TIME psychology

Quiz: Are You A Narcissist?

Take the Narcissistic Personality Inventory, developed by Robert Raskin and Howard Terry.

Check the answer in each pair that comes closest to describing you. Don’t leave any pairs blank; try to complete the survey in just a few minutes. The highest possible score is 40, the lowest is 0.

Penguin Group

Excerpted from The Narcissist Next Door: Understanding the Monster in Your Family, in Your Office, in Your Bed—in Your World

Read More: The Evolution of a Narcissist

TIME Books

The 5 Greatest Fantasy Novels of All Time

From C.S. Lewis to Susanna Clark, Magicians author Lev Grossman makes his top picks

TIME book critic and technology writer Lev Grossman recently published The Magician’s Land, the final book in his fantasy trilogy. To accompany his essay about how fantasy literature is transforming the pop-culture landscape, he’s also named the five most influential fantasy books ever written.

TIME Healthcare

One Patient, Too Many Doctors: The Terrible Expense of Overspecialization

Doctored, by Sandeep Jauhar
Doctored, by Sandeep Jauhar Courtesy Farrar, Straus and Giroux

As physicians become more specialized, our health care system becomes increasingly costly, sloppy and disorganized

Not long ago, a primary-care physician called me about a patient with a right-lung “consolidation” — probably pneumonia, though a tumor could not be excluded — that a lung specialist had decided to biopsy. My colleague wanted me to provide “cardiac clearance” for the procedure.

“Sure, I’ll see him,” I said, sitting in my office. “How old is he?”

“Ninety-two.”

I stopped what I was doing. “Ninety-two? And they want to do a biopsy?”

My colleague, who is from Nigeria, started laughing. “What can I tell you? In my country we would leave him alone, but this is America, my friend.”

Though accurate data is lacking, the overuse of health care services in this country probably costs hundreds of billions of dollars each year out of the $3 trillion that Americans spend on health. This overuse is driven by many forces: “defensive” medicine by doctors trying to avoid lawsuits, a reluctance on the part of doctors and patients to accept diagnostic uncertainty (thus leading to more tests), lack of consensus about which treatments are effective, and the pervading belief that newer, more expensive drugs and technology are better. However, perhaps the most important factor is the overspecialization of the American physician workforce and the high frequency with which these specialists are called by primary-care physicians for help.

The past half-century has witnessed great changes in American medicine. One of the biggest shifts is the rise of specialists. In 1940, three-quarters of America’s physicians were general practitioners. By 1960 specialists outnumbered generalists, and by 1970 only a quarter of doctors counted themselves general practitioners. This increase paralleled an equally dramatic rise in medical expenses, from $3 billion in 1940 to $75 billion in 1970.

Specialist-driven care has now become a fact of medical practice. In the past decade, the probability that a visit to a physician resulted in a referral to a specialist has nearly doubled, from 5% to more than 9%. Referral rates to specialists are estimated to be at least twice as high in the U.S. as in Britain.

The consequences for patients are troubling. Besides high costs, having too many consultants leads to sloppiness and disorganization. As Drs. Donald Berwick and Allan Detsky recently wrote in the Journal of the American Medical Association, inpatient care at hospitals has become a relay race for physicians and consultants, and patients are the batons.

I remember a 50-year-old patient of my Nigerian colleague who was admitted to the hospital with shortness of breath. During his monthlong stay, which probably cost upward of $100,000, he was seen by a hematologist; an endocrinologist; a kidney specialist; a podiatrist; two cardiologists; a cardiac electrophysiologist; an infectious-disease specialist; a pulmonologist; an ear, nose and throat specialist; a urologist; a gastroenterologist; a neurologist; a nutritionist; a general surgeon; a thoracic surgeon; and a pain specialist. The man underwent 12 procedures, including cardiac catheterization, a pacemaker implant and a bone-marrow biopsy (to investigate only mild anemia). Every day he was in the hospital, his insurance company probably got billed nearly $1,000 for doctor visits alone. When he was discharged (with only minimal improvement in his shortness of breath), follow-up visits were scheduled for him with seven specialists.

This case — in which expert consultations sprouted with little rhyme, reason or coordination — reinforced a lesson I learned many times in my first year as an attending physician: in our health care system, if you have a slew of specialists and a willing patient, almost any sort of terrible excess can occur.

What to do about this overspecialization? One option is accountable-care organizations, an idea put forward by the Affordable Care Act, in which teams of doctors would be responsible (and paid accordingly) for their patients’ clinical outcomes. This would force specialists to coordinate care. Unfortunately, most doctors, notoriously independent and already smothered in paperwork, have generally performed poorly in this regard.

Reforms will also have to focus on patient education. Medical specialty societies recently released lists of tests and procedures that are not beneficial to patients. By using these lists, cardiologists have been able to decrease their use of imaging tests by 20%. Better-informed patients might be the most potent restraint on overspecialized care. A large percentage of health care costs is a consequence of induced demand — that is, physicians persuading patients to consume services they would not have chosen had they been better educated. If patients were more involved in medical decisionmaking, there would be more constraints on doctors’ behavior, decreasing the possibility of unnecessary testing. This could serve as a potent check on what the doctor ordered.

Today roughly 1 of 6 dollars spent in America goes toward health care. If we do not succeed in controlling these costs, they will gradually crowd out other necessary societal expenditures. Improving health literacy will be critical to these efforts. Without a better understanding of what doctors are actually doing, one may end up like the patient who had 17 consultants and 12 procedures and who reinforced a further lesson I have learned many times since entering practice: when too many specialists are involved in a case, the result too often is waste, disorganization and overload.

Jauhar is a cardiologist and the author of Intern: A Doctor’s Initiation and the new memoir, out today, Doctored: The Disillusionment of an American Physician

TIME Books

The Real-Life Alex From Orange Is the New Black Is Writing a Memoir

Laura Prepon orange is the new black season 3
Jill Greenberg—Netflix

Piper Kerman's former lover will share stories from her life in drug-trafficking and her time in prison

Fans of the Netflix show Orange Is the New Black can read Piper Kerman’s best-selling memoir of the same name to find out the real-life story of Kerman’s time in prison. And soon, they’ll be able to hear the same story from another perspective—that of Cleary Wolters, Piper’s lover, who inspired the character of Alex Vause on the show.

The real-life inspiration for Vause, played by Laura Prepon on the comedy drama, has signed a deal with HarperCollins’ HarperOne to publish Out of Orange in May of 2015. Wolters, who went to jail for participating in a drug trafficking and money laundering scheme, will address her complex relationship with Kerman, her crimes leading up to her imprisonment and her experience inside prison in the book.

“Alex [the character] and Piper have inspired me to tell my whole story — an unbelievable saga that takes place all over the world: Africa, Europe, Asia, and the U.S. both in prison and out,” Wolters said in a statement. “I think people may be surprised at what happened to me after I turned myself in — and where my life is now.”

TIME Books

Meet J.K. Rowling’s New Harry Potter Character

Celestina Warbeck, the "Singing Sorceress," is a favorite of Molly Weasley

J.K. Rowling unveiled a new character in the Harry Potter universe Monday, and she’s a stylish songstress who just happens to be Ron Weasley’s mom’s favorite singer.

Celestina Warbeck has never been seen in the flesh in any of the seven Harry Potter books, but Rowling wrote a new story about her excerpted on Today.com and released in full on Pottermore.com. Here’s a hint about Warbeck’s humble half-Muggle origins and her blockbuster music career:

Internationally-acclaimed singing sensation Celestina Warbeck (sometimes known as ‘the Singing Sorceress’) hails from Wales. Her father, a minor functionary in the Muggle Liaison Office, met her Muggle mother (a failed actress) when the latter was attacked by a Lethifold disguised as a stage curtain…

Some of Celestina’s best-known songs include You Charmed the Heart Right Out of Me and A Cauldron Full of Hot, Strong Love. Her fans are usually older people who love her grandstanding style and powerful voice. The late 20th-century album You Stole My Cauldron but You Can’t Have My Heart was a massive global hit.

You can listen to a full track of Celestina Warbeck’s hit single You Stole My Cauldron but You Can’t Have My Heart on Pottermore.com, but you need a membership and you have to “unlock” it first by playing in the Pottermore universe.

[TODAY]

 

 

TIME Books

Why You Need to Hit the Beach Right. This. Second.

506064383
4kodiak—Getty Images

There's some serious science behind water's ability to reduce stress, inspire creativity and promote empathy. How's that for a day in the sand?

What is it about water that pulls us, soothes us, inspires us and connects us?

During the decade I spent pursuing that simple question for my book Blue Mind: The Surprising Science That Shows How Being Near, In, On, or Under Water Can Make You Happier, Healthier, More Connected, and Better at What You Do, I interviewed and met people around the world with a wide variety of relationships to water: surfers, swimmers, psychologists, artists, ocean managers, fishers, veterans, captains, floaters, neuroscientists, explorers, divers, inventors, educators, poets—and people with the surname Cousteau.

Being by the water can pull the stress from us, inspire creativity and draw us closer to those we love. Research shows that feeling of awe and wonder we get by the sea can also promote compassion and empathy.

Turns out there’s some serious science behind the Beach Boys’ famous lyric, “Catch a wave, and your sittin’ on top of the world.”

So dive in and rank how blue your mind is—or how beach deprived you might be this summer—with this quiz.

Wallace J. Nichols is the author of Blue Mind and a Research Associate at the California Academy of Sciences. He has spent his life getting near, in, on, or under waters all over the world. He also loves sea turtles.

MONEY

Amazon vs. Disney, Explained by Classic Animated Character Quotes

140811_EM_AmazonDisney
Hugh Jackman as Wolverine in X-MEN. 20th Century Fox Film Corporatio—Everett Collection

If you're having trouble understanding Amazon's battles against Disney and the Hachette Book Group, perhaps some wisdom from Jiminy Cricket, Wolverine, and Dr. Doom can clear things up.

In its storied, revolutionary history, Amazon.com hasn’t been hesitant to employ ruthless strategies in its quest to rule retail. The company’s tactics have been so tough that they’ve inspired consumer boycotts from time to time. Amazon’s latest skirmishes position the world’s largest e-retailer in standoffs against Hachette, a book publisher being pressured to lower its prices, and Disney, which failed to reach some contractual agreements with Amazon, and which is being punished by Amazon’s refusal to sell preorders of some of its movies.

We thought it would be helpful—or at least a heckuvalot more fun—to explain more about the ongoing disputes using classic quotes from Disney films and Marvel Comics, which Disney also owns.

“I just can’t wait to be king.”
These words, sung by Simba in Disney’s “The Lion King,” sum up the ambitions of Jeff Bezos and Amazon: The goal is to be the undisputed king of selling us stuff. As soon as possible, naturally. From one-click ordering to Amazon Prime, and from it forays into everything from groceries to a phone that encourages users to shop more at Amazon, it’s clear that Amazon wants to be the Everything Store—and to so thoroughly dominate the world of e-commerce that it essentially takes over the retail world.

In any attempted coup, the grab for money and power can be ugly. Often, the subjects aren’t happy with the policies and terms dictated by the new ruler, especially when they question the legitimacy of the king. In this case, Disney, Hachette, and others are the subjects that aren’t happy with how the self-appointed new ruler is trying to push them around.

“If your heart is in your dream, no request is too extreme.”
Jiminy Cricket said these words to Pinocchio, who dreamed of being a real boy. Amazon’s dream is different—to be the real boss of retail. To make Jeff Bezos’s wish come true, Amazon has been making some fairly extreme requests, including an insistence than Hachette cap its e-book prices at $9.99. Amazon is also using some extreme negotiating tactics in its standoff with Disney, notably making it difficult or impossible for customers to pre-order some of the company’s highly anticipated movies, including “Maleficent,” “Muppets Most Wanted,” and “Captain America: The Winter Soldier.”

“I am but a humble servant of my people!”
Amazon’s justification for playing hardball with movie companies and book publishers is that it is merely fulfilling its mission to serve its customers best, by way of figuring out how to offer them the absolute lowest prices possible. “We will never give up our fight for reasonable e-book prices,” Amazon said in a recent statement, regarding its ongoing dispute with Hachette. “We know making books more affordable is good for book culture.”

Oh, and where did the quote above about the “humble servant” business come from? It’s a line from Dr. Doom, who was constantly being stopped by the Fantastic Four in his life’s mission to take over the world.

“Avengers, assemble.”
Whenever the bad guys are doing something bad, Captain America calls his Avenger teammates to join together and put an end to the mayhem. Likewise, more than 900 authors have joined forces in a call to arms to stop Amazon’s attempt to break Hachette. “We feel strongly that no bookseller should block the sale of books or otherwise prevent or discourage customers from ordering or receiving the books they want,” reads a statement signed by writers such as Stephen King and John Grisham that was published in a New York Times ad over the weekend. Among the other forces that are gathering allies and assembling for war: Google and Barnes & Noble, which teamed up last week in a direct attack on Amazon when they announced they would jointly offer same-day delivery of book purchases.

“With great power comes great responsibility.”
The famous wisdom of (Uncle) Ben Parker directed his nephew, Peter Parker (a.k.a. Spider-Man), to the path of righteousness. Critics say that Amazon is being irresponsible with the great power it now wields, and literature and the publishing world are among those being hurt as a result. In an open letter titled “If I Were Jeff Bezos” published last week on CNN, best-selling author James Patterson wrote that if he was the Amazon founder and CEO—the guy known for the “superhuman confidence of his laugh”—he would not be “so carried away with this success that I am going to lose sight of scale or sanity. Sure, I have ushered in the age of Internet commerce, but, no, I am not now hanging around just to collect my financial reward, or even to bask in the public recognition.”

And why not? “You see, I, Jeff Bezos, am actually trying to make this a better world … You think I want to be known as the man responsible for the biggest quality drought in the history of novel writing?”

“You give them an inch, they swim all over you.”
Retailers and manufacturers enter tough negotiations all the time behind closed doors; what’s unusual here is that these squabbles are repeatedly being fought out in the open, for all to see and judge. “It’s rare in physical retail to have contract disputes become so public. Most retailers just aren’t willing to hurt themselves by cutting off sales,” Forrester Research analyst Sucharita Mulpuru told the Wall Street Journal. “Amazon has demonstrated that they’re not going to be the one to blink in these negotiations.”

On the flip side, Disney and the book publishers don’t want to give an inch in negotiations. If they did, the fear is that Amazon would swim all over them, so to speak, in every future negotiation, to paraphrase Sebastian, the crab from “The Little Mermaid.” Sebastian was talking about teenagers, not power-hungry corporations, but you get the idea.

“There is a war coming. Are you sure you’re on the right side?”
Wolverine hadn’t really chosen a side yet when he said these words to Storm in the original “X-Men” movie. The typical consumer probably hasn’t chosen a side in the Amazon wars either. But essentially we’re all being asked to pick—more money and power for the seller (Amazon) or the producer and manufacturer (Disney, Hachette). By following the X-Men metaphor through, you’re siding with a mutant no matter which way you go.

It’s up to you to figure out which side is figuratively being led by Charles Xavier, and which is helmed by Magneto. And how do you decide? Let’s turn back to Jiminy Cricket for an answer: “Always let your conscience be your guide.”

TIME Books

50 Great Books That Will Change Your Life

Real Simple asked renowned authors from every genre in the bookstore to name the title that moved them most. Here are the works they passionately recommended—from classic to obscure, wisecracking to wistful—and the discoveries that they found inside. Visit realsimple.com to read the full list.

Here are the first five books:

  • Alice’s Adventures in Wonderland by Lewis Carroll

    “If you have never read this classic, or pooh-pooh it as being only for kids, think again. Alice and her adventures will make you see things with childlike curiosity. The story helps us remember that we need to be playful in love, life, and especially words.”

    Recommended by Lily Koppel, the author of two nonfiction books, The Astronaut Wives Club ($28, amazon.com) and The Red Leather Diary($15, amazon.com).

    To buy: $25, amazon.com.

    (MORE FROM REAL SIMPLE: 5 Ways to Win People Over)

  • Black Tickets by Jayne Anne Phillips

    “I took a fiction workshop with Phillips in college and was shocked when she assigned her own book. (It’s a collection of stories about everything from serial killers to mothers and daughters.) But I’m glad she did. Never before had a book given me permission to write so frankly about sex and sexuality, to try on different voices, male ones included, and to write from a dark, honest place. The stories are varied, some emotional and others shocking, but they are all authentic and utterly compelling.”

    Recommended by Jennifer Gilmore, the author of three novels, the most recent of which is The Mothers($26, amazon.com).

    To buy: $14, amazon.com.

  • The Best American Short Stories

    “I first read this collection in the early 1990s. Culled annually from magazines, the anthology was my introduction to legends of the short-story form—John Updike, Joyce Carol Oates, as well as then-newcomers Lorrie Moore and Charles D’Ambrosio. I was amazed by the ability of these writers to bring a page alive with sly humor and perfect sentences. To this day, I still consider the anthology the ideal place to discover a new writer or remember why I love one to begin with.”

    Recommended by Curtis Sittenfeld, the author of four novels, includingPrep ($15, amazon.com) and the forthcoming Sisterland($27, amazon.com).

    To buy: $15, amazon.com.

    (MORE FROM REAL SIMPLE: What Do Your Fingers Say About You?)

  • Drawing on the Right Side of the Brain by Betty Edwards

    “I once confessed to a girlfriend (who is a designer) that I was inept at drawing, and she told me about this book. It breaks drawing down into five basic perceptual skills—of edges, spaces, relationships, lights and shadows, and the whole—and provides instruction on dipping into our right brain, which helps develop overall creativity. And who couldn’t use a dose of creativity?”

    Recommended by Elaine Griffin, an interior designer and the author ofDesign Rules: The Insider’s Guide to Becoming Your Own Decorator($25, amazon.com).

    To buy: $20, amazon.com.

  • The Inn at Lake Devine by Elinor Lipman

    “I read this punchy romantic comedy while finding the courage to leave my job as an attorney. The story, which centers on a Jewish girl’s fixation on an anti-Semitic hotel in Vermont, stayed in my mind and heart and filled me with the notion of becoming a writer: I can do this, I thought while turning every page. At the very least, I have to try.

    Recommended by Emily Giffin, the author of Where We Belong($16, amazon.com), as well as five other novels.

    To buy: $15, amazon.com.

TIME celebrities

Kim Kardashian Is Publishing a Book of Selfies

Universe

The selfie-titled book is due out next spring

Kim Kardashian is coming out with a book of selfies called Selfish. The 352-page hardcover ($19.95) will be published in April 0f 2015, by the Universe imprint of the renowned art bookseller Rizzoli, E! reports.

During an episode of Keeping Up with the Kardashians, the 33-year-old reality TV star said she got the idea from a “sexy” Polaroid photo book she gave hubby Kanye West for Valentine’s Day. “It ended up turning out so cool that we come up with this idea to do a book, a selfie book,” she says. “And so, I’m going to make some super-racy. I mean every girl takes full pictures of their a** in the mirror…I might share some of them.” (For background, see the viral one she posted last fall to show her fans how her backside looked after giving birth to North West.)

That means you can probably expect most of the book’s 352 pages to be filled with selfies like this one she posted a week ago featuring Kanye lying in bed with the caption “Side chicks be like….”

And in addition to the risqué ones, will she publish the selfies that she risked her life taking? Like that time she got “attacked” by an elephant mid-selfie in Thailand? (Well, technically, the elephant was just trying to “kiss her back,” she joked at the time.)

 

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