Working part-time as an ER doctor
2. Doing the right thing

1. Sleep (& fun) deprivation in medical education: contrary to Maslow's hierarchy of needs
2. Starting an ER group or Urgent Care Center

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