altDemocracy, like love, is often blind, lacking cool objectivity and critical distance. But the deepest truths are written in braille. If the directions which our profession should take are not felt, they are not truly internalized. This country is in trouble, and I’m a patriot. But a true patriot weeps more than he brags.

A Samuel Beckett play is somewhat like a confession without hope of absolution. A sense of sin that lies too deep to be expiated. Past societal guilt about present actions continue and such remorse is denied relief. Beckett’s characters reach out for affection, and frustratingly embrace only the tormented feelings of themselves.

It’s that time of year again, when I am “forced” to prepare for the ACEP national meeting, the Scientific Assembly. It’s in San Francisco this year – not bad. It has a list of courses that boggles the mind and virtually every committee of the college, as well as the ACEP Counsel and Board of Directors, comes together to debate the issues of our time.

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.

altInductive 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.

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