In this brief episode of The Girl Doc Survival Guide, Christine shares that it is another week with a bit of a break and shows two aquarium photos: one of fish in an aquarium at Smilow Cancer Center and another of a manta ray seen at Atlantis in the Bahamas.

Just a quick update! Spring break travel!

Defining Investing Success: Goals, Asset Allocation, Diversification, and Consistency with John Shanley, CFP

On The Girl Doc Survival Guide, Christine interviews John Shanley, CFP, Partner and Managing Advisor at Connecticut Wealth Management, who shares how he connected with founders Dennis Horrigan and Kevin Leahy, and sought a fiduciary approach where client and firm interests align. Christine discloses Shanley is her family’s advisor and frames the episode for physicians who want to plan better, referencing Dr. Adam Rubin’s points on compounding. Shanley says successful investing starts with defining personal goals and understanding yourself, then building an integrated plan that includes taxes, estate, charitable intentions, and risk management like disability coverage. He discusses asset allocation (stocks for long-term growth, bonds for stability), diversification as accepting uncertainty, and cautions on private equity due to illiquidity and “too good to be true” promises. He contrasts investing with gambling, emphasizes minimizing downside, staying disciplined through market cycles, starting now even if late, and concludes: “Get organized before you get fancy.”

00:00 Meet John Shanley

00:37 Finding a Fulfilling Career

01:19 Fiduciary Values and Serendipity

02:58 Why Physicians Need a Plan

04:14 Define Investing Success

06:00 Personalized Planning Beyond Rules

07:11 Staying the Course

09:37 Asset Allocation and Diversification

11:47 Private Equity and Lockups

12:44 Asymmetric Risk and Consistency

14:34 Starting Late Still Works

15:31 Money Mindset and Psychology

16:42 Final Takeaways

This content is for educational purposes only and is not intended as personalized investment advice. The information provided does not present a complete picture of every material fact related to the companies, securities, and industries discussed. The information provided will not be updated any time after the date of publication. The owner of The Girl Doc Survival Guide is a client of the firm. Their participation does not constitute an endorsement of our services, and all discussions are focused on business insights rather than personal financial matters.

Founded in 2010, Connecticut Wealth Management, LLC (CTWM) is a registered investment advisor (RIA) that provides holistic financial planning, tax planning, and investment advice for high-net-worth individuals, including business owners, executives, and multigenerational families. Registration with the SEC does not imply a certain level of skill or training and does not imply the endorsement or approval of the qualifications of Connecticut Wealth Management and its representatives.

Decision Fatigue, Perception, and Making Better Choices

This compilation episode of The Girl Doc Survival Guide explores metacognition, limits of explaining perception, and how fatigue affects decision making. Dr. Claudia Mello-Thoms notes that while cognition can be studied, perception cannot be directly accessed; eye-tracking shows clinicians’ explanations often come after perception, which matters for visually based diagnosis in dermatology and dermatopathology. She suggests difficulty deciding can signal the need to step back or ask for help, and cites mammography research where cases not recognized within 5–10 seconds are best set aside and revisited with “fresh eyes.” Dr. Bulat Ibragimov reports fatigued users overlook more and make faster decisions with less information. Dr. Mary Steffel emphasizes delaying important decisions if you are not fresh, while warning that opting out is still a costly decision; she also notes decisions are social and delegation/support increases choosing. The episode closes with advice to involve others and stay curious and open-minded in complex problems.

00:00 Decision Making Overview

00:10 Perception vs Metacognition

02:21 Fresh Eyes Strategy

03:32 Decision Fatigue Signals

04:52 Don't Avoid Choosing

05:41 Decide With Others

Dr. Lisa Sanders on Diagnosis, Cognitive Bias, and Making Time to Listen

Christine interviews Dr. Lisa Sanders, Yale School of Medicine professor and Medical Director of Yale’s Long COVID Multidisciplinary Care Center, known for the New York Times “Diagnosis” column and consulting on House. Sanders describes switching from Emmy-winning CBS News producer to physician after seeing a sports medicine doctor perform CPR and save a drowning woman, and realizing she wanted to save lives. She discusses avoiding diagnostic cognitive bias by staying aware you can be wrong, keeping a differential diagnosis, and “trust but verify,” sharing a case where she accepted a patient’s self-reported POTS diagnosis and later found hyperthyroidism. Sanders argues diagnostic errors often stem from rushed visits and urges physicians to demand more time, noting she secured hour-long new-patient visits and 30-minute follow-ups. She addresses patients not being believed, especially with post-infectious syndromes like long COVID, POTS, MECFS, and fatigue, and advises support for non-linear career paths.

00:00 Welcome and Guest Intro

01:00 From TV News to Medicine

01:31 The CPR Moment That Changed Everything

03:42 Fighting Diagnostic Bias

04:45 Trust but Verify POTS Mix Up

06:49 Reclaiming Time With Patients

10:45 Why Patients Aren't Believed

12:11 Fatigue and Post Infectious Syndromes

13:45 Advice for Nonlinear Careers

14:43 Final Thoughts and Farewell

Dr. Adam Rubin on Adapting, Coalition-Building, and Time in a Dermatology Career

Christine hosts Dr. Adam Rubin, Director of Dermatopathology at NYU Langone and Editor-in-Chief of the Journal of Cutaneous Pathology, reviewing his extensive roles in nail disorders, dermatopathology organizations, and major textbooks. Rubin shares an anecdote about taking a medical dermatology fellowship with Dedee Murrell in Sydney after discovering a fellowship listing was a misprint, and describes learning to adapt to different clinical cultures, emphasizing that individuals must adjust to existing systems. He advises building forward momentum in small steps, using coalition-building and organized meeting processes learned at the AMA, and focusing on relationship-centered leadership and big-picture decisions in journal work despite resource limits. Career tips include doing work you love while maintaining non-work interests, learning investing basics early to benefit from compounding, and being selective with time by thoughtfully saying no.

00:00 Welcome and Guest Intro

01:39 A Fellowship Misprint

03:05 Adapting to New Systems

03:48 Career Progress and Coalitions

05:40 Leading a Journal

06:51 Do Work You Love

07:40 Investing and Compounding

08:31 Protect Your Time

09:10 Host Reflection on Stress

Dr. Kevin Ko on Biomarkers, Oral Dysplasia, and the Limits of H&E Diagnosis

Christine interviews Dr. Kevin Ko (DMD, MD), a pathologist at the BC Cancer Agency with training in oral and maxillofacial pathology, anatomic pathology, and dermatopathology. They discuss his ASDP 2025 lecture on using p53 in oral dysplasia as a potential new approach and the broader problem of diagnostic discordance and over-diagnosis when relying on H&E alone. Dr. Ko shares examples from practice, including recognizing oral porokeratosis (previously followed as dysplasia for years) and a chemotherapy-related lip lesion initially suspected to be severe dysplasia but supported by wild-type biomarker results and clinical history, resolving after stopping chemotherapy drugs. He emphasizes the need for reproducible biomarkers and possibly molecular-based classification to improve consistency and patient outcomes, while also describing the pressure to be near-perfect in pathology, the risk of burnout, and efforts to build sustainable systems (QA sessions, colleague consultation, protected time). The conversation closes with his approach to presentations as storytelling, interest in prospective multi-center research, and a final message about balancing perfectionism with rest while remaining open-minded to new diagnostic methods to improve patient care.

00:00 Welcome & Meet Dr. Kevin Ko (DMD/MD, Dermpath at BC Cancer)

01:00 The Controversial Idea: Using p53 Biomarkers in Oral Dysplasia

01:18 Oral vs Skin Pathology: Discovering Porokeratosis in the Mouth

02:07 Diagnostic Error & Overdiagnosis: Why Reproducible Biomarkers Matter

05:19 Case Study: “Severe Dysplasia” vs Toxic Erythema of Chemotherapy —Context Changes Everything

06:36 The Perfectionism Trap in Pathology (and Why 95% Isn’t Good Enough)

08:04 Burnout, QA Systems, and Building Sustainable Workflows

09:14 Work–Life Balance, Kids, and Choosing Priorities (Family vs Research)

11:14 How to Build a Great Talk: Storytelling, Cases, and Future Studies

11:38 Final Takeaways: Balance, Open-Mindedness, and Better Diagnostics

Dr. Raymond Barnhill on Diagnostic Drift, Uncertainty, and the MPATH-Dx V2.0 Approach to Melanocytic Lesions

In this episode of The Girl Doc Survival Guide, Christine interviews Dr. Raymond Barnhill, a world-recognized dermatopathology expert known for work on diagnostically challenging melanocytic lesions, melanoma pathology references, and contributions to WHO skin tumor classification and AJCC melanoma staging. Dr. Barnhill shares career anecdotes and key communities at Yale and in Boston, collaborations with numerous melanoma leaders, and the founding of the North American Melanoma Pathology Study Group and the International Melanoma Pathology Study Group, as well as participation in the NIH-funded MPATH Study Group. The discussion focuses on overdiagnosis, underdiagnosis, and diagnostic discordance in melanocytic lesions, including evidence of diagnostic drift toward calling more lesions melanoma over time and the overlap between melanoma criteria and atypical/dysplastic nevi. He describes MPATH research, explains the revised MPATH-Dx V2.0 schema, explicitly recognizing uncertainty along a continuum rather than a strict benign/malignant threshold. He emphasizes practical diagnostic approaches including measuring lesion size (noting a 4 mm threshold associated with conventional dysplastic nevi and increasing concern at larger sizes), focusing on key architectural features (junctional nest variation/disarray and lentiginous proliferation), using nuclear size relative to keratinocyte nuclei (including a 1.5× threshold and counting atypical cells per high-power field) while accounting for site-specific pitfalls such as scalp nevi. The conversation also covers “gestalt” versus systematic review, the importance of due diligence using full clinical and morphologic information before ancillary testing, and cautions against overreliance on immunohistochemistry or molecular tests. Dr. Barnhill closes with career advice ends with a message that setbacks can be opportunities for growth.

00:00 Welcome + Meet Dr. Raymond Barnhill (Dermatopathology Legend)

01:51 Career Origins & Melanoma Pathology Mentors (Yale → Boston)

03:59 Building Melanoma Pathology Study Groups (North American & International)

05:57 Overdiagnosis, Diagnostic Drift & Why Discordance Happens

09:43 Inside the MPATH Study: Measuring Interobserver & Intraobserver Agreement

11:39 MPATH-Dx V2.0 Explained: Standardized Classes & Treatment Guidance

13:59 Redefining “Low-Risk” Melanoma: Stringent pT1a Criteria + Embracing Uncertainty

18:47 Practical Grading Tips: Lesion Size, Architecture & Nuclear Atypia Thresholds

22:42 Gestalt vs Due Diligence: Avoiding Traps + Using IHC/Molecular Wisely (PRAME)

28:39 Career Advice: Passion, Mentors, Community + Final Reflections