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


My response to a sarcastic doctor

Q: Thank you for all the wonderful information! What better way to prevent the brightest young minds from entering the field of medicine! Much better to have our smartest and most ambitious driving around in UPS trucks or for Uber.

Sure, you're right that being a doctor does not guarantee wealth and many docs live paycheck to paycheck; but I would be remiss as a fellow physician to not point out that your pessimistic view and overall negative impression of medicine (clearly derived from your time as an ED doc where burn out is way too common) are not a fair representation of why people go into medicine in the first place. I think an approach such as that taken by the White Coat Investor is not only more accurate than the picture you paint, but also does not paint medicine as a relative graveyard where smart people go to kill their career ambitions.

I don't disagree with the information you have provided but rather your overall catastrophic tone and clear bias against medicine, so I think you should take responsibility for the fact that you're going to dissuade some amazing people from going into medicine who could really make a difference. Not to mention if we get more good people into medicine, we can clean up this mess in terms of ridiculous med school costs and declining reimbursement.

Bottom line: You as a physician have a responsibility to the future of medicine to provide accurate, realistic information to future doctors, but not to seek to dissuade them from entering medicine in the first place due to your own bias. And if you do, you should take responsibility for that and accept the damage you are doing.

All the best,
– CantsavetheworldfromaUPStruck

Answer by , MD: I will preface my response by excerpting a section from an article I'm writing:

How selective reporting distorts the truth

Cardinal Richelieu said, “Give me six lines written by the most honorable of men, and I will find an excuse in them to hang him.”

It's true; it is so easy it's child's play. With a real-life example, watch me turn a hero into a villain worthy of a long prison sentence, if not hanging:

When I was about 8 years old, I was in the middle of a lake when a stranger plucked me out of the water, threw me in his boat, and raced me to his house where he carried me inside, took me into his bathroom where his mother immediately stripped me naked without saying a word—and with me also speechless, frozen in fear, my young mind not fully grasping what just happened and what was going on, all without precedent in my life.

What I reported so far is all true and makes them sound as if they are kidnappers and child molesters.

Now let's add context and see how the story changes. I'd fallen through the ice, struggling unsuccessfully to get out when the man, in his late teens or early twenties and dressed in a white short-sleeved T-shirt (no coat, brrr!), pushed his skiff toward me while running. After pulling me and my dog out (he'd also fallen through the ice) and taking me into his home, his mother removed my clothes soaked with freezing water and put me in a tub of warm water because she was obviously concerned about hypothermia.

Omitting context makes them sound evil, but with context, they sound like intelligent, concerned, and heroic people. A hero goes above and beyond the call of duty or responsibility and puts his or her life in jeopardy to help a stranger and his German Shepard—grabbing one by the neck takes courage! The man who rescued me repeatedly fell through the ice, but used his boat to distribute his weight across the thin ice and pushed himself up to keep coming toward me. He could have stayed in his home or looked up the number to the county sheriff (911 service didn't exist then) and called him to fish my body out of the water. Or he could have retreated to safety the first time he fell through the ice, but he didn't.

That is a hero, yet omitting details paints a distorted picture and blurs the context so much they seem like scoundrels.

I usually don't bother responding to people lacking the courage to identify themselves because it's so easy for a nameless, faceless person to look at something I wrote and draw erroneous conclusions from a fraction of it. You must have missed the several times when I changed my opinion, yet even if everything you claimed is true, those prior writings serve to balance the predominant overall too-rosy picture of what medicine is like from its many cheerleaders who gloss over the drawbacks of medicine, luring in students until it is too late, with many of them burned out and depressed before they complete medical school (the references listed on this page are alarming yet just a fraction of what I could cite, with all of that suffering very real and predictably stemming from those drawbacks).

As you noted, my perspective was influenced by working in the ER; had I chosen another specialty, I'd likely be less pessimistic. However, I've heard from many docs in other specialties who rue their career choice, and in my career knowing many doctors of all types, only a handful seemed to generally enjoy medicine while the rest manifested varying degrees of cynicism, bitterness, anger, irritability, hopelessness, depression, and coldness. They felt beaten by a system that is perennially dysfunctional and feeble because of its lack of cohesiveness. It's not that doctors aren't smart enough to figure out how American medicine isn't optimally serving patients (but doing a great job of financially raping them); it's that docs are generally too pusillanimous to stick their necks out and DO something. They just complain. I've heard decades of whining yet rarely see anyone lift a finger.

“Don't find fault, find a remedy; anybody can complain.”
— Henry Ford

My goal was two-fold: discourage the moneygrubbers, the marginally qualified, and the marginally committed while encouraging the best of the rest, and to help them whenever I could—and I did, investing years of my life (unpaid) helping thousands of them around the world become doctors. As I previously mentioned online—and you overlooked—pointing out drawbacks sometimes enables people to avoid them or to minimize their impact.

How many students have you helped, Doctor Innominate? And exactly what are you doing to help patients receive markedly better care at significantly less cost? You deserve an award if you've done one-tenth of what I've done, most of which I've never mentioned online.

Precisely none of the doctors I know work 365 days per year as I do, primarily to help people avoid becoming patients. Instead, they devote their free time to frivolous activities such as wine tastings, fine dining, boating, traveling to ritzy destinations, and otherwise immersing themselves in meaningless pursuits. Isn't this odd? Aren't the best minds supposed to derive pleasure from more cerebral activities? Why not invent something conducive to health?

I never recommended driving for Uber (nor would I), but I noted how you trivialized the value of what UPS drivers do. Mine have delivered countless parts I've used to build prototypes of my inventions, all of which help people. I sold some of them to a company led by a friend of Bill Gates and have thousands more. The latest pertains to lawn care. How does that help people, you ask? People commonly perform that task using expensive, noisy machinery with engines that pollute the environment and emit exhaust they inhale.

For years I've followed research documenting the health hazards of exhaust, which are worse than most people—and doctors—realize. Then I had a flash of insight, thinking it might be possible to perform that task just as well or better without an engine or motor, using a new process I invented that is much more efficient. After a year of making and testing prototypes, I succeeded. To my knowledge, this is the first time in history that something without an engine or motor can outperform a ton of today's best machinery costing thousands of dollars.

This is a good example of what smart people should be doing: not sitting around criticizing others, but doing something to help people.

I'll list some of the benefits of this invention:

From a health standpoint, the big plus is the absence of pollution. Because my device can be sold for significantly less than powered equipment, that will encourage its widespread use. With millions of users, I will inevitably save lives otherwise lost to heart disease, cancer, and other problems.

I have other innovations with a more immediate impact on health for more people. When I told one of the smartest doctors I know, a former boss and now a venture capitalist, about three of them, he exclaimed “Holy shit!” and was eager to invest.

So, Doctor Innominate, what have you invented that amazes other doctors?

More quotes to ponder:

“The critic is a man who prefers the indolence of opinion to the trials of action.”
— John Mason Brown

“If we judge ourselves only by our aspirations and everyone else only their conduct we shall soon reach a very false conclusion.”
— Calvin Coolidge

“Don't criticize what you don't understand, son. You never walked in that man's shoes.”
— Elvis Presley

“If you are not criticized, you may not be doing much.”
— Donald Rumsfeld

“To escape criticism: Do nothing, say nothing, be nothing.”
— Elbert Hubbard

“It is much easier to be critical than correct.”
— Benjamin Disraeli

“Criticism is an indirect form of self-boasting.”
— Emmet Fox

“Criticism is the disapproval of people, not for having faults, but having faults different from your own.”
— Unknown

“Don't criticize them; they are just what we would be under similar circumstances.”
— Abraham Lincoln

“The pioneers take the most arrows.”
Google's Larry Page on Why Moon Shots Matter

“A critic is someone who never actually goes to the battle, yet who afterwards comes out shooting the wounded.”
— Tyne Daly

“It is not the critic who counts, not the man who points out how the strong man stumbled, or where the doer of deeds could have done better. The credit belongs to the man who is actually in the arena; whose face is marred by the dust and sweat and blood; who strives valiantly; who errs and comes short again and again, because there is no effort without error or shortcoming; who knows the great enthusiasms, the great devotions and spends himself in a worthy cause; who at the best, knows in the end the triumph of high achievement, and who, at worst, if he fails, at least fails while daring greatly; so that his place shall never be with those cold and timid souls who know neither victory or defeat.”
— Theodore Roosevelt

Roosevelt admired doers, not armchair second-guessers whose 20/20 vision is utterly worthless.

So what can you do to help?

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