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

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

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

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

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

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

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

After all charges were dropped yesterday against the Duke University students accused of raping the black exotic dancer (or is it more politically correct to say African-American exotic dancer?), I began to think of various things our society does that perpetuate the corrosive aspects of discrimination and racial bias. Ironically, in an attempt to help black people, societal do-gooders have implemented affirmative action programs that perpetuate racial divisiveness and breed resentment as well as skepticism of minority accomplishments.

As an undergraduate at Michigan State University, I witnessed MSU do something in the name of helping black students that should incense anyone who cares about justice and academic integrity. I wrote about this topic years ago on my www.ERbook.net site. Here’s an excerpt:

I worked for MSU tutoring primarily minority students [all of whom were black]. In the course of my tutoring job, I discovered that MSU had certain class sections that were hidden from other students—and hence inaccessible—in the course enrollment book. Certain sections were reserved for athletes, and certain sections were reserved for qualifying minority students. Students in those classes were guaranteed a passing grade if they merely showed up for the exam and signed their name. (Perhaps the professors in those classes took to heart the quip by Woody Allen, “Eighty percent of success is showing up.”) If the students attempted to answer any of the questions, they were given a B, and if they got any question correct (even if it was by random chance), they were awarded an A. That ticked me off! I had to work my butt off to succeed, and here were people being given a free ride through life just because of their skin color or because they could catch a football. However, it is important to note that not all minorities and athletes were handed a degree on a silver platter after four years of pretending to be a student; some of them took regular classes and worked just as hard as anyone else. Nevertheless, the fact that any student could be awarded college credit in such a fraudulent manner is alarming. Why it happened is another matter. My guess is that the university bowed to political pressure to graduate more minorities—and we all know that sports teams can be big money-makers for colleges, so there is an obvious incentive to give dumb jocks a helping hand.

It is no secret that affirmative action exists, but I was shocked by the degree to which it is sometimes so blatantly offensive. This isn’t just offensive to hard-working non-minorities who are displaced by minorities given an unfair boost, it is also a slap in the face to hard-working minorities who achieve success on their own. In fact, those latter people should be particularly incensed, because the existence of these scandals undermines public confidence in the legitimacy of their achievements.

People who criticize affirmative action risk being labeled as prejudiced. Research has shown that all humans tend to possess a reflexive distrust of others who are not like them. Basically, xenophobia seems to be part of our genetic heritage. However, I think that this innate tendency can be overcome by one’s life experiences. For example, in the ER I noticed that black patients, especially older ones, tended to like me more than white patients. I am not sure why that was true. Perhaps it is because I treated them with respect and concern, which they may not have been used to getting. In any case, it is natural to like people who like you.

Furthermore, when I meet a black person who is intelligent and contributes to society instead of having his hand out, I like that person even more than I would someone with equal attributes who is white. Based on that, if I harbor any prejudice as a white person, it seems that any bias I have is a slight bias against white people. Consequently, if I speak out against affirmative action, it is not a manifestation of prejudice. I think affirmative action, although well-intended, hurts everyone in one way or another. I think that there are better ways to achieve diversity. For example, Joe Klein wrote an interesting article in the December 18, 2006 issue of Time magazine entitled “There’s More Than One Way to Diversity.” After reading him for years, I believe that his opinions tend toward the left side of the political spectrum. If Joe Klein criticizes affirmative action, then there is probably something fundamentally wrong with it. I think that Mr. Klein and others would be even more critical of it if they knew of some of the most heinous things done in the name of affirmative action, such as the sham college degrees awarded to some black students by Michigan State University.

The February 12, 2007 issue of Time magazine included an interesting article by Scott Haig, M.D. entitled Doctors without Dollars. As Dr. Haig illustrated, the traditional practice of medicine is no longer as lucrative as it once was, so doctors are looking for other ways to make a living. Some doctors have turned to cosmetic surgery and offer things such as laser treatments, Botox injections, and hair transplants. Other doctors offer alternative medicine therapies that border on quackery, yet pay better than mainstream medical treatment. Many doctors have left the practice of medicine altogether, and are now stockbrokers, financial analysts, or realtors. I discussed this topic several times in my www.ERbook.net site, beginning in 1996. I graduated in the top 1% of my class in medical school and was trained as an ER doctor, yet I would rather mow lawns or do virtually anything else than work as an emergency room physician. I know one surgeon who quit his job to become a bartender in Montana, another surgeon who now sells Amway products, a neurosurgeon who is a plumber, and a few doctors who are now artists. Then there's the internist who sells women's clothing in her home, a cardiologist who now makes furniture, and a doc who makes stained glass windows.

Years ago, it was almost unheard of for doctors to transition to other careers. If you were smart enough and dedicated enough to become a physician, and you were lucky enough to pass all the hurdles that society imposes, then you generally practiced medicine until the day you retired. Medicine was perhaps the prototypical “great career,” offering respect, unsurpassed job security, and income that ranged from excellent to superb. Finding a doctor who was a millionaire was about as surprising as finding a cheerleader who is pretty.

Medical careers no longer offer such financial security. Some docs continue to rake in money, such as ophthalmologists who perform LASIK operations and can make more money in an hour than many other doctors make in a week or two. However, many other doctors now make less money than some real estate agents, salesmen, autoworkers, UPS drivers, and even teachers (I prove how a UPS driver can earn more than a doctor on my www.ER-doctor.com site on this page). Nothing against teachers, but becoming a teacher is considerably easier than becoming a licensed physician. Paradoxically, many people still harbor the notion that doctors are overpaid. The father of one of my ER patients mumbled something about “you doctors are paid too much,” and then demonstrated his resentment by leaving the emergency room to smash my car, much to the amazement of the security guard who witnessed this.

As I mentioned in my ER site and some of my books (Fascinating Health Secrets and True Emergency Room Stories), society has a vested interest in training and retaining the most intelligent, dedicated, and conscientious doctors. To get the best people, society must pay them very well and reduce the endlessly escalating hassles of medicine, such as dealing with unfathomable bureaucracy imposed by the government and insurance companies, as well as the ever-present threat of a malpractice lawsuit even when no medical errors were committed (a Harvard study revealed that over 80% of malpractice lawsuits lack merit). The more noxious a medical career is, the more likely it is that the most intelligent people will choose another profession. I made that prediction several years ago, and just after that the number of people applying to medical school dropped four years in a row—something that had never occurred before.

What is even more worrisome than the declining number of applicants is the fact that such a dwindling pool invariably reduces the quality of it. Consequently, many people who now get into medical school would never have been accepted two decades ago when I applied, when the competition was fierce. While watching ABC-TV’s The Bachelor with a friend who is a cardiac nurse, we were amazed that the bachelor, a young physician, had actually graduated from medical school. After listening to his characteristically unintelligent manner of expression, we looked at one another and simultaneously asked, “Is he retarded?”

His place in medical school could have been taken by someone with more brainpower, but as I mentioned elsewhere, many of those people with higher IQs who would have chosen a medical career years ago are now repelled by the realities of modern medical practice and therefore chose another career. Anyone smart enough to be a good physician has the intelligence to do countless other things. It is easy to find a job that pays better than medicine, requires less devotion, and does not require working nights, weekends, and holidays.

My mom died of cancer two years ago, and I truly resent all the holidays and other family get-togethers that I missed because I had to work. Once those precious family days are over, they are gone forever. I was willing to make that and 1001 other sacrifices because I thought that I would eventually be rewarded for doing things that no human being should ever have to do. How many of you have worked 40 hours in a row? I’ve done that numerous times with no sleep and no breaks, working at a frenetic pace to treat trauma and other patients who constantly poured into the hospital. Trying to cope with these impossible demands, some of my colleagues turned to amphetamines. I was offered speed but declined it, instead choosing to drink liters of Pepsi and chew caffeine pills as if they were candy. My ER residency director once commented that I was the smartest resident they ever had, yet she also chastised me once or twice about how cranky I was. Gee-whiz, I wonder why? After years of sleep deprivation and running on so much caffeine that I shook like a leaf, it is no freaking wonder that I would be less than diplomatic when, for example, a nurse refused to chaperone me so that I could perform a pelvic examination on a rape victim who was very eager to get her evaluation over with so that she could go home and shower. In this case, the nurse was just standing around waiting for her shift to end, but I didn’t want the patient to wait for the next shift, which could have imposed a delay of an hour or more.

A few days ago, a 14-year-old girl with aspirations of a career in emergency medicine wrote to me and asked various questions, one of which was if I would still go into medicine if I had to do it all over again. Emphatically, NO! I have written extensively on why going into medicine is now such an unwise decision that many medical students sincerely regret their career choice even before they graduate. I won’t repeat what I wrote before, but suffice it to say that I apparently made such cogent arguments for avoiding medical careers that many people have exhorted me to stop dissuading people from choosing to be a doctor. Those people pleaded with me, saying things such as, “We need good doctors.” I agree with them, but I do not believe that the way to get the most qualified physicians is to give people a misleading idea of what it’s like to be a doctor in the 21^st century. I am certain that I could sell more books if I did not have ethical reservations that precluded me from tricking or deluding people. However, I won’t lie or even shade the truth to make a buck.

If society wants the smartest and hardest working people to choose medical careers in the future, it cannot do that by deception. However, politicians are too stupid to understand the nexus between careers with second-rate rewards and career applicants with second-rate qualifications. Lawyers and bureaucrats have no incentive to back off, so for the foreseeable future medicine will continue to be a career that is best avoided. The smartest students realize this and often choose alternative careers, leaving the spots they would have occupied in medical school to people, like the bachelor, who amaze me not with their intelligence, but with their lack of it. Society needs the smartest possible doctors, but we are not doing what it takes to get them.

Update: This posting prompted a teacher to send me a nastygram complaining about what I said about teachers. This person was so hot under the collar that I wondered if he were mentally ill with a chip on his shoulder. What triggered his outburst was my statement that "becoming a teacher is considerably easier than becoming a licensed physician." This statement is so obviously true that arguing about it makes about as much sense as claiming that walking in a park is more arduous than running a marathon. The enraged teacher then rhetorically asked about the many teachers I had, whose tutelage enabled me to become a doctor. First, the best teacher I ever had was my mother, who had many jobs, none of which involved teaching. Second, only a few of my teachers were exceptional; most were decidedly lackluster. Bottom line? Most of the learning that propelled me to the top of my class in medical school (and beyond) was acquired from self-study, not from a teacher or professor. If teachers and professors really knew how to teach, virtually every student could replicate my feat of transforming myself from dunce to doctor. Even the best teachers cannot do that because their antiquated teaching methods do not provide the necessary catalyst to fuel that intellectual metamorphosis.

A high school teacher once took me aside and, almost gushing with stars in her eyes, asked me if I were John Denver. Umm, no. There were several reasons why that could not possibly be true:

1. I'm not named John. Or Denver.
2. I don't look like him (judge for yourself).
3. He was an adult when I was a kid in high school.
4. He was on tour and doing things that I could not have possibly done, given that I attended school five days per week.

Another person wrote to tell me how sick and tired he was of "greedy doctors" focused on money. Sorry, bub, but doctors are nowhere near the top of the ladder when it comes to greed; their lust for money is surpassed by lawyers, CEOs, gas and oil companies, actors, singers, assorted celebrities, software tycoons, professional athletes (most of whom refuse to perform unless they are paid far more in a year than most physicians make in a lifetime), and countless others. Second, that person totally missed my point that to get the best people in medicine (and retain them), society must be willing to pay for their brainpower and the many years of ungodly hard work and sacrifice that it takes to become a doctor. Make a profession less rewarding, and you'll simply divert the best and brightest into other careers.

A question for teachers: If teachers are doing such a great job, why can homeschooled kids routinely trounce their peers educated in public schools? Students who attend school have a number of advantages that should increase their performance, yet their achievements are often disappointing and even embarrassing manifestations that public school teachers have not implemented simple and effective ways to augment learning.

What do you do when a movie star's daughter begins to tell you intimate details about his love life? Well, if you're an ER doctor, and that daughter is your patient, you close the door, then sit and listen. So I did. I generally do not have much time for listening, but this shift was slow, and I was curious to hear what she had to say — and why she wanted to tell me. I'm an ER doc, not a psychiatrist, but listening is (or should be) something that all physicians do.

The daughter, who I'll call Amy, came to the ER for a bladder infection, so this catharsis was unrelated to her presenting complaint (i.e., ostensibly why she came to the ER). Amy's parents are divorced, and she attends a private school far from home. She spent last Christmas with her Dad and his girlfriend Heather, who is scarcely older than Amy. Amy was "creeped out" (her terminology, not mine) by this for the obvious reason, and one not so obvious. You figure out the former; I'll tell you the latter. Amy thought that Heather was the epitome of an airhead, and devoid of common sense when it comes to matters that are better left unsaid. Such as an explanation of why her father was so good in bed, and why Heather's last lover was not. Amy did not know how to respond to such revelations, and she wondered if Heather was high on something. Amy tried changing the subject to more appropriate topics, but Heather demonstrated no apparent interest in discussing music, sports, hobbies, or her family. Just sex.

Amy said that when her father was present, Heather never discussed sex. However, when Heather and Amy were alone, Heather would return to her favorite subject. Amy had enough of this after three days, so she called her mother and asked to spend the remainder of the Christmas vacation with her. When she told her Dad why she was leaving, he looked at Heather in stunned disbelief, blushed, then stormed out of his house. Amy left before he returned, and never mentioned the subject to her mother.

Amy was dreading the next time she would see her Dad, or speak with him. He hadn't called in a month, which is very atypical for him, so she knew that he was avoiding her. She did receive some encouraging news from her mother, who — unaware of Heather's inappropriate Christmastime chitchat — said that Amy's Dad was no longer seeing Heather. That's good, but how to repair the relationship with her Dad? Should she call? What should she say? Or should she continue to wait until her Dad called? Amy was concerned that she might embarrass her father even more if she were to call, and she thought that he would call when his humiliation subsided. However, she wanted my opinion. My opinion as a doctor, or as just another person? Before I had a chance to respond, I was paged to the Trauma Room to treat the survivors of a head-on collision. As I completed their paperwork 90 minutes later, I suddenly remembered Amy. I went to see her again, but she'd already left. She has a history of frequent bladder infections, so I may see her again. By that time, I hope that the discomfiture between Amy and her father will have dissipated. I don't have any brilliant tips for mitigating what is bound to be an awkward conversation.

The recent press coverage of how war veterans receive substandard treatment in VA hospitals might lead you to believe that such deplorable treatment is a new development, probably triggered by VA hospitals being overwhelmed by the number of injured vets returning from Iraq. In reality, veterans have been getting the short end of the stick for years, even in times of peace and prosperity. I wrote about this in my first book, Fascinating Health Secrets:

America's raison d'être is freedom. Millions of Americans have fought to maintain our freedom. These veterans deserve our respect and gratitude. And how do we thank these veterans? By giving them health care in the most backward system in the United States, the Veterans Administration (VA) hospitals. The conditions there are atrocious, and unimaginable for most of us. I will never forget coming in one morning and seeing a man lying dead in the hallway, with people passing by him as if he were a cigarette butt.

During my stint in medical school, I became acquainted with the VA concept of medical care. For example, I remember calling to check on a lab result for one of my patients. I was curtly informed that the test would not be performed. Curious, I asked why. I was told that the budget for the month had been exceeded, and therefore the test was automatically cancelled. I asked if I could reorder the test. I was told that it would not change anything; the test was cancelled, and that was that. How disgusting.

By applying that same standard to the veteran when he was in World War II, he should have been able to tell his sergeant, "Sorry, sergeant, I've done my quota of work today. It's quitting time. Tough luck." A serviceman with that attitude would be shot. We don't give military personnel the option of excusing themselves from work because they feel as if they have already done enough. So why should we tolerate an abnegation of our promise to provide medical care for our veterans? They are the ones that deserve the best possible medical care in the United States — not the crack-head scumbags who litter the ERs, saying, "I be havin' chest pain." No shit. If I did $600 worth of crack in a day, I'd have chest pain, too.

Medical resources are now, and will always be, limited. Why, then, should we give the best possible medical care to some pimp or dirtbag drug dealer who gets shot by one of his rivals, yet tell a man who fought for the survival of this country that he doesn't deserve to receive any more health care? Where is the logic in that? There is none! And what about the multitudes of steatopygic welfare recipients? It takes a lot of food to result in such physiques, and the money that bought that food was paid for with tax dollars. I say, take the money from them and give it to a group that truly deserves it, the veterans.