Having begun the discussion on power last month, we move now to the types of power that emergency physicians actually possess, and how they can be utilized. The first is the power to reward. I urge you to use it early, often and with reckless abandon.

Power is an unusual commodity for many reasons, not the least of which is the fact that you first have to decide what it is. To my mind, the most useful definition is “the ability to influence events and outcomes in one’s favor.”

Pope John Paul II, in his seminal work Fides et Ratio, states that “Faith and reason are like two wings on which the human spirit rises to the contemplation of truth.” Democracy, more than any other form of government known to history, requires the exercise of reason on the part of its citizens in order to function.

Inductive reasoning begins with observation and moves with variable speed to generalized theory. Deductive reasoning moves the other way: theory, hypothesis, observation and finally confirmation. But when you are dealing with risk management issues you need to do both simultaneously or you can be caught by the tsunami of thought and blown out with the tide of history.

Our mortality is both certain and universal. We are born, live and die, pretty much following the path of maturation, procreation and disintegration as homo sapiens have done for the past 175,000 years.

It is a moral imperative that EPs become philosophers, asking the critical questions of why we do what we do. In his 1981 magnum opus After Virtue, Alasdair MacIntyre – who may be our greatest living philosopher – challenges us to look for a new paradigm to examine our life’s work and accomplishments.

To reprise anything, one first has to conclude that it made some impact the first time. Following the entr’acte, you expect only the mellifluous strains that carry the strong feelings of the first act. To this end, I want to acknowledge all of you who have written about the last column which dealt with the natural maturation continuum of a career in emergency medicine.

“Laborare est orare”-Horace/St. Benedict. This famous quote from Horace can loosely be translated as, “To work is to pray.” St. Benedict, in his grail-like quest for Western monasticism, used it to point out to his devotees the value of work.

To think that ethnic prejudices are the only prejudices we carry around is a huge mistake; we have all kinds of forces that push the way we believe and act every single day. The key to being an emergency physician is understanding your own prejudices and controlling them.

This year, on the exhibit floor, there were at least four booths advertising scribe systems. I don’t understand why there weren’t 14. As there is going to be more pressure on medicine to produce more patient care for less money, the scribe is the obvious way to go.