Page 5 - Mecklenburg_Medicine_April-2020

President’s Letter
Taking Chances
IBy John R. Allbert, MD
love country music. It was defined as “three chords and the truth,”
by songwriter Harlan Howard in the 1950s. I love the stories
the most. In a song about making a poor choice, Dierks Bentley
sings, “I knew what I was feeling, but what was I thinking?”
There is one story Ed Young, MD, told me about 30 years ago that
I never have forgotten. At the time, he was a pediatric resident and
was driving from CMC to Presbyterian with Duncan Morton, MD.
At a stoplight, Dr. Morton turned to him and offered this profound
observation, “You spend your whole life building your reputation
People have a and you can screw it all up in 30
weakness for
the immediate seconds.” Soon after, two physicians
were fired for having inappropriate
relationships at work by a very
prominent hospital administrator,
who himself had to retire early a
gratification few years later after having his own
inappropriate relationship at work.
of a pleasant People seem to keep making the
same bad decisions about money, as
experience, even well as love. It seems like every time
I read the paper, someone prominent One of my mentors told me, “If you are attracted to someone who
if it is likely to lead
to regret later. is being investigated for insurance
fraud, embezzlement or running a
Ponzi scheme.
In light of these examples of
shattered reputations and disrupted
careers, you would think prominent professionals would not take
this kind of risk again. However, I boldly predict the allure of fame,
money and sex will continue to seduce many more good folks down
a terrible path.
The people I know personally who have made big errors in
judgement are (almost always) otherwise really good people.
Therefore, I have to put a lot of thought into how to avoid making
these kinds of mistakes, because I figure if they can make bad
decisions, I certainly can too.
Homo sapiens originated in east Africa, and over a brief 100,000
years, expanded all over the world. What enabled this expansion
was the pursuit of new and exciting experiences, like exploring new
places, hunting and the risk of mating with people outside their small
group. This desire to take risks, like everything else, works well in
moderation. However, too little risk leads to stagnation and too much
risk can lead to early death or a ruined reputation.
There are factors that increase one’s chances of committing to
reckless behavior. Hormonal changes certainly can alter one’s ability
to make good choices. In times of stress when events get in the way
of our goals, increased cortisol can affect our ability to make good
decisions; increased testosterone is associated with violence, drug
abuse and irresponsible sex behavior. Emotions get in the way of
making sound decisions, especially anger, which we all know makes
one less rational. Depression also increases the chances of risky
behavior, as do genetic mutations affecting the dopamine system
which plays a major role in the motivational component of reward-
motivated behavior.
People have a weakness for the immediate gratification of a
pleasant experience, even if it is likely to lead to regret later. It
provides an instant feel-good endorphin hit that can be irresistible.
We overestimate the chance of something good happening and
underestimate the negative consequences. We also have a tendency to
believe bad things only happen to other people. You can inform your
patients that smoking, being sedentary and eating too much sugar
will cause severe morbidity and early death, but they probably will
think your advice only applies to other people. Also, psychological
experiments clearly show being around people who take questionable
risks increases your chances of making similar poor decisions.
Allowing yourself to make little judgement errors often leads to bigger
problems. A defense attorney once told me that large embezzlement
cases he defended always started with a $20 nonapproved loan.
What can we do to avoid being overconfident and having a lapse of
judgement (besides not taking supplemental testosterone)? Having a
strong social support group has been shown to lower cortisol levels.
Spending quality time with family and friends protects against the
negative effects of stress. I firmly believe having good friends, who
hold you accountable, is invaluable.
We have all heard of simple rules to keep us out of trouble, like
never sending a letter written while angry or hurt and never sending
an email after 10 p.m. We need to be aware we are all vulnerable.
We must be cognizant of situations that stoke our fears and desires.
works for you, avoid being alone with her.” You may think you can
keep it professional, but why risk it? Remember, emotions get in the
way of making good decisions, and we all tend to overestimate the
chance of something good happening and underestimate the bad
(like getting caught).
Finally, when debating if a choice is too risky, ask yourself, “What is
the worst thing that could happen?” Then consider how you would feel
if that outcome happened. Understanding how emotions can sidetrack
us when it comes to money and love, whenever we have a critical
decision, we should ask a trusted friend or an independent expert. If
we aren’t willing to do this, we’ll likely be singing, “I knew what I was
feeling, but what was I thinking?”
Respectfully yours,
Mecklenburg Medicine • April 2020 | 5