Why Hesitation Is Keeping You Working Late

During a recent coaching session, Dr. K shared with me how preparation helped her finish all her charts on time, and that she had time at the end of the day to prepare for the following day’s patients. I was excited to hear this, and asked if she was ready for the following day. Dr. K’s reply was “not quite” – because she was not sure what to do for a few patients. As we continued our discussion, it was clear that Dr. K knew what the next step would be for those patients, but she was hesitant to commit to her decisions, which was delaying her preparation for the day. She was uncertain about being right and was afraid of the potential consequences of being wrong.

This scenario is common for many physicians, even when you are not a brand new attending, especially after a full day of clinic. Indecision does not just feel uncomfortable – it has more costs than we realize.

What is really holding Dr. K and other physicians back from making decisions is fear. There is the fear of uncertainty – not knowing what will happen. The fear of being wrong – what if the choice made was incorrect and resulting in a bad outcome? The fear of judgment from patients, colleagues and yourself. The hesitation is not from a knowledge gap; it is a mindset and emotional barrier.

The hidden costs of hesitation come in several forms. There is the time cost. When you are revisiting the same question repeatedly, it takes time for you to think and process. When you are overthinking your decisions, especially after hours or when you are in bed, it delays and shortens your time to rest and recharge. The mental drain and cognitive load build up as you go back and forth on trying to make a decision. Many things hinge on a decision. Without making a decision, such as the decision on a treatment plan for a cancer patient, you cannot move forward. You cannot start the process of writing the chemotherapy orders, send in prophylactic medications, schedule the patient to start treatment, just to name a few. When you are hesitant to make a decision and you operate without a clear plan, your efficiency is reduced, which results in longer workdays, working the extra hours you did not sign up for. The other hidden cost is the potential perception of patients, that they believe you, the physician, are lacking confidence or competence. Naturally, the patients or their families will start questioning you, which means more face to face time spent to take care of a patient.

You already have the knowledge to make the decision. Physicians are one of the smartest groups of people. You have gone through years of rigorous training. You keep up your knowledge with constantly learning and taking continuing education steps. I invite you to believe that you are making the best decision given the available information, clinical guidelines and the individual patient’s condition and preferences. Medicine inherently involves incomplete information. You can make decisions and move on based on what is available.

A more effective approach to decisions is to make the decision. Commit to the decision based on the current knowledge and resources. Part of the commitment to the decision is to take action and move forward with a plan. Action creates clarity. The more action you take, the clearer the path becomes. Course correct if needed. As you take more actions, as more information emerges, adjust your plan accordingly. Medicine is fluid and things can change at any time. Allow yourself to be flexible and practice good clinical care.

When you have decisive thinking, your efficiency improves. Less time is spent because you are not revisiting the possible decisions you will be making. There is more time for you to complete your work. This translates to reduced after-hours work. There will be fewer unresolved decisions lingering at the end of the day to haunt you or to drag you down. When you are decisive, you are minimizing repeated mental loops and decreasing decision fatigue, which means you are more efficient in making more decisions. Your mental clarity is increased as you are freeing up cognitive space for other important tasks. When you are decisive and you believe your decision, patients can sense it. The physician-patient connection is stronger and it is easier to build trust.

The main goal of decision making is not perfection, but thoughtful and timely care for the patient. Make your decisions based on the individual’s medical history, evidence-based guidelines and the best interest of the patient.

Indecision costs way more than imperfect decisions. We are not perfect and that is alright. Trust your training. Make the decision and go with it. Adjust as needed along the way. Decisiveness if not about certainty. It is about moving forward toward the best patient care you can offer given the knowledge and resources you have.