Future Proof, MD
Future Proof, MD
MD Magazine Contributor

How to Defeat Wishful Thinking


My residency program recently invited Dr. Jay Baker from Duke University to give a talk on mammography.  In addition to being a renowned expert in breast imaging, Dr. Baker happens to also be a fantastic orator.  The entire talk was excellent.  I won't bore you with the details that only a radiologist should know.  However, a portion of the talk that really grabbed my attention was titled "what happens when you break the rules - be careful of wishful thinking," which I will share with you. 

A bit of background information - mammography utilizes a very well structured reporting system called Breast imaging-reporting and data system (BIRADS) which is divided into seven categories:
  • BI-RADS 0 - incomplete study, further imaging needed  
  • BI-RADS 1 - negative study, normal exam  
  • BI-RADS 2 - benign findings. E.g. Cyst  
  • BI-RADS 3 - probably benign findings - less than 2% chance of being cancer 
  • BI-RADS 4 - Suspicious finding  
  • BI-RADS 5 - Highly suspicious finding - "I'll eat my hat if it's not cancer!" 
  • BI-RADS 6 - Biopsy proven cancer 
As you can imagine, the category that tends to cause the most angst among radiologists and patients is the BI-RADS 3, which means we think it's probably nothing to worry about but we're not sure.  We have rules for imaging features which will help classify a finding into any one of these categories.  And when radiologists don't follow the rules, sometimes bad things happen.

Wishful Thinking: 

As physicians, we live to heal and we hate breaking bad news.  Radiologists are no exception. Baker's point was that sometimes we see a feature that is BI-RADS 3 that we "want" to be BI-RADS 2 and we err.  Similarly, do you know anyone who may take the same approach to their finances?  Tell me if you know a fellow resident who has $300,000 in student loans, $20,000 owed on a car, $5,000 owed on credit cards, yet they always have the solution – “I’ll pay it all off when I get paid the ‘real’ money.”  I can almost guarantee you said resident will not “pay it all off” as he/she imagines.  We are all creatures of habit and guess what?  There will always be more reasons to borrow money -  a new car, a house, private school education for your children just to name a few.  And because of the income physicians command, there will always be people lining up to loan you money.

The Rules:

In mammography we have rules to help us classify a lesion as likely benign or malignant.  Most of these rules are authored by Dr. Edward A. Sickles of UCSF, so you can think of them as Sickles’ rules.  In personal finance, we have rules as well, most of which are considered common sense, the most fundamental one being “To be debt free, spend less than you earn.”  Yet it’s not uncommon to meet someone who’s trying to borrow their way out of debt.  As they say "common sense is not so common".

How to Defeat Wishful Thinking:

The problem isn’t that we don’t know the rules.  The problem is that we fall into the trap our habits set for us.  As financial guru Dave Ramsey would say - “personal finance is 80% behavior and only 20% head knowledge.” The key to financial independence lies in figuring out how to change our behavior.  Here are some tips to whip your own behavior into shape:

1. Make it a challenge – why do people climb Mount Everest?  Why do they try to run, swim, or bike faster? Why do others devote their entire lives to finding a cure for an obscure condition?  It’s the thrill of overcoming, the joy of achieving, and the exhilaration of breaking through. Whatever it is you want to achieve, think of it as your board exam. You set a goal score for your USMLE exam and you worked hard to reach that goal. Make the same commitment to your money.

2. Make it a competition – have you ever sat thru a monotonous lecture where you could barely keep your eyes open? I have. But there is one type of lecture I have never fallen asleep during.  Occasionally our attendings will host case conferences in Jeopardy format and divide the residents into teams. Even the most introverted person became a fierce competitor. Do you know anyone else who is interested in achieving the same financial goals?  Make it a friendly competition and you’ll reach your goals that much faster.

3. Make it a treat – I can go into details on this one, but why reinvent the wheel?  Check out why you should “make it a treat”, courtesy of my fellow physician money blogger Physician on Fire.
Do you have any wishful thinking behaviors you want to whip?  Let me know at http://futureproofmd.com/.



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