Medical professionals make hundreds of decisions each day, from the ordinary (what time to wake up, what to wear) to the job-specific (what labs to order, what medications to prescribe). For many doctors, their work-related decisions are routine to the point of being scripted – what’s the first-line anti-hypertensive for this demographic? Done.
The ER is a little different. While we also have a routine, the ER is a constantly changing, time-restricted, high-pressure, high-stakes environment. Yet we must make decisions rapidly, often based on incomplete information. We use a recipe based on our training and experience, with a dash of instinct and creativity thrown in for flavor. This rapid-fire decision-making can be the most enjoyable and the most stressful part of the job.
Business owners also face what seems like endless decisions. While most carry low stakes, some can truly affect the outcome of a business, and by extension, your finances and the livelihood of your employees. When too many of these big decisions come at once, it can become overwhelming, affecting your mental and physical health.
In this article, we will discuss decision fatigue: what it is, how it can affect you, and how to combat it.
Personal Therapy
I’ll let you in on a little secret. When I write an article, I’m not always teaching the reader something I already know. Occasionally, I am researching something that’s on my mind or that I need to learn. This is one of those times.
There’s been some turmoil in one of my main businesses lately, forcing me to make some hard decisions over the last few months. These include personnel changes and even the closure of a location. These were difficult choices with real-world consequences for myself and others. I’ve found myself losing sleep, lacking energy, being easily distractible, and procrastinating; things I would normally never associate with myself. It’s been difficult.
Over the next 6 – 12 months, there will be more difficult decisions. Times like this occur in every business, and they can be the most exciting and rewarding if things go well. They are also the most stressful. These challenges left me wondering, what can be done to combat decision fatigue and put yourself in the best position to make good decisions?
Decision Fatigue
We’re surrounded by decisions. Some are so small as to seem inane – Starbucks or Pete’s, coffee or tea, large or small (or whatever the hell Venti is), how many sugars? Others are more profound – should we hire a new manager, expand or not, or close an underperforming clinic? Regardless of the size, being faced with too many decisions can leave you feeling mentally and emotionally exhausted, leading to poor or rushed outcomes.
Symptoms of Decision Fatigue
- Procrastination or Avoidance – Do you find yourself avoiding emails, calls, or questions so you don’t have to choose? Are you stuck in an endless “research” loop, hoping that a little more information will help you know what to do? Are you constantly choosing lower-priority tasks over what really matters? I’ve found myself doing all of these in the last month.
- Exhaustion – While physical exhaustion can result from a range of medical conditions, it can also be a symptom of decision fatigue. When important decisions loom, you can feel overwhelmed and physically/mentally exhausted.
- Irritability – Blowing up at those around you over small things may signify more than just you’re an a**hole. Or at least I hope so.
- Impulsiveness – Drinking too much, eating poorly, making uncharacteristically rash choices – all of these can be related to decision fatigue.
- Physical Stress – This can include a wide range of symptoms, such as headache, nausea, intestinal problems, and fatigue. When a patient asks me, “Could what I’m feeling be caused by stress?”, my answer is always “Yes.”
Who is Affected?
Decision fatigue can affect anyone, but is most common in the following:
- Those who make a lot of decisions every day (like business owners).
- Those whose decisions affect other people (like doctors).
- Perfectionists (like business-owning doctors).
- Those facing difficulties or uncertainty – times of life change or tumult.
What Can You Do to Combat Decision Fatigue?
Ok, I’ve now diagnosed myself with decision fatigue based on the signs/symptoms. Am I destined to be an impulsive, exhausted, irritable, stressed-out, procrastinating jerk for the next six months??
While there is no miracle cure for the burdens of responsibility, there are a few things that can lighten the load: optimize your decision-making process and reduce the number of choices you make.
1. Reduce the Number of Decisions You Make
This solution seems obvious. If making decisions stresses you out, make fewer of them. However, we don’t want to procrastinate or avoid, which are defense mechanisms and symptoms of the problem we’re trying to solve. Our goal is to deliberately reduce the number of small, repetitive, and inconsequential decisions we make on a daily basis. By reducing these “easy” decisions, we save our strength and concentration for the most important choices.
Automate
Picture in your mind an image of iconic Apple founder Steve Jobs. What is he wearing? In nearly every photograph and video of the famed CEO, he is wearing jeans and a black mock turtleneck. Why? Legend has it that wearing the same thing every day became one less decision he had to make, one less drain on his mental energy and focus.
Automating is something our brains do naturally to conserve energy. You don’t consciously think about the mechanics of brushing your teeth or driving to work. It just happens subconsciously. We can take this a step further and automate minor decisions in our lives, as Steve Jobs did.
I’m lucky to get to wear scrubs to work every day and not have to think about what to wear. When I’m off, I usually lay out my clothes before I go to sleep, so whatever is on the couch in my bedroom gets put on the next morning. I eat the same breakfast nearly every morning. I drink the same drinks every day (two cans of Cherry Coke Zero, one bottle of green tea, one black tea, and a glass of water). While this may seem boring, my routine reduces the number of decisions I have to make.
Delegate
Do you have to make every decision yourself? Let partners, managers, and trusted employees make all but the most consequential of decisions. Let your spouse or your children decide where to eat or what to watch, especially when you’re having a challenging time at work. Perfectionists are more likely to suffer from decision fatigue, so just let it go. Not every detail is life-or-death.
Pareto’s Principle states that 80% of effects come from only 20% of the causes. If you focus your energy on the 20% of decisions that affect 80% of outcomes, you are utilizing your time wisely. Allow others to manage the other 80% of choices that have only a minimal impact.
Reduce Choices
Have you ever eaten at a restaurant with a menu so vast that you can’t seem to decide? I’m looking at you, Cheesecake Factory. You look, and you look, and then finally make a rash decision right when the waitress arrives. You’re not even sure that’s what you really wanted. That is the problem with having too many options. It’s harder to choose.
2. Optimize Your Decision-Making Process
There are plenty of decisions that aren’t appropriate to automate or delegate. It’s important to have a process to assist in your decision-making.
Time Management
An effective way to reduce decision fatigue is to limit the time you agonize over decisions. Set boundaries by establishing a firm deadline. For minor choices, make the deadline very short. Give yourself one minute at a restaurant to peruse the menu and make a choice, then stick with it. Do the same for other inconsequential decisions – what you wear, what you drink, what movie you will watch on the airplane. A minute of mental strain is better than ten.
For more consequential decisions, set a reasonable yet firm deadline, which may be a day, week, or quarter, depending on the gravity and complexity of the situation. But there must be a cut-off that doesn’t allow for procrastination or avoidance.
Another tactic is to make important decisions early in the day, before you are exhausted from countless other, less impactful decisions. I remember reading a study concluding that ER physicians were more likely to prescribe narcotics and antibiotics near the end of their shift. After 10-12 hours of being worn down, doctors were more willing just to give patients what they wanted.
For high-stakes decisions, block time to think. Set aside uninterrupted time, preferably early in the day, to run scenarios. One method is to utilize the three-outcome plan.
Three Outcome Plan
Anytime I’m discharging a patient from the ER, and I don’t know have an exact diagnosis (which is often), I tell them, “Although I can’t predict the future, there are only three possibilities when you leave. One, you get better. Great. Two, you get worse, in which case, come back. Three, you stay the same. Since we’ve already ruled out any emergency, this gives you time to follow up with your PCP.” The same is true for any decision we make.
When you’re evaluating a serious decision, examine three divergent outcomes. First, the ideal result: everything goes better than you expect, and life is great. Next, what’s the worst that can happen? Finally, what is the most realistic outcome?
What will you do if everything goes better than expected? While this is the best-case scenario, life isn’t perfect. Success brings problems, and even good problems still have to be dealt with. Will you use your success to expand, reward employees, or bank the profits? Thinking about success ahead of time leaves you better prepared when you catch lightning in a bottle.
What if everything blows up? How bad will it be? Is the risk asymmetric? If the upside is small and the downside catastrophic, maybe you should rethink your decision. Can you mitigate the consequences of failure? Entrepreneurs are naturally optimistic, but it helps to cover your backside.
Now that you’ve covered the two ends of the spectrum, focus on the realistic middle. What is the most realistic outcome, and is the juice worth the squeeze? You can become very successful hitting doubles your whole life. You shouldn’t have to hit a home run for an endeavor to be successful. Swing for contact and the dingers and strikeouts will (hopefully) even out.
By the time you’ve analyzed the three outcomes, you should be able to make a well-thought-out decision.
Stress Management
Your body and mind are a decision-making machine that must be properly maintained. If you are tired, malnourished, and out of shape, you can’t think clearly and act decisively. Part of optimizing the decision-making process is taking care of yourself. Get proper sleep, eat well, exercise, and meditate. Your machine will thank you.
Thinking in Bets
I read professional poker player Annie Duke’s book, “Thinking in Bets”, several years ago. I even included it in My Top 10 Business Book Recommendations for New Business Owners back in 2023. My takeaway from the book is that you must separate outcomes from decisions. Too many people fall prey to a cognitive bias called “resulting,” where they judge a decision based on the results.
Betting your life savings on the New York Knicks to win the NBA Championship at the beginning of this season was a bad decision, even if they end up winning. Conversely, making a bet in poker when your hand has a 90% success rate is always a good decision, even if you happen to lose.
Decisions should be judged on their own merits without regard to the outcome. Unfortunately, we can’t precisely measure the odds of success in business the way Annie Duke can in poker. Business decisions are often more like the ER – we don’t have complete information, but we make do with what we have. Calculate the most likely outcome and choose accordingly.
Conclusion
If you are reading this article on this site, you either are or will be the shot-caller. You are not average. Be it your personal finances, a business endeavor, or just your medical career, you want to be the one with the ball in your hands when the game is on the line. But decisions carry consequences, sometimes good, sometimes ill. No article or decision-making tool can alleviate this pressure. Heavy is the head that wears the crown.
You should now understand that when indecision, procrastination, and avoidance find their way into your life, it may be decision fatigue. By following the process outlined above, the unbearable weight of decisions should lessen.
Warning: decision fatigue is, by its very nature, temporary. If you find yourself suffering from these symptoms for extended periods of time, especially after implementing the methods discussed above, and/or after your stressful situation is resolved, there may be a deeper problem like depression. If this is the case, seek professional help.
Thank you for reading Business Is the Best Medicine. Have you ever suffered from decision fatigue? Do you have any methods that have helped you in the past? Let us know in the comments. Also, consider subscribing to the blog so you don’t miss any upcoming articles.