When Even Small Decisions Feel Hard

Decisions, decisions. The whole day is filled with decision making. As a physician, you decide how to take care of your patients, which patient to evaluate first, or how you approach a difficult conversation. The more decisions you make, the longer it may take you to make more decisions because your brain is getting tired.

Have you noticed how you think slower later in the day? You have a certain level of reserve in your mental tank. The more you use it, the faster it is depleted, and that is when you start to experience decision fatigue. When you are mentally exhausted, you are less efficient. It takes you longer to make one decision. You are more prone to doubt yourself, doubt if you are making the right decision.

Preventing or minimizing decision fatigue can preserve your efficiency, sanity and creativity. There are two approaches to tackle decision fatigue: increase your mental reserve and decrease decision making.

I have recently shared in another blog post about the importance of rest and adequate sleep. Resting is an opportunity for you to recharge and increase your mental capacity. This is the same idea as when you charge your phone. When you are well rested, you feel refreshed and you have a clear mind. You can make more decisions and more complex decisions before feeling tired. I cannot emphasize how taking small breaks during the day can help you recharge your brain reserves. These are ways to increase your mental capacity to make more decisions.

What are some strategies to minimize decision making? One way is to make some decisions in advance. For example, decide what to wear to go to work the night before. When you wake up in the morning, all you have to do is to wear the clothes you have already put aside. That is one less decision to make. If there are certain things you do on a regular basis, make them part of your routine and do things in the same sequence. For example, I always do my morning routine the same way before leaving for work. When I arrive at the office, I park at the same spot. I turn on the computer, log in, and check the EHR the same way as always. I am minimizing the decision of “what to do next”.

Make certain things a habit. For example, in your clinical day, conduct the interview with patients in a certain format. Write your notes in a particular way that follows a sequence – so you do not forget the next step, and you do not have to think about what you are missing. That is the idea of using templates or smart phrases. The more things you pre-set, the less you have to think about and make decisions for.

Make important and serious decisions first, early in the morning, when your mind is fresh. This is when you have a clear mind and you can focus the best. Prioritize to do more complicated tasks earlier in the day.

When you feel stuck, ask for help. You are not a lone fighter. You work together. Collaboration brings about more efficiency and better results. In medicine, especially when it is difficult to decide on a treatment plan, ask your peers. Or discuss in a conference, such as the weekly tumor board. When you cannot make a decision, you cannot move forward. The more time you spend dwelling in indecision, the more mental energy you are draining, and the easier you feel frustrated.

Keeping it simple, without over-simplifying, is the key to most things in life. When there seems to be many decisions to make, pick the most important one first. Tackle one thing at a time. If things are spinning in your head, pause. Write them out. Visualizing things in different ways can help you see that we sometimes over-complicate things in our mind. Claim more mental reserve by resting and taking breaks. Minimize decision making by creating more habits and routines. Prioritize to make the heavier decisions first. Ask for help when you feel stuck. Always keep things simple. When you minimize decision fatigue, you get to have more energy to focus. Your mind is clearer. You get to make better decisions, faster decisions and be more efficient.