Shirley M. Mueller, M.D.

Before I retired from medicine, I was showing signs of burnout and did not know it. All I knew was that I was miserable. 

The morning started out fine. By one or two, however, I was ready to flee. My thought was always the same—get in my car and drive West. What I imagined was that seeing the open countryside would make me feel free of all responsibility. At that moment, and, that time in my life, it was a welcome thought.

Well, that drive into the sunset never happened. After trying to scale down my practice, I was still in pain. As every practitioner knows, it is difficult to support staff while deliberately seeing fewer patients to save one’s own soul. I retired.

What might have spared me was not available then. But, fortunately for the medical profession, it is now. Enter Dr. Jed Brewer M.D, Ph.D., a neuroscientist, and psychiatrist, who transforms recent research findings into programs to treat addictions and burnout. Since Dr. Brewer is a physician himself, he is particularly sensitive to the plight of the medical profession, who now are not only under the usual pressures, but those of COVID as well. 

Dr. Brewer calls himself Dr. Jud, I assume to make himself more accessible. And, that he is, with his exceedingly calm demeaner and easy to understand instruction. 

His main message is that we humans are responsive to triggers which lead to an action that, in turn, precedes a reward. In its simplest terms, this is hunger (trigger), eat food (action), satisfaction and pleasure (reward). 

Of course, a nurse or physician’s response to a patient who is suffering is more complicated. When the medical caregiver identifies with the suffering herself (empathy), she hurts as well. This leads to burnout. Dr. Brewer refers to this as learned helplessness on the part of the medical caregivers.

On the other hand, he says that a different response to the same patient’s suffering can benefit both the medical professional and the patient. Instead of focusing on empathy, she places her energy into compassion. Then, even if the suffering on the part of the patient continues, she can feel as though she is contributing in the most effective way she can without a side effect of burnout or learned helplessness. She is not living the suffering, but a partner in obviating it.

Now, for a word about the difference between empathy and compassion, two words with similar but different meanings that can easily be confused. 

Empathy suggests that the caregiver relates to another person’s pain vicariously, as though she is experiencing that pain herself. Compassion, on the other hand, refers to both an understanding of another’s pain and the desire to somehow mitigate it—a broader definition.

Dr. Brewer tells this story in his elegant way in videos which, at the present, can be accessed free of charge by the medical profession. The advantage is that watching them takes little time and there really is nothing to lose except an hour or so. Please see them for a deeper understanding which Dr. Jud explains far better than me. 

Module 4: How mindfulness decreases clinician burnout and builds resilience

Module 5: How to move from empathy fatigue to compassionate action (and build resilience)

Putting Dr. Jud’s Program in Perspective

In the past, I recommended making art and appreciating art as a relief from the intensity of the medical profession, i.e. combating burnout. That series, 

, chronicled four M.D.s who found relief and joy outside of their practices through collecting art, taking photographs, making sculptures, and painting. 

Dr. Brewer’s approach, to me, is different. He wants to nip stress-related burnout in the bud by teaching those who are vulnerable to understand it better so that their response to it is healthier right from the get-go. In this way, there may be fewer cases to begin with—a victory not only for those in medicine, but their patients as well.

The views expressed in this piece are those of the author, not necessarily those of the publication.

Inside the Head of a Collector: Neuropsychological Forces at Play

Articles

As every practitioner knows, it is difficult to support staff while deliberately seeing fewer patients to save one’s own soul. 

Stress and Burnout:  A New Approach

It may not be as philosophical aquestion as Hamlet posed, butthe "to hire or not to hire a financialadvisor" question still requiresthe same prompt attentionâ€”especiallyif you're in need of financial help.Like other interested physician-investors,you're probably plagued bythe same doubt: Will a financial advisorreally help me or will they just bea waste of good money?

Unfortunately, the articles that arewritten about this subject tend to beboth dry and unhelpful. In addition,authors generally insist that anyonewith a credential (eg, CFP&#174;) will produceresults, which is not necessarilythe case. So then, just what shouldyou look for once you've decided tohire a financial planner? There are 2essential criteria your potential advisorshould meet.

First, your advisor's practiceshould offer full servicesâ€”beyondmoney management. Your advisorshould also instruct you on investmentplanning, trust and estate planning,charitable giving strategies, andwealth transfer strategies. If you'reconsidering an advisor in a largerfirm, check to see whether they offerbanking and family services.

When your advisor's practiceoffers full services, you benefit in 2ways. You won't have to shoparound for other financial services.All of your financial needs will betaken care of by your advisor. Inaddition, these needs will be takencare of by 1 practice, which willlikely make your total cost less.

Second, the practice that youradvisor belongs to should be large.Practice size is important because alarge practice ensures continuity inthe unfortunate case that somethinghappens to your advisor. For example,if your advisor leaves the firm ordies, you won't have to find areplacementâ€”saving both yourtime and your sanity.

If your chosen advisor meets thesecriteria, most likely you'll be workingwith Certified Financial Planner™practitioners, lawyers, trained investmentplanning specialists, and a hostof other professionals. Choosing theright firm means you won't have toworry about degrees, because thefirm already did the footwork for you.

Additionally, you'll be treated as awhole person. Your advisor won't payattention to only a portion of yourfinancial needsâ€”they'll keep all ofyour financial needs in mind.Therefore, your money managementwill be done in unison with otherfinancial factors in your life.

So, in your search for a qualifiedfinancial advisor, it's a good idea tokeep in mind 3 things: You deserve tobe respected, provided excellent service,and treated as a whole person.When you find someone who meetsthese requirements, you will knowthat you are making the right decisionâ€”and reap the benefits. 

 is boarded inneurology and psychiatry. Shewas a practicing neurologistuntil 1995. Since then, she hasretrained and is active in theinvestment and financial planningarea. Dr. Mueller is a senior wealthadvisor at Star Wealth Management in Indianapolis,Ind. She welcomes questions orcomments at MyMoneyMD@aol.com.

Don't Let Luck Lead Your Advisor Search

A few days ago, I had lunch with a physician-investorinterested in transferring his assets.In our discussion, he brought up someknowledgeable points that seemed to indicate hisgood judgment. However, while discussing his previousinvestment experiences throughout the years,he made a few statements that inspired adifferent opinion. As I finished off thelast of my lunch, I couldn't help butreflect on a common investing qualityassociated with poor judgment or shakethe feeling that I was staring across thetable at one of its victims.

Throughout our conversation, thephysician frequently discussed how wellhe had done in the past. He explainedto me in detail how he had made greatgains in the late '90s and how he hadcashed out of specific investments early.In his mind, this physician-investor hadsuccessfully managed to guide his portfolioto victory. And, obviously, hehad—reaching the top of his game andwinning in the market.

So, what's wrong with sharinginvestor war stories over lunch, especially whenthey're happy? Usually nothing. Most investorsenjoy patting their own backs every now and then,especially when it's well deserved. However, duringthis particular conversation, it wasn't so muchwhat my lunch partner said; it was what he didn'tsay. And that's what inspired my reflection on theterm "cognitive dissonance," which, unfortunately,seemed to have taken my physician-investorcolleague out to lunch.

Cognitive dissonance is a fancy psychologicalterm that means your brain ignores or lessens negativeinformation and fixates on the positive.Evidently, the brain does this to preserve our self-image;it's a protective strategy. To endure the realityof some of our poor decisions would cause toomuch pain. Therefore, we ignore negative evidenceor attenuate it by not recognizing thewhole truth. And although I didn'tknow my lunch partner that well, itseemed obvious to me that he dabbledheavily in cognitive dissonance.

While cognitive dissonance may notlead to eventual financial demise, lack ofrecognition can influence our decisionprocesses adversely. First, we may notmake necessary decisions because it istoo uncomfortable to contemplate facingunfavorable results. For example, wemay not keep accurate documentationof our investment results so that wedon't have to face the possibility of apoor outcome. Unfortunately, this typeof behavior can spell trouble forinvestors. Knowing our results usuallyhelps us invest better in the future.

In addition, we tend to sift through new informationto accommodate our beliefs that our previousdecisions were better than they really were. Inother words, we change our beliefs to suit our self-imageand not the facts. To illustrate this commonconsequence, a group of architects was asked toestimate the return in their pension plans the previousyear. They recalled their investment performanceas 6% higher than the actual return.Furthermore, they estimated that they had beatenthe market by 5% more than they actually had.Other studies have been performed with educatedinvestors, and the results have been similar.

So what does cognitive dissonance have to dowith you? Hopefully nothing. However, beingaware is the key to resistance. And although it ishuman to yield to cognitive dissonance, it is literallydivine to resist it. This means that objective figuresare necessary in terms of your investment performance.Not only do you need to know how wellyour portfolio performed in reference to its appropriatebenchmark, but you also need to know itsrisk-adjusted return. This is because the risk-adjustedreturn tells you if you are being compensatedin terms of return for the risk you're taking.

How do you find this data? Most of the time it'sdifficult, unless your investment advisor keeps trackof it for you and provides you with the informationregularly. This is 1 advantage of a good investmentadvisor. Ask them for this data if you're currentlyworking with one. It's much easier than trying tofind the data yourself. However, if you don't havean advisor and are interested in doing the legworkrequired, there are some useful Web sites you canvisit (see the sidebar for more information). By takingthe time to know objective results about yourinvestment performance, you don't have to accommodateyour beliefs about it. Ultimately, this canonly lead to better investment results for you. 

www.finportfolio.com/education/tutorial/tutorial_risk-adjusted_return.html

Information on the Sharpe ratio, which measures

www.investopedia.com/terms/s/sharperatio.asp

A Web site that offers risk-adjusted return on

The Great Investors Face Their Mistakes

I was discussing money management witha very successful man, whose wealth isbeyond the dreams of most of us physicians.He said, "I hope some of my moneycan be used to do something stupid." I wasunclear as to what he could mean. Heexplained, "You know, something stupid,like a high flier, something risky." I wasastonished. He was talking about amethod of investing that regularly erodesnet worth. Yet, he clearly wanted to do it.

Upon reflection, the man's statementprobably wasn't unexpected. He's a personwho attained his present position, in part,by taking risks. He not only enjoys risks,but may even crave them. For him, using asmall portion of his portfolio for a riskyhigh flier might be justified if it made himfeel good. He did have an abundantamount of money. But what about the restof us? Why consider a risky investment?

One major reason is the chemistry ofour brain. Dopamine release in the brainleads to a feeling of satisfaction. Somepeople have, what geneticists KennethBlum and David Cummings call, "rewarddeficiency syndrome." People with thissyndrome are unable to get sufficient satisfactionfrom the usual rewards in life andneed to up the ante. One way to do this isto take a risk, which releases dopamineand therefore enhanced satisfaction.

The geneticists have identified a variationof a normal gene that preventsdopamine from binding to cells in thereward pathway. Therefore, the satisfactionusually felt with the release ofdopamine is diminished and must constantlybe reinforced. Although the studiesto date have been focused on addictivebehavior, there may be variations ofthe condition (eg, chronic risk-taking,which is a form of gambling).

Day traders from the bubble days arean example of risk-takers. These peoplequit their day job, paid money to use acomputer with specialized market access,and tried to earn money by tradingstocks multiple times during the day. Inreality, only 10% made money. Theexcitement sensation overwhelmed theday trader's logic. The dopamine rushovercame the reality that the vast majorityof day traders weren't making money.

How can you recognize impulsive tendenciesin yourself that lead to risky financialbehavior? The signs are similar tothose of compulsive gambling. You canfind a large list at www.trimeridian.com/warningsigns.html. A few of the mostimportant indicators include:

 Using risk-taking financial behavior as an escape from problems such as anxietyor depression.

 Using increasing amounts of money for risk-taking behavior to achieve thedesired excitement.

 Borrowing money to continue risk-taking behavior.

 Jeopardizing a relationship or job because of risk-taking behavior.

These characteristics suggest that theimpulse of risk-taking is chronic, and hasled to a loss of money and an erosion ofopportunities or relationships.

Seasoned professionals agree that thedifference between success and failure inequity trading is risk management. Moneymanagement is a defensive activity. If risk-takingis a part of it, it has to be wellthought out and deliberate, not impulsive.

If taking excessive risk is a pattern yourecognize in yourself, there is a way tocombat it. Turn your focus to the rewardfor not taking risk. Ask yourself how motivatedyou are to change the behavior. Ifyou recognize benefits in reducing thatbehavior, and are resolved to do so, thefirst step has been taken. Then, focus onwhat your net worth would be if youbypassed tempting arrangements thatoffer more optimism for return than realreturn. Other more specific therapeuticapproaches can be found at www.trimeridian.com/programs.html. Take sometime out when you recognize you're thinkingof behaving impulsively or hastily.Rethink the issue. At the end of the day,your investment return will reward you. 

 is boardedin neurology and psychiatry.She was a practicing neurologistuntil 1995. Since then,she has retrained and is activein the investment and financialplanning area. Dr. Mueller is a seniorwealth advisor at Star Wealth Managementin Indianapolis, Ind. She welcomes questionsor comments at mymoneymd@aol.com.