WCI #471: What My Brain Tumor Taught Me About Life and Money

Summary

Podcast Summary: White Coat Investor Podcast #471

"What My Brain Tumor Taught Me About Life and Money"

Date: May 14, 2026
Host: Dr. Jim Dahle
Guest: Dr. Josh Daly

Episode Overview

This deeply personal episode features Dr. Josh Daly, a diagnostic pediatric cardiologist, program director, and respected White Coat Investor contributor. Dr. Daly recounts his unexpected and ongoing journey with a recurrent brain tumor (craniopharyngioma) and its dramatic effects on his life, career, and philosophy around money, happiness, and what makes a life well-lived. The conversation weaves together practical financial lessons, the realities of navigating serious illness as a physician, and profound reflections on flourishing, meaning, generosity, and the nature of happiness.

---

Key Discussion Points & Insights

1. Dr. Daly’s Medical and Personal Journey

• Background:
  • Pediatric cardiologist and fellowship program director in Little Rock, AR (05:08).
  • Passionate about physician financial literacy; developed and co-directs a medical student course on the topic (05:51).
• Initial Diagnosis:
  • Four and a half years ago diagnosed with a craniopharyngioma, a non-cancerous but locally aggressive brain tumor (06:06).
  • Underwent major brain surgery; experienced complications but recovered and returned to work (06:58).
• Tumor Recurrence:
  • Tumor recurred three and a half years later, with sudden health issues while on a family vacation (12:39).
  • Symptoms included excessive thirst and urination, followed by rapid loss of peripheral vision — a classic sign of optic chiasm compression (14:00).
  • MRI confirmed the tumor was larger than before (15:19).
• Innovative Treatment:
  • Rather than repeat risky surgery, pursued experimental targeted therapy (BRAF/MEK inhibitors) after confirming the tumor’s mutational status (17:03).
  • Rapid improvement of vision and dramatic tumor shrinkage (90% at one month, 98% at six months) (20:33).
  • Ongoing medication has serious side effects, including full pituitary insufficiency (pan-hypopituitarism) and intermittent rhabdomyolysis (21:27, 22:38).
  • “Modern medicine is doing miracles,” notes Dr. Dahle (25:52).

Memorable moment:

“I was blind before, and now I see. It’s pretty incredible.”
— Jim Dahle [25:12]

2. Navigating the Medical System as a Patient-Physician

• Leveraged deep professional networks and insider knowledge to accelerate care, access off-label medications, and appeal insurance denials (18:17, 19:43).
• “The system is broken in many respects,” Dr. Daly reflects. As a physician, he could ‘cut through it’; patients without these privileges face daunting obstacles (25:52).
• The difference a truly caring and competent doctor makes—above and beyond technical knowledge—is profound (26:09).

Quote:

“There’s a case for skill, for mastery, for just becoming great at our trade and how much of a difference that makes in the lives of our patients.”
— Dr. Josh Daly [27:13]

3. The Imperative of Disability & Life Insurance (08:54)

• Too many physicians neglect disability insurance, despite earning potential being their greatest asset.
• Dr. Daly’s experience: After diagnosis, could not buy any further insurance — “Grateful I had both [policies] in place” (10:03).
• Detailed the need for proactive documentation and planning, even for ‘obvious’ disabilities (11:10).

Takeaway:

“You have to recognize the risk and make the decision long before the event arises.”
— Dr. Josh Daly [09:33]

4. Reflections on Mortality, Disability & “The Good Life” (28:12)

• Coming to terms with mortality, not as a distant abstraction but as a present reality.
• Grieving the loss of strength, capabilities, and future dreams, while practicing profound gratitude (29:09, 30:46).
• “There’s room for loss and grief and lament...not that I become hopeless, but I do allow it to wash over me some.” (30:22)
• Shifts in priorities away from prestige, titles, and traditional career advancement toward meaning, communication, service, and family (31:32-34:37).
• Drawing from research on human flourishing: “High-quality relationships are the primary determinant” (33:07).

Quote:

“If you talk to the version of myself from 10 or 15 years ago, [he] would have anticipated that my life would look very differently now...
Those things aren’t that important for me.”
— Dr. Josh Daly [31:06, 31:32]

5. Money and Happiness: What the Research Really Says (39:14)

• Most people publicly deny believing money buys happiness, but act as if it does.
• Research summary:
  • Money does matter for happiness, especially below ~$70k.
  • Recent studies: for most, happiness continues to increase with income, but the slope is much higher among already happy/quasi-happy people; unhappy people see plateau in effect beyond ~$60k (41:08).
  • Key discovery: Feeling “in control of your life” (autonomy) explains most of the relationship (42:36).
• Experiences (especially shared) bring more lasting happiness than possessions (44:55).
• “Take that high income and leverage it for margin in your life, for more control — both at work and outside of work — that will make you happier.” (43:40)

Memorable moment:

“Experiences tend to provide more happiness than things. But it’s shared experiences that promote deeper connections.”
— Dr. Josh Daly [44:55, 45:17]

6. Hedonia, Eudaimonia & Finding Balance (46:12)

• Happiness consists of both hedonia (fun, pleasure) and eudaimonia (meaning, purpose).
• Dr. Dahle recounts self-correcting by scheduling “fun days” after too much purpose-driven activity (46:12-47:22).
• Solo vs. communal experiences: “It’s even better, and generates more happiness, with people you care about.” (47:22)
• Positive rhythm includes both solitude and shared experiences (47:41).

7. The Impact of Generosity on Happiness (48:09)

• Generosity is consistently associated with greater happiness and health, but some of the effect may be due to happier people giving more (48:13).
• It feels like loss in the moment but yields rich returns in well-being over time (49:21).

Quote:

“You want to be the kind of person that’s a generous person, and you’ll reap the benefits on the back end.”
— Dr. Josh Daly [50:15]

8. Rapid-Fire Financial Pearls:

a. Residency Retirement Match (50:39)

• Nice to have, but not a primary residency selection factor—focus on training quality.

b. Cheapest Home in a Nice Neighborhood—Cautionary Tale (51:43)

• Hidden costs: social comparison, creeping lifestyle inflation, children’s expectations; any extra housing appreciation rarely compensates for these effects.

c. Flourishing at Work (53:52)

• Main drivers: high-quality relationships, autonomy, growth/mastery, meaningfulness, time affluence—not prestige or salary.

d. Your “Future Self” Is a Stranger (54:44)

• Humans consistently misunderstand what will make them happy in the future due to present bias and affective forecasting errors.
• Counteract this by visualizing your future self, writing letters as your 75-year-old self, and maximizing future flexibility (57:00-59:01).

e. Biggest Pet Peeve (59:31)

• “Most doctors don’t really know what leads to human flourishing. We know our medical literature, but not the science of happiness and meaning.”
• Recommends every doctor read at least one evidence-based book on happiness; e.g., “The Good Life” (60:28).

---

Notable Quotes & Moments

• Miracle of Modern Medicine:
  “I was blind before, and now I see.” — Jim Dahle [25:12]

• Skill and Mastery in Medicine:
  “Sometimes I think in this day and age, we emphasize just caring and intention. There’s something to be said for skill—being really, really good at what you do.” — Dr. Josh Daly [26:45]

• On Loss and Acceptance:
  “I probably never will summit a 14’er...There’s some strength and capability that I’ve lost and it’s probably permanent...There’s real loss in that, but also much to be grateful for.” — Dr. Josh Daly [29:44]

• On Autonomy:
  “The primary determinant of human flourishing is high-quality relationships...But the biggest factor linking happiness to income is: do you feel in control of your life?”
  — Dr. Josh Daly [33:07, 42:36]

• On Meaning Amidst Struggle:
  “If I could go back, I’d still rather not have the brain tumor and learn these things another way. But I am very grateful for them on the back end.”
  — Dr. Josh Daly [38:20]

• On Generosity:
  “You want to be the kind of person that’s a generous person, and you’ll reap the benefits on the back end.”
  — Dr. Josh Daly [50:15]

---

Important Timestamps

• 05:08 – Dr. Daly’s career and financial literacy work
• 06:06 – Brain tumor diagnosis and initial surgery
• 12:39 – Discovery and symptoms of tumor recurrence
• 17:03 – Decision for targeted therapy and quick action
• 21:27 – Managing pituitary loss and medication side effects
• 25:52 – Reflections on skillful, caring physicians and system barriers
• 28:12 – What the good life means after diagnosis
• 39:14 – Does money buy happiness? What research says
• 42:36 – Autonomy and happiness: the most important link
• 44:55 – Experiences vs. things, and the value of shared moments
• 47:22 – Hedonia vs. eudaimonia; solo vs. communal joy
• 48:09 – Generosity, money, and happiness
• 50:39 – Rapid-fire: residency match, homes, job satisfaction, future self, and main advice

---

Book Recommendation

• “The Good Life” by the directors of the Harvard Study of Adult Development — An in-depth, research-based exploration of what leads to lasting happiness and flourishing in life (60:28).

---

Wrap-Up

Dr. Josh Daly’s story is both a cautionary tale and an inspiring testament to resilience, the importance of planning (especially insurance), and the life-changing effects of practicing gratitude, pursuing meaning, and connecting with others. The key message echoed throughout: Don’t just chase compensation or prestige; invest in relationships, autonomy, generosity, and growth—you’ll flourish in ways money alone can’t deliver.

---

For more:
Visit whitecoatinvestor.com for Dr. Daly’s columns and other personal finance resources for high-income professionals.

Transcript

[Jim Dahle]

This is the White Coat Investor Podcast where we help those who wear the white coat get a fair shake on Wall Street. We've been helping doctors and other high income professionals stop doing dumb things with their money since 2011.

This is White Coat Investor Podcast. This podcast is sponsored by Bob Baiani at Protuity, an independent provider of disability insurance planning solutions to the medical community nationwide and a longtime White Coat Investor sponsor. Bob specializes in working with residents and fellows early in their careers to set up a sound financial and insurance strategy. If you need to review your disability insurance coverage or to get this critical insurance in place, contact Bob by emailing infoprotuity.com or by calling 973-771-9100 or by simply going to whitecoatinvestor.com Protuity P R O T U I T y join us May 14th at 6pm Mountain for a free live class and learn how to go from broke resident to millionaire in five years. Your first 12 months after training are the most important of your financial life. This free information can literally make a difference worth millions of dollars. Over the course of your career, you're going to learn the importance of financial literacy for wealth building. You're going to learn how to manage your student loans and minimize their cost. You'll learn how to prioritize your money and start investing. You'll learn which insurance policies you need to protect yourself and your family. And you'll learn how to reach your financial goals and spend the rest on whatever you like, guilt free. We think this is so valuable to you that we're going to bribe you to attend it. Five attendees will win a free copy of the Fire your Financial Advisor resident course at 299 value. Go to whitecoatinvestor.com resident to sign up today. Even if you can't make it live, we'll get you a copy of it and you can watch it at your own convenience later. All right, welcome back to the podcast.

[Joe]

We have got a great interview today. We've got Josh Daly with us. If you don't know who Josh is, I know many of you do because you've read his columns at White Coat Investor. You've heard him at wcicon. You may have sat in the class he put together in Little Rock to help physicians become more financially literate, more financially disciplined. He's pretty well known in this space and it's going to be fun to have a chat with him about what's going on in his life, which is not insignificant, as well as some of the advice he has for the rest of us. And like many in his sort of medical situation, he's becoming a little more philosophical every year.

[Dr. Josh Daly]

And I think that's a good thing

[Joe]

for most of us. But before we get there, I want to go over a couple of things. The first one is, is that we have got the opportunity to help you make a little bit of money with your free time. We call these paid surveys. Right?

[Jim Dahle]

There are people who want your opinion, your knowledge, and your opinion is valuable as a doc.

[Joe]

And so if you go to whitecoatinvestor.com surveys, we can connect you with companies that will pay you for your opinion, pay you to fill out surveys, and that can be helpful. It gives you a little bit of extra spending cash. Occasionally I've run into somebody who just goes crazy on these. You know, I've seen as much as $30,000 a year be made on these surveys. It helps if you're in a specialty that prescribes expensive medication, if you're in neurology or rheumatology or oncology or something like that, I've found. But every specialty, there are surveys available to you. It can also be helpful if you just need a little bit of 1099 income for this side business of yours, so you can open a solo 401k, maybe roll an IRA or something in there, so. So you don't get prorated on your backdoor Roth IRA process every year. Anyway, that URL is whiteconinvestor.com surveys. Check it out. It's not free money.

[Jim Dahle]

You gotta do a little bit of work.

[Joe]

But it's probably way easier than what you're doing the rest of the day, which, by the way, is pretty darn significant as we're gonna talk about in this podcast. So thank you for doing that. Our quote of the day is from Benjamin Graham, Warren Buffett's mentor. He said it is absurd to think that the general public can ever make money out of market forecasts. I think there's a lot of truth to that. There sure are a lot of forecasts,

[Jim Dahle]

especially at the beginning of the year. And you know what?

[Joe]

When you go back and look at them at the end of the year,

[Jim Dahle]

it is not impressive.

[Joe]

Their track record is not impressive.

[Jim Dahle]

And yet we still pay attention to them.

[Joe]

When they do another forecast the next year, it makes no sense whatsoever. Okay, let's get Josh on the line. We've got a long conversation today. I think you're going to enjoy it. I'll see you on the backside.

[Jim Dahle]

Our guest today on the white Coat Investor podcast is Dr. Josh Daly. Josh, welcome back to the podcast.

[Dr. Josh Daly]

Thanks, Jim.

It's great to be here.

[Jim Dahle]

I don't know how many episodes it's been since we had you on the podcast. It's been a few. So let's introduce you a little bit to the audience. I mean, hopefully a lot of the audience knows who you are. They read the blog, they've read some of your guest posts, et cetera. But let's kind of start at the beginning. Tell us, you know, your professional career track and maybe some of the things that have been unique in your life.

[Dr. Josh Daly]

Sure. So I'm a diagnostic pediatric cardiologist.

I live in Little Rock, Arkansas where I also serve as our fellowship program director.

I practice clinically but do a lot

in the educational domain.

And like many listeners to the podcast, I grew up with the intention of going to medical school. Had a physics major in college, went straight into medical school, went to residency fellowship and jumped in as an attending

right away with no real sidetracks along the way.

And finances weren't a big part of that up until really residency and fellowship. When I came across the blog, did a deep dive, thoroughly enjoyed that material. Then as a newer attending, I recognized that I ended up just having basically read the blog and a few books,

knew more than the vast majority positioned around me. So I ended up giving a couple

lectures to residents and then fellows and that grew into medical student course that

I co direct and I write academically about. The intersection between medicine, finance is fairly common. So that's become a bigger part of my life.

But germane to this podcast, the more significant aspects of that journey. About four and a half years ago, I was diagnosed with a cranial pharyngioma, which many of the listeners may know what that was or what that is.

I did not. I'm sure I learned about it at some point in medical school, but it

is a non cancerous but locally aggressive

brain tumor that originates at the very

center of my brain, so it arises from my pituitary and then was filling

the third ventricle, which for those that aren't medical is the very middle of your brain in an area that in

which a lot of important structures sit

and is very difficult to get to.

I was on the podcast, oh about three and a half years ago where I told some of my story around

that first diagnosis and kind of the

events that transpired around that. And I ended up undergoing a complete resection, big surgery, had some issues following

that, but overall did well and then

had been kind of transitioned back into normal life. And that brings us to some of what we'll be talking about today, which

is unfortunately, a recurrence, which I'll, I'll get into as we go forward in the podcast.

[Jim Dahle]

We'll certainly get into that. So what people might not realize, particularly newer listeners, is this connection with White Coat Investor and Little Rock, Arkansas, right?

[Dr. Josh Daly]

That's right.

[Jim Dahle]

I mean, I've been going to Little Rock for a long time for White Coat Investor kind of stuff. It was the birthplace, really, of perhaps the first in school financial curriculum. So I've been out there several times and a lot of great memories of going to Little Rock and seeing what has come out of that. And you're just one of the wonderful people that's come out of Little Rock helping physicians to be, you know, financially literate, financially disciplined. And, you know, a lot of people may not realize that there's a, there's a little connection there with Little Rock. Okay, now let's talk for a minute about disability. Right. I mean, I think insurance is maybe one of the more boring things that we talk about all the time around here. But I'm always appalled when I find out how many docs there are that don't have any sort of disability insurance. Right. They're going to make something like 8 to 15 million dollars during their career, and that's probably their most valuable asset. And they haven't bothered insuring it at all, or they've just settled for whatever their employer handed them. As someone who has dealt with a legitimate disability, something unexpected popping up in your life that you did nothing to deserv. Go fall off a mountain after taking risks, maybe you shouldn't have been taken. Can you speak a little bit to the need for disability insurance for most docs?

[Dr. Josh Daly]

Sure.

I'm sure you're far more familiar with the stats than I am. But the bottom line is that very few physicians anticipate that they will ever become disabled. We envision our future selves and our lives practicing full careers. And the reality is that many, many

doctors become disabled for some period of

time, and that's reflected in the cost of disability insurance. And in many cases, it has nothing to do with something that either you

brought upon yourself or that you could protect yourself from. My, my case is obviously a great example of that.

The best of my knowledge is not

related to lifestyle or choices I make.

And like many other types of insurance, unfortunately, you have to recognize the risk

and make the decision long before the event arises.

So when I was diagnosed with about four and A half years ago I had a policy that was okay. It wasn't. If I were obviously shopping for it

now and doing what I know now, I would have gotten the very best

policy I could possibly get, as much

[Jim Dahle]

of it as they'd sell you. I'm sure that's exactly right.

[Dr. Josh Daly]

And I it was a reasonable policy, but I hadn't done a deep dive. I had the sense that I knew

I probably needed it. I thought my risk was probably smaller than it actually was.

And then when I was diagnosed, I quickly had lost any ability to buy additional disability insurance. And basically I haven't been able to buy any disability insurance or life insurance since that inciting event four and a half years ago. I'm very grateful that I had both. And I have reasonable policies. There may be, there are, you could

argue that they could certainly be improved.

But I had policies in place that would, if I died, provide for my

family and my wife and four young children in that event.

And then if I became disabled, we would have to make some cuts, but

we can maintain a reasonable standard of living and have a good quality of life.

That being said, especially the second time around, as soon as I was diagnosed, I mean my primary focus was in

getting appropriate care, having a plan of action and so forth.

But very soon thereafter I reached out to actually disability attorney here through White Coat Investor and had them look through my plan in detail, give me feedback and their sense was overall it's a good plan, hopefully you won't need to use it. And then my big primary question is related to what are the things I need to do now to document, to make it as crystal clear as possible that if this progresses and I lose

the ability to work, then I'm not going to get any pushback.

And I'm very grateful. The feedback that I got in my case because it's somewhat black and white,

I mean, I've got a tumor in

my brain and my vision decompensated rapidly

over a period of few weeks.

And it was clearly caused by the tumor. It is a diagnostic cardiologist who does imaging in the setting of very poor

vision that that would be crystal clear, clear cut.

As you know, death tends to be black and white, disability as many shades of gray. Luckily I was on the darker end

of the shade of gray spectrum, so

it would have been more clear cut to me. So I haven't had to use it.

And I've been able to work throughout

all of this, but I am acutely aware that that could occur and I'm trying to Take some practical steps to

protect myself in the event that it could.

[Jim Dahle]

You know, it is a little bit similar to my disability.

[Dr. Josh Daly]

Right.

[Jim Dahle]

When I fell off the mountain, got hurt, I had already canceled my disability insurance. You know, I had two good policies that would have paid. Actually, neither one of them would have paid because my, my disability period was only two months. Right. And both of them didn't, wouldn't have started paying until three months. That was the way mine were set up. But, you know, having those close brushes with serious, possible long term disability really makes things crystal clear on why that's such important insurance for anybody that's not yet financially independent. All right, well, I'm sorry to hear about this recurrence issue. Give us an update. What's going on with it?

[Dr. Josh Daly]

What's your treatment plan?

Sure. So last summer, it had been about three and a half years after my resection and they'd gotten all my Tumor, all my MRIs had been clean. My last MRI had been December right before them. So about five, six months before the

time when all this manifested.

And in the words of my surgeon, at this point, the risk of recurrence, he said, is almost non existent. We even talked about spacing out my

MRIs to a greater duration.

Then in the middle of the summer, first I noticed that I started being more thirsty than I typically was and I was potentially urinating a little more frequently. And in classic fashion, I dismissed that and thought, oh, it's the middle of the summer, it's hot, it's Arkansas, got

a lot going on.

I'm sure I'm probably just on the

thirsty side and drinking a little bit more.

Not in any way anticipating that could in some way signal my tumor coming back. We're coming up on a vacation.

We're going to be driving like 18 hours to northern Michigan to see my sister.

And around the same time, I started having a few other symptoms. So I called my endocrinologist and she said, let's come in and let's just check your urine and your serum and make sure that you're not developing what's called diabetes insipidus, which I know you're familiar with. For the readers, it basically is a scenario in which one of the hormones

that helps your kidney concentrate urine is

absent and so you can't concentrate your,

so you just pee a lot.

So I had my labs checked and it was within the normal limits. In retrospect, it was like right at the cut off, but it was technically within normal limits. So I quickly dismissed it went off on Vacation. Meanwhile, on vacation, my vision rapidly deteriorated over a period of really one to two weeks. And I, in my mind, I'm like, I just need glasses.

I'm 43. This happens.

And I vividly remember. So I'm driving back 18 hours from northern Michigan, and I am struggling to

see the car in front of me,

and I start checking my peripheral field, and all of a sudden I'm like,

oh, my gosh, I've lost my peripheral vision.

Which for doctors who are aware, you know, that there's a very specific kind of vision loss when your peripheral field

on both ends end up being lost.

It indicates that there's not something wrong

with your eye, but there's something in the brain.

And in particular, the location of my tumor had been right next to what's called the optic chiasm, which is the part of the brain that really interprets stimuli from the eyes and allows you to see. So first my wife and I switched places in the car. We finished the rest of the drive home. I, like many here, had many medical contacts and so was able to get in, get my vision checked basically the next day, and confirmed what I was worried about, that I had this very clear visual field defect that suggested something

was going on in my brain.

Even then, I did not think it was a tumor. I thought, there's no way the tumor is going to come back this far. After all these clean MRIs, something else is going on in there.

Yeah, I need an mri.

But I don't think. And in typical fashion, my university was backed up.

It was hard to get an MRI scheduled.

And so what I ended up doing is called. A good friend of mine is a neuroradiologist, my children's hospital where I take care of patients. He's like, come in tomorrow morning at 5am I'll scan you before anyone else gets here. So I show up in my own hospital, get scanned. He's not even there yet.

It's just the tech who does it.

And I go and I sit in the chapel while I'm waiting, which is where I. I'd spent, had countless conversations with patients talking about the illness and potential death of their own children. And I remember sitting there and then my friend calls me and tells me the tumor's back. Not only is it back, it was larger than it was initially. It was about 2.5 by 2.5 centimeters. And it was compressing my optic chiasm with clear effects on the optic chiasm. And so here I am standing still, no doctor, that actually takes care of

Me knows about this. This is my buddy who just did the mri.

So I'm calling my neurosurgeon, getting a hold of him.

Luckily, I have his cell phone number.

Of course, he, in typical surgeon fashion, was very quick to say, I got this. Let's come back.

I can get this.

Let's do surgery. And he's a fantastic sur did an excellent job the first time. But I can read the literature like a redo. In this case, the outcomes are not very good. The risk of either permanent damage to my vision, complete loss of pituitary function, hypothalamic damage, and a variety of other

things are really high.

And, of course, I want to believe I'm an outlier, that, oh, that wouldn't happen to me. I've got a great surgeon.

I'm in good health, but you got

to look at the base rates. So I'm very grateful that I'd done a lot of studying on the front end and was aware of some investigational

options with what's called BRAF and MEK

inhibition, which is a kind of oral chemotherapy pills you take every day that basically work on a specific receptor that's

typically present in my tumor.

And luckily, I'm so grateful for this. The first time around, I had pushed my surgeon to send genetic testing on my.

On my tumor.

It was BRAF positive, which is not standard a carry syntax. I knew that this was kind of investigational, had done that the first time.

So I already had that data available

to me, and I'd reached out and connected with the expert who'd actually identified this mutation in this kind of tumor at Harvard. So I already connected with her a few years prior, talked through some options. So I immediately reached out to her that morning. I'm so grateful for this. She called me from Tokyo. She was in a conference, stepped out of the conference to call me, and time was really of the essence. In large part, my vision was deteriorated.

So I got to do something quickly in order to progress rapidly over a period of a week.

And she told me, these are the. If you want to start this targeted therapy, these are the meds you need to get. This is the dose you need to do, which none of this is FDA approved for this indication. These tumors are very rare. She had kind of teased a lot

of this out for her own research,

but she says, you've got to find a local doctor to prescribe it for you. Meanwhile, there wasn't a single neuro oncologist

in the entire state of Arkansas, which is crazy and rather frustrating.

So I take advantage of every single professional contact and courtesy that I possibly can and reach out to as many friends as I can. And I had one of my patients, his dad is the president of another institution that does a lot of oncology treatment, just nothing with the brain. And he's one of the many people I reached out to and they had an oncologist there who uses these exact same medications to treat melanoma and this exact same. So he's very familiar with the side effects and the regimen and so forth, but isn't a neuro oncologist. And he said, I'll learn, I'll figure this out, let's do it together.

So grateful for him.

So I got in that very next day. He was able to figure out a way to get me pills immediately from the pharmacist there. They were able to scrounge enough samples for medicine.

It's pre darn expensive.

So I started it basically the day after I got my mri, which is

the day after I got back from vacation.

And I am fully recognized that that is entirely a function, one of God's provision, but to the fact I'm a doctor and the average patient does not

have access to those kind of doors being open that rapidly.

So I was able to start those medications right away. Meanwhile we start jumping through the hoops with insurance. And within a week my vision was clearly recovering. And at 10 days I had all my visual fields formally tested again and there was significant improvement.

It was very, very clear cut.

So I hadn't had another mri, but

it was clearly working.

Then I get the letter from insurance. We're not paying for this, it's not indicated too bad. And I work at a university where we self insure. So I did everything I possibly could have made it very clear that I work here, I'm a doctor here.

This can go very poorly for those

of the university if I become disabled,

lose my vision because you won't pay for the meds.

And they ended up finally agreeing to that. But I also recognize that's a function of me being a doctor, knowing how the medical system works and being highly

motivated to get them to approve this meds.

And I knew how to find the New England journal paper and how to

do a quick literature review and write

up a great letter using in part ChatGPT as quick as I could.

That made a very compelling case, but

got the meds improved, was able to stay on it at a month. My next MRI showed that the tumor had shrunk by almost 90% which is

incredible to have that kind of shrinkage now.

Simultaneous to that, there was a number

of other things going on from a medical perspective.

I was feeling, wasn't sleeping as well, just had low energy. In retrospect, my mood was poor. I think I was entering into a realm of depression and my pituitary basically stopped working. So I developed pan hypopituitarism, which means I tipped into full diabetes insipidus, where I was peeing non stop.

I remember one night I woke up, I peed eight times that night to get out of bed.

And so I was able to start medicine for that. Similarly, I had adrenal insufficiency, which one of the hormones the pituitary releases tells your body basically to release steroids that

allow for normal living and function.

So I immediately started on steroids. I was already on testosterone, increased my levothyroxine. So I entered this domain of basically replacing all my pituitary function, which I've had to do. Even as the tumor shrunk.

I haven't had any recovery of pituitary.

So in the interim, the tumor has continued to shrink. My last MRI was beginning of December and it was by volume. It had shrunk almost 98%, which is really incredible. And my next MRI is actually next week.

So by the time this airs, I'll probably have had my next mri.

The long term hope is that we stay on this and treat it entirely with this and that. We basically wait till it becomes, in the words of my oncologist, a dot. And then on serial MRIs there's no

residual change indicating that whatever remains is hopefully scar tissue.

And then we stop with very close fault. Now, that being said, there's almost no, there's no long term data, very limited midterm data, a little bit of short term data. You know, there might be like 12 patients in the US that have had these meds that have, have been on

them for more than a year. So we really don't know what's to come.

There's a very reasonable chance it may recur. I may need radiation, I mean aid

of surgery after all.

But I really think this gives me my best odds of recovery without disability

and without death and having a high quality of life.

So at the moment I'm doing reasonably well. Now, that being said, these meds come with side effects like anyone knows. Now, on the spectrum of chemotherapy, they're

on the more mild end, but I've

been in and out of rhabdomyolysis. So for those that aren't medical Basically, when your muscles become inflamed or break down a little bit, they release an

enzyme that can be damaging to your kidneys.

It's called a CK level. So my CK levels have climbed. Wasn't in a place where it's hit my kidneys yet. So we held one of the chemo meds that came down. We've restarted at half the dose.

And I seem to be tolerating that okay.

But there's always this balancing act of you want a high enough dose that impacts a tumor, but not so high

that it does permanent damage to healthy tissue within your body.

So that anyone that's dealt with chemotherapy knows that dance.

And I've had to do that as well.

So that's kind of the rundown from

a medical perspective of where that brings me to.

Now in the midst of this, I've been able to work. I took a little bit of time

off in the front end.

My vision recovered fast enough, I could read echoes again. So I've continued to work. My colleagues have been very supportive and

helpful, and I've had a little bit lighter clinical load than I have in years past.

But I've been able to continue to do my job.

I'm fully engaged at home, four young

kids coaching my four year old soccer

team right now, doing a lot of

the normal life things in the midst of balancing some more, some difficult stuff.

I don't mean to minimize that, but

there's an aspect in which many parts

of my life are still really good.

[Jim Dahle]

So many things to touch on. And I wanted to allow you to tell that story to the podcast audience so that the rest of what we talk about today is really in context of knowing what you've been dealing with. But if nothing else, we ought to talk just for a minute about the miracles that modern medicine is doing, right? I mean, this is incredible. You're one of, you know, a dozen people that has had this treatment. It's been very successful. You know, your life's been extended. You're not only are you living longer, you're still, you know, very functional, able to work, coaching a team, you know, raising kids, all this, you know, writing, you know, guest posts and columns for White Coat Investor, being on this podcast, right? What people are doing out there in medicine is incredible, right? And you ought to all give yourselves a big pat on the back for developing these therapies and using these therapies to really improve people's lives. And you're a great example of someone whose life has been dramatically improved. The Bible story is Jesus Healing somebody by putting some mud on his eyes. And he's asked by the Pharisees later, you know, who did this to you? It couldn't have been Jesus. And he says, look, here's all I know. I was blind before and now I see, you know, and really you were blind before and now you see? It's pretty incredible. And sometimes we forget just how important what we're doing out there in our medical centers, in our clinics, et cetera, is and the lives that we're affecting. So any of you out there feeling a little burned out, don't forget what you're doing. Really, really important.

[Dr. Josh Daly]

I had two reflections related to that. That one, our medical system is, is broken in many respects. We provide technological advancement and incredible care like this. But the actual system of navigating is really hard. And I had the blessing of a

doctor and I was able to cut through all that.

It was eye opening to recognize what

my patients have to deal with every day to cut through that.

But then secondly, and more powerfully, I

have been so deeply reminded of the incredible impact of a doctor who deeply

cares and is highly competent. In the midst of what I do on a day to day basis, things can feel rote. Doesn't feel like I'm making a big difference there. There are exceptions to that.

And I often forget how important what we do as physicians are.

And having a doctor, one that really deeply cared, I mean to go out of their way that step out of a conference and take a phone call in Tokyo, another one that's willing to read for three hours a night before seeing me to learn everything about this specific tumor and do all this extra work to see me whenever I need to be seen.

I'm so grateful for that.

And that Priscilla Brastionis and Harvard and Sam McCool here in Little Rocker, the

two doctors, I'm so grateful for them.

But not only that, sometimes I think in this day and age we emphasize just caring and intention. There's something to be said for skill. Being really, really good at what you do. Not just base level confidence, not just

good enough, but being great.

Like if Dr. Braskunos hadn't said, I want to figure this thing out, you know, 10 years ago, I don't know where I'd be today. And if they didn't push the envelope and weren't really good at what they did, I really don't know what happened to me. And it has just been deeply encouraging

to me about this, the opportunity for

impact in the lives of our patients. And in a case for skill, for mastery, for just becoming great at our trade and how much of a difference

that makes in the lives of our patients.

[Jim Dahle]

All right, let's transition a little bit to talking about life philosophy, what a good life is. As I sit here and I complain about my little tiny health problems, which are nothing compared to what you're dealing with. And I think, well, what's my life expectancy? Probably 35 years or so. You don't know as well what your life expectancy is. What thoughts have you had as you've dealt with this over the last four and a half years on what the good life is, how to make a good life? Maybe not knowing how long that life is going to go and what abilities you're going to have during that life. How has that affected your philosophy on the good life, for lack of a better term?

[Dr. Josh Daly]

Yeah, that's something I deeply wrestled with. And there wasn't one moment in time

where the clouds parted, the sun shone down, and I felt like I had some revelation about how all this works.

It's been iterative and there have been stages and I continue to wrestle with that. And as even I wrestled a lot with my own mortality, one, even if this goes well, I'm probably at least

halfway through my life.

Even if I'm recovered from this, there's just a reality that at 43, that I'm probably over halfway there and we will all die. And so I've wrestled with some of that and that's been forefront in my

mind in a way that's different from many others.

Then there's been the aspect in which the risk of me dying from this is relatively low. The risk of disability and dealing with really complex medical issues and dealing with medical fragility, the rest of my life is really high. And that's actually been the harder thing

for me as of late.

I did not picture being in my

mid-40s being medically fragile.

I just didn't think I was going to be there. I went out to Colorado this fall

for a conference and brought my 11

year old with me and we ended up staying a day late and went for a hike.

And in my mind I'm like, I

got this, I'm fine, I'm in good shape.

And I felt terrible.

And I hiked a few miles, was

constantly winded, was hurting.

And it dawned on me, I'm probably never going to summit a 14 old. That's probably unwise for me to do it anyway. And there was some real loss in that, not in just what that actual event but what that represented, that there's some strength and capability that I've lost,

and it's probably permanent. I'm probably never going to get that back now.

There's good life on the back end of that. There's so much to be grateful for, but there's real loss in the middle of that. And sometimes even when we deal with a difficult situation in loss, that's very uncomfortable for us, whether we're the one

dealing with it or interacting with someone in that.

And the tendency is to basically shine a light on it and. And put silver edges and to say, well, at least you're still alive. At least you can still work, at least you can still be involved with your kids. And there is a room for hope

and gratitude, and that's deeply interwoven my life. But there's also room for loss and grief in lament.

And so I've even tried to enter into some of that recently.

And not that I become hopeless or

that I allow it to take over

me, but I do allow it to

watch over me some. And so I've even dealt with just being okay, crying and acknowledging what I've

lost and what that may mean for the future.

Couple it with practices of gratitude and

connection with those around me. But I've dealt with that a lot as of late.

And it's. I've done some reflection about my life that a lot of people naturally do in their 40s.

And then it's probably been accelerated for

me and then morphed in a little bit different ways as I've dealt with all this.

In the midst of this, what I

want to focus on next season of my life.

What are the things that are most important?

What are things that I may have

emphasized a lot that are of very little importance?

If you talk to the version of

myself from 10 or 15 years ago,

I would have anticipated that my life

would look very differently now than it does.

And in particular, well, I probably would have envisioned moving up the ladder with an academia, pursuing leadership positions, having impressive

titles, having a lot of people knowing my name, that kind of stuff.

And that has just faded in the

background for me, not because I'm deeply

mature, but just the reality of life,

that those things aren't that important for me.

And so I've done some transitioning there on that end. I've also discovered some things that I

find deeply meaningful that I really enjoy.

And that's in the domain of communication,

both verbally and through written word.

And it's not just like I like giving a lecture about ventricular septal defects in cardiology. I enjoy that. But it's not as deeply meaningful as some other domains. If a medical student learns about that, maybe they'll remember it. They'll probably forget most of it. It probably won't impact the care they

provide to a patient.

But when I get to teach in the, in an area that really matters in their lives, in this domain of suffering, human flourishing, meaning and significance, and I can connect with them in that area.

And often money is a doorway into that, which is one of the reasons I'm so drawn toward engaging the financial area. Because you get it values and principles and priorities and those kind of things.

I come alive in that space. It is both feels deeply meaningful and significant. And then I also think I have

aptitudes and gifting that align with that,

such that I experience some of the state of what's called flow, where like you're engaged in a task and you're knowledge and skill is equally matched to the task at hand and you're so

caught up in it, you lose track of time.

I get that more in those kind

of spaces than anywhere else.

So I'm even restructuring some of my

life and pursuing some of those things right now.

And then as I've reflected on life on a couple different levels, one from a relationship perspective, when you look at the literature and the research surrounding human flourishing as a whole, it is very, very clear the primary determinant of human

flourishing, of high quality relationships.

And I find it very interesting. As doctors, we know a lot about

what the evidence says about our specialty, the care we provide for our patients,

and we're practice evidence based medicine. But when it comes to living our lives, most of us don't really know

the evidence to support community first, we

don't know the research, we can't cite the studies. And we're more influenced by our friends, by culture, by movies, by all these

other things that ultimately influence what we prioritize. So I've been very aware of that.

So I've done a little bit of a deep dive even in some of those specific areas and even restructure some of our finance class around not just

what's a Roth ira, although we do

that, but some of these other parts,

what makes a job great, what really

matters in the context of vocation, those kinds of things. How can you prioritize deep connections with

others in the midst of being a fantastic doctor? And how are those balanced?

So I've done some restructuring my own

life along those lines and now I, I both Write and teach in those spaces as well.

I'm also a lot more willing to take risks, especially risk without a lot of downside. So for instance, even with a light code investor, I'd written a couple guest posts and I enjoyed that and I thought, I like doing this, maybe they'll let me be a columnist and write more. So I reached out to Josh, he said, sure. And in about three months I wrote 25 posts, enough for like three years. So I had to slow down a little bit. I've enjoyed that so much. You have to ask Josh.

He has a huge list of posts poster. They're gonna last a while.

[Jim Dahle]

Yeah, he, he, he mentioned that to him like, sweet. He can take over for me. This is great.

[Dr. Josh Daly]

And that has been so deeply fulfilling.

Boy, I've enjoyed that.

That has been life giving. And even if 10 people read it, even wrestling with those issues, the written word helps me sort out in my

own mind in a more meaningful way. So I've thoroughly enjoyed that.

And then even this has been more recent. So one of my areas of focus in medicine, especially on the academic side, is how physicians make decisions, especially in high stakes arenas in areas of uncertainty. So I do a lot of teaching

and writing in that area of cognitive

bias and motivated reasoning, group think and how all those intersect. And as I've developed expertise in that one, I recognize this. These same mistakes that we see really intelligent, highly trained doctors make, they certainly buy the money. And so if you look at many of my posts, most of them relate

to that in some way. That's kind of a theme interwoven through it.

And then I've also recognized, so my

faith is very important to me.

I'm a Christian and that's a big

part of my life.

That same lens that I've applied to people of my faith, I see those same mistakes, but they manifest in very distinct ways with spiritual language and the same underlying motivated reasoning. And then there's some confusion about beliefs

in God and so forth that can be really destructive.

So I just, in the last, oh, six months I became really interested in that.

So I write a lot on that now as well.

And I decided to write a book. I've never written a book before, but

I wrote a book in the last

few months on that subject about the interplay of the science of high quality decision making and scripture and God's will

and theology, bringing all that together and hopefully helpful framework help people of faith make better decisions. So I've loved that. I never thought I wanted, you know,

[Jim Dahle]

what's the Title of the book. You have a title?

[Dr. Josh Daly]

My I have multiple working titles and

it depends on what the publisher ends up deciding on.

The the initial title is Choosing well How Christians Can Make Better Decisions in a Fallen World. The more provocative title is the Peace Trap. One of the things I talk about a lot is how, at least in, in Christianity we use this language of saying God's peace and we treat it like a compass. And it's if there's some open door and then we don't feel good about it, we say God just hadn't given

me peace about it.

And it's like this, it puts up this armor around it where you can't argue with that because it's God's peace

he hasn't given to me, so why would I possibly pursue that?

Or we baptize our own desire in spiritual language. You know, maybe there's something we want

to do, but we feel very uncomfortable

just saying I just want to do that. So we say things like God calling

me, God's leading me, God's given me peace about this.

And basically what it does is it means no one can actually give you healthy feedback. No one can actually penetrate this spiritual

armor that you put around you.

And so you end up making dumb decisions. And so there's a lot of confusion around that. So a lot of the book focuses around that. So the topic, the title may be

a little bit more along those lines, but we're still wrestling with that.

And even within that, I'm a first time authority, it may not get published

by a big publisher.

I have an agent, we're sending it

to all the big publishers now.

We'll see. But one of the things I talk about in it is base rate neglect.

And that would be dumb for me to ignore that.

And the odds of a first time

author getting published are between 1 and 5%.

And so I probably am subject to that as well. I'd like to think I've done some

things to modify those odds on an

upward direction, but there's a chance that

may not get published. But either way, I have loved that

and I never would have tackled those

kind of things had I not been dealing with all the medical issues.

So while it's there's real loss and real suffering and pain and the full spectrum of negative emotions, there are some real blessings that have come out of this. First and foremost through my own perspective

on life and relationship and God and

then through some of these other things

I'm pursuing that I never would have pursued before.

So I'm I'm so grateful for this. If I were to go back, I'd still rather not have the brain tumor

and learn these things another way, but I am very grateful for them on the back.

[Jim Dahle]

I can totally relate to this sense of simultaneously feeling incredible, incredibly grateful, while at the same time mourning the loss of some ability you used to have and realizing life is now different. There's a before and there's an after, and they're two different lives. And I can relate to that in large part after my little fall a year and a half ago. So totally understand that a lot of your work that you've submitted to the White Coat Investor is on things like happiness. One of your posts that I think we published last December was Does Money Buy Happiness? What the research really says what should people know about how money can buy happiness and how it can't buy happiness?

[Dr. Josh Daly]

Well, it's interesting. People often have beliefs and attitudes surrounding

this that they may not be fully aware of.

If we are standing in a conference,

not the White Coat Investor conference, than

any other conference, and ask people, you think money buys happiness? No one would raise their hand.

They'd be embarrassed to think that or say that.

Yet they simultaneously act like it really does. You know, they pursue money and spend money willy nilly and all sorts of

things they think are going to make them happy.

It's like there's this unspoken belief that

if I just have more, if I

have more things, more experiences and more money that can buy those, I will be happier.

Yet we're embarrassed to admit that we believe that.

So we pretend like it doesn't matter,

but we act like it actually does.

And the reality is that in the domain of human flourishing, money is not one of the primary drivers of flourishing. There are other things that matter far more. Things like high quality relationships, things like

having autonomy and control over your life,

meaning and significance in the work that you do, growth and mastery, this idea

of competence in the domain that you're

working in and kind of this time, affluence, work, life, balance, those are the primary drivers.

Those matter far more.

But money does matter. It does impact happiness. The research is pretty darn clear on this. And there was there was previously research that suggested the threshold effect by the Nobel laureate Daniel Kahneman that suggested at least in $2010, once you make above around 70,000 or so, extra income doesn't

buy more happiness below that, it really does.

And there's been additional research in the

last few years that have somewhat debunked that.

If you're interested in the actual methodology of how that's been teased out.

Feel free to look at my article on the Whitefield investor.

But the bottom line is at every income level, happiness continues to increase, although the slope changes.

[Jim Dahle]

Right. The slope's pretty steep below 70 or 100,000 and not quite as steep once you get into the six figures, seven figures, et cetera, as I understand it.

[Dr. Josh Daly]

Well, so this is fascinating.

It's more nuanced than that.

So Kahneman did this initial study back in 2010, and then Killingsworth came out with this other study in 2021 or so that seemed to suggest the slope just continued. So at all income at a similar slope. That sounded contradictory and I'm so grateful for them. The two of them got together and said, let's combine our data, let's figure this out. So they published a third study a couple years ago where they combined their data and they analyzed. And one of the things they found is not everyone's the same. There's this subset of people that are the bottom 25% of happiness, kind of the curmudgeons. And there's a pure threshold effect there, like it helps up to 60s and then nothing beyond that. If you're just an unhappy person in general, a lot of extra money is

not going to make any happy.

So you lump everyone together and shows one pattern.

But when you divide it, break it

down by groups, it shows different patterns. The highest happiness group, as your income exceeded that threshold, the slope actually increased, it actually went higher.

[Jim Dahle]

Interesting.

[Dr. Josh Daly]

Which is really interesting to me that

[Jim Dahle]

their baseline is they're relatively happy people all the time. They're the ones who more money actually makes them happiest. Huh?

[Dr. Josh Daly]

Yes.

And that's some of that is genetics. Some of us are pre programmed to be happier, but a lot of it has to do with a high quality

relationship with other drivers.

But then probably the most powerful finding. So in this Killingsworth study, 75% of the relationship between happiness and income was explained by how respondents answered a single question. And that's to what extent do you

feel in control of your life?

[Jim Dahle]

Control. It's all about control. It's about autonomy. I think this is why the fact that far more physicians are employees now than there used to be is contributing to so much burnout. I think it's a major factor, the fact that docs don't own their jobs, not necessarily because they make less money, but because they have less control over their work. And I think it really does contribute a lot to people being unhappy, being burned out, et cetera.

[Dr. Josh Daly]

Yeah, Very much so. And the autonomy certainly is autonomy in the workplace. You have control over how the your patient flow is when you work, when you don't have that structured, which as an owner you do. As an employee, I may not, although some employees do. Especially if you leverage negotiation but also control over your life. This idea that a If I'm working 60 hours a week, I've increased my consumption lifestyle to completely match what I

make, I'm barely getting by month to

month, I'm flying home to get the kids in bed. I have no margin whatsoever. I have no control. That is a recipe for burnout.

You're not going to be happy.

So in so much as you can take that high income and leverage it

for margin in your life for more

control of your life, both at work and outside of work that will make you happy. That's kind of the bottom take home message of all of those studies and

happiness and money and the interplay, which is really fascinating.

[Jim Dahle]

Now I have often preached to people that you're going to get more happiness by spending your money on shared experiences with people you care about rather than buying stuff. And I get a fair amount of pushback. People are like, well, I just bought this really sweet car, this nice truck or this boat and the boat allows me to go have fun experiences. I'm getting a surprising amount of happiness out of some of the stuff I'm buying. What do you think about that? What, what's your take on that?

[Dr. Josh Daly]

Well, I think what you're seeing there is motivated reasoning. People spend their money in the way they want to spend it. They want to justify, they spend it,

feel good about it.

So if you provide discon confirming evidence or a opinion that suggests that they're spending their money in dumb ways is

not going to make them happy.

We have a lot of cognitive dissonance that's deeply uncomfortable. So we want to discharge that dissonance. And you want to explain away the

data in a way that allows us to preserve a positive view of ourself in our decisions.

And that's this underlying force that impacts how we interpret data constantly and how

we interact with things.

I think the research is pretty clear

and I completely agree with you.

Experiences tend to provide more happiness than things. Now there's a nuance to that that

a lot of people don't recommend.

So let's say you're working 60, 70 hours a week and you think I just want to get away and sit on the beach and do nothing and that's going to make me happy. There's A. If you do that, there's a reprieve at first. You get some more sleep. It feel good to sit there. But if you go by yourself and

you just don't do anything, you don't

actually feel recharged at the end. You mentioned this, but a lot of people miss it. But it's shared experiences that promote deeper connections. And it's that relational connection and shared experience that I think is really the key to flourishing in the midst of

experience, not just the experience themselves.

[Jim Dahle]

There's a couple of concepts I've encouraged people to explore when trying to figure out how to have, you know, a happy life. And that's to balance your eudaimonia with your hedonia. Eudaimonia think of as, like, purpose in life, to have some meaning in your life. And hedonia, of course, is fun. You know, you've heard of the hedonic treadmill. That's where that comes from. And you've got to get those balances right. Like last Thursday, I had a shift in the er. I left early Friday morning to go to New Orleans to speak to a group of rheumatologists. Got back, you know, Saturday evening, and, you know, by Monday morning, I was like, I don't want to work anymore. I don't need the money. Why am I even working?

[Dr. Josh Daly]

I should retire.

[Jim Dahle]

I mean, I was. The whole flight home from New Orleans, I'm like, what am I doing? I should just retire. And the fact was I just let the pendulum swing a little too much toward eudaimonia and not enough hedonia. So I basically took yesterday, which was Monday off. I went skiing for three and a half hours. I couldn't find anybody to go with me, so I went by myself. I skied 10 runs. I just got my snowboard repaired. So I put my snowboard on, did three more runs. I came home, I played video games for a couple of hours. I literally did nothing that day except have fun. Took my daughter to her hockey practice that evening. I actually wrote two blog posts during her hockey practice because by then I kind of recharged. You know, the pendulum had swung back. So I think it's important to keep both those concepts in mind. Sometimes we need more purpose in our life, and sometimes we need just a little more fun, some time off, and that's okay. It's not bad to take a break sometimes and go have a good time. And the data is pretty clear that if you have that good time, not the way I did yesterday morning, skiing by myself, but with People you actually care about, it's even better and generates even more happiness.

[Dr. Josh Daly]

Yeah, I think there is some research around this idea of silence and solitude and time by yourself and that being, that's all you do, that's not good for you. But that being a part of rhythm of our life, like deep connection with others and shared experience with moments of slowness and silence and solitude, especially in nature, the combination of all those I

know can be very life giving for me.

[Jim Dahle]

Now there's some data out there, I'm changing the subject a little bit here. There's some data out there suggesting in fact quite a bit of data suggesting that givers, you know, people that give away not just money, but mostly money, but also time and effort and energy are not only wealthier, but they're happier and they're healthier. Does that surprise you to hear about studies showing that effect?

[Dr. Josh Daly]

Not in the least. And I think anytime there's correlation, you

have to be a little bit careful about assuming causality.

Although what I naturally want to say that that aligns with the teachings of Christianity, for instance, which I hold to.

So of course I'm going to want to endorse that.

But I do think some of that

may be that happier people who are

deeply connected with others are naturally more generous. It's not purely that acts of generosity fosters other things, although I clearly think

that works in both directions.

And the research is very clear those, those things all cluster together and whether the causal link is from A to B or B to A or some combination. Although in the day pursue them all, you're gonna have a much better life, deep connections with others, a life marked by regular generosity, pursuing meaning and significance.

All three of those make a really good life.

And that's I think really clear cut both from a psychological perspective and if you look at the research and from the perspective of major world religions, I mean that is a theme that's true

in most people who are spiritual individuals.

Some component of generosity and what's interesting about that, it also highlights this idea that emotion and like what we feel like we're drawn toward can sometimes be very, a very helpful signal, but sometimes lead us astray. Generosity off on the front end feels like loss.

You're giving something away and then you

end up gaining so much more on the back end. And if you operate entirely based on

emotion, which is called the affect heuristic or emotion is a reliable indicator. Do I pursue or withdraw?

It's really good for very, it's very near sighted emotion is very good at Indicating what's going to actually make me feel better or worse in the next hour or two is terrible.

At 5, 10, 20 years down the

road, you know, I might feel really hungry, like I want to go have

a cupcake after this.

That's going to feel really good in

the short term, but in the long term will not.

And so generosity is one of those where in the moment to give up

my hard earned money and to give

it to somebody else is. There's some pain in that, but there's

so much life on the back end of that, enjoying happiness.

And some of that's an act of faith of trusting that that will come

on the back end, not in that

as promised, if you get a dollar

away, you get $2 back.

But this is, you want to be

the kind of person that's a generous person and that, that will, you'll reap

the benefits on the back end.

[Jim Dahle]

All right, let's get into a little bit more nuts and bolts. We're going to move into kind of a rapid fire round. We don't have a lot of time left. But I want to touch on some of the pieces you've submitted recently to the White Coat Investor, or at least that we've published. I guess we've got a whole stack of them that you've submitted that we haven't published yet. And I just want you to give, you know, the 22nd elevator message of what this post is about.

[Joe]

Okay.

[Jim Dahle]

One of them is you wrote, is a residency retirement match really that valuable? What was your point in that post?

[Dr. Josh Daly]

The bottom line is that residents should

not prioritize that in picking a residency.

It's a nice benefit if it's there. And if two programs are otherwise equivalent, sure, wait in the balance. But at the end of the day, you want to go somewhere and get

great training, you're going to be happy. That'll matter, of course, far more to

your lifetime earnings than it is if

you get a little bit of matching residence.

[Jim Dahle]

Yeah, totally agree. The big factors are the people you're going to be with, the quality of your training. The location is probably a big factor for most people. And your residency retirement match or what your salary is when you get there. I'm not even sure they're in the top 10 things you ought to be considering when making your residency rank list.

[Joe]

Okay.

[Jim Dahle]

Another one was why buy the cheapest home in a nice neighborhood? Could be horrible advice. This has been going around for a long time, right? I think the idea is if you buy the cheapest home in the Nice neighborhood, it'll appreciate more quickly than anything you could have bought for the same amount of money. Why is that or why can that be horrible advice?

[Dr. Josh Daly]

That's because of what I like to call the housing ripple effect. And that's the way in which the

home that you choose to purchase has ripple effects throughout the entirety of your life.

So if you live in a neighborhood, you tend to be friends with those

people you live around, your kids tend

to be friends with those kids you put. You drive your 10 year old Honda Accord parked in your driveway and you notice your neighbor has a Lexus, the

other one has a Tesla, the other

one has some $100,000 pickup truck. And the next thing you know, you

feel far more dissatisfied with what you have.

All of your neighbors send their kids to the elite private school. You can't be the one doctor that

sends your kids in a public school. That's not a good education.

Suddenly your camping trip over a spring break pales in comparison to the trip to Europe that the neighbors across the

street are making and so forth.

And so you're, you become less content

with what you have.

You naturally compare yourself to those around you. And whether you intend it or not, your lifestyle tends to increase. And then there's the impact of your kids. And I deal with this all the time. So now my, your kids are friends with all these other upper class families that have all these other special things. I still vividly remember my son coming home and informing me he had to have the 200 plus pair of basketball

sheets were, I can't remember their Jordans or whatever they were.

He's gotten really into all the sneaker stuff that to play at a high

level basketball because all the best, all the players on the team had this.

But there's all these expectations to impact

your family and you and even if

you end up your home appreciates a little bit more. It is not enough to account for all of those behavioral effects of living in an expensive neighbor neighborhood and having

friends that spend a lot of money.

[Jim Dahle]

But people want to be in the safest possible neighborhood. They care about their children. They want them in the best possible school district.

[Joe]

Right?

[Jim Dahle]

I mean this is what people say, you know, people justify, you know, buying cars this way. They're like, oh, I don't want to drive a 2023. It doesn't have three more safety features they put on cars. Since 2023 I care about my kids. Why don't you care about your kids? You know, you can use these sorts of arguments to justify all Kinds of things.

[Dr. Josh Daly]

All right.

[Jim Dahle]

Another post you wrote was Flourishing at work. What physicians get wrong about career happiness, what do they get wrong?

[Dr. Josh Daly]

So we talked about this a little

bit earlier in the post, but we

tend to highlight prestige and compensation and working our way up the ladder. And those things don't really matter very

much from a flourishing perspective.

We already reviewed some of this literature, but the primary drivers are high quality relationships, autonomy and comp. Autonomy in your life, growth and mastery, the meaning and significance, and then really

time affluence for most submissions matters way more than it does actual financials. Yeah.

[Jim Dahle]

And yet we shop by. By the finances.

[Joe]

Right.

[Jim Dahle]

That's how we. That's how we choose way too much.

[Dr. Josh Daly]

And it's easy to compare.

We are drawn toward highlighting metrics that

are easy to compare.

So job A is offering me 300,000.

Job B is offering 400,000.

Well, job B is clearly better. It's harder to measure some of those other things. But just because something's hard to measure

doesn't mean it's not really important. Yeah, good point.

[Jim Dahle]

Okay, this is another topic you've spoken about before, you've written about before, and that is the idea that we don't really know our future self as well as we think we do. Your post was titled your future self is a stranger. Here's how to change that. Why do we all think we know what's going to make us happy 10 years from now and then are surprised when it turns out that's not what makes us happy?

[Dr. Josh Daly]

So it's really this combination of these two biases. One, the present bias, where we tend to focus on the present and the distant future, is not very vivid.

It's hard to imagine.

And then we presume that the things that our present self cares about, our

priorities, our values, will persist in the future.

It's hard for us to envision the

things we care deeply about now we may not care about in the future.

And then that's combined with something called an affective forecasting error. And that relates to our difficulty with anticipating what will. How future events will actually impact our emotional state. We're good at valence, so I recognize that if I my targets totaled, I'm going to be less happy. We don't think it's going to make us happy, but we're terrible with magnitude how unhappy or happy that will make us. And then duration. And we significantly overestimate both in both directions. So we think, I'm going to be an attending and make all this extra money.

I'm going to be super happy or

I'm going to get this new house or in my case, I have a brain tumor, I have pan hyphel pit, my life is over and terrible. And hedonic adaptation works in both directions in either, in both you tend to return to your baseline. So we really struggle to make, to anticipate how future events will impact our emotional state. And then we make decisions assuming that things are going to have a much

bigger impact than they actually do and

often undervalued or under prioritizing the variables

that actually tend to matter in that period.

One of the biggest things though, and one of the things I outlined in that article is our future selves. We can't picture them. They are this, with this vague sense, oh yeah, one day I'm going to be old, we can't look at a picture of them. We have a, can't have a conversation with them. And so one of the interesting research studies that was done is you take a picture of yourself and you age progress it and you look at it and then you decide how much to save for retirement. You save more money if you look at an age progressed picture yourself than

if you have not.

There's even some really cool say this is some ways that large language models are being used where you can have a conversation with an age progress video of yourself. And that is even a more profound. This studies are just coming out now about how if you can actually not even look at them and talk to them, hear them talk about what's important to them. One of the just easy things anyone could do today is write a letter as if you're 75, writing to yourself today, thanking yourself for the things you

did to take care of them.

And then read that. There's, there's these various practices we can

do to make that more vivid, make it more real and to help us

prioritize the things that will actually be

important in their future state.

But we are so hardwired to focus

on the here and the now and to prioritize that. And we strongly struggle so much to

actually accurately predict the future and prioritize

what's likely to happen.

[Jim Dahle]

So are we better off trying to divine what we're going to be like in 10 or 20 years and what's going to make us happy? Or are we better off just trying to maximize flexibility so that we can change our life to whatever it is that's, that's making us happy at that time?

[Dr. Josh Daly]

Well, I think one big part is flexibility that gives you more autonomy and allows you to pivot and adjust. I've had to pivot and just a

lot in my life.

Another part of it is you don't have to make predictions just off what you feel and think there's research out there. And this is an area in which like at least my faith greatly influences

my assessment about what actually leads to life and flourish in the future. So I, I read and study the Bible every day. I memorize and meditate on scripture and

I try to fix my mind on

the things that matter most from that perspective.

So you're not, we're not less left to just guess. There's real good data from a research perspective on what drives human flourishing and then from a faith perspective from whatever faith tradition you come from, all of

them deal with what really leads to life on the back end.

And so I think I would one, prioritize flexibility as you mentioned, but also pursue the things that have been shown

to matter even if they don't feel like they do anymore.

[Jim Dahle]

Okay, last, last rapid fire question for you here. And that is you've got whatever 20 or 25 or 30,000 people listening to this white coat investors out there. What's your pet peeve right now? What's the one thing out there that way too many white coat investors are getting wrong? And you want to tell them to quit doing this thing or quit thinking this way. What's your number one piece of advice that you can give to white coat investors in general?

[Dr. Josh Daly]

Well, I have a long list of pet peeves.

I won't go through all of those

and many of them are things that

I care a lot about that probably in the grand scheme of things don't matter that much.

So I'm going to choose to pick

something that I think actually matters more.

And I alluded to this earlier, but that's the fact that most doctors don't

really know what leads to human flourishing. We haven't really read a good book

that summarizes that little yet read the primary research. And we devote so much of our life to experts in our field of clinical practice and we know the latest literature in those areas, but we are completely unaware of the things that, what

the research says about the things that matter most.

I wish every doctor would read one book on happiness or human flourish that's research based and have some basic understanding

of what the research really shows about what matters in life and what's going to lead your flourish in the future. Very good.

[Jim Dahle]

And, and if you had to name a book or two, they ought to choose from what, what should they be

[Dr. Josh Daly]

considering the Good Life, which was published a few years ago. There's an excellent one and it was written by the authors of the Harvard

Study, which is the Long or the

PIs of the Harbor Study, which is

the longest longitudinal study looking at human flourishing.

It's.

I won't go into all.

We can do a whole podcast just on that study.

It's fast, very cool.

But they summarize a lot of the research.

I think that would be a great starting point.

[Jim Dahle]

All right, we've been chatting with Dr. Josh Daly, a WCI columnist, a physician, financial educator. Josh, thanks for all that you're doing in your life. Thanks for contributing to the podcast today. We appreciate your time and your expertise.

[Dr. Josh Daly]

Thanks, Jim.

It's been really great being here. I'm very appreciative.

[Joe]

All right. I hope you enjoyed that conversation as much as I did. Josh is great. I could talk to him all day. Looking forward actually to seeing him here in a couple of weeks at wcicon. I think by the time this runs, this is actually not going to drop until like a month or more. After that, we're a little bit recording in advance, which we often do, is we come up to WC Icon just because we know it's to be a busy period for us. But I hope his insights are helpful to you. As somebody who's been to the edge of serious medical problems and back, I think there's some value in listening to what he has to say about what's important in life. As I mentioned at the beginning of

[Jim Dahle]

the podcast, SOFI can help medical residents

[Joe]

like you save thousands of dollars with exclusive rates and flexible terms for refinancing your student loans. Visit sofi.comwhitecoatinvestor to see all the promotions and offers they've got waiting for you to one more time. That's SoFi.com WhiteCodeInvestor SoFi student loans originated by SoFi Bank NA member FDIC. Additional terms and conditions apply. MLS 696891 don't forget about those paid surveys. Whitecoatinvestor.com Surveys is the URL where you can take those earn a little bit extra spending cash.

[Jim Dahle]

Thanks for leaving us five star reviews

[Joe]

and telling your friends about the podcast. You can leave those anywhere that you get your podcasts and we appreciate it in all those locations. A recent one came in from greenmed051

[Jim Dahle]

terrific no hype resource.

[Joe]

This podcast is great for commutes, but make sure you combine it with a fantastic WCI webpage. It's got concise, clear articles on nearly any question you have. This is one of the single best financial literacy sources I've found in years. 5 stars. Thanks for that review. Okay, keep your head up, shoulders back. You've got this. We'll see you next time on the White Coat Investor Podcast.

[Jim Dahle]

The White Coat Investor Podcast is for your entertainment and information only and should not be considered financial, legal, tax or investment advice. Investing involves risk, including the possible loss of principal. You should consult the appropriate professional for specific advice relating to your situation.