6 Proven Ways to Conquer Decision Fatigue
Do you feel mentally drained at the end of the shift and feel that you "can't make one more decision"?
Have you ever felt that you are not making the same decisions at the end of your shift compared to the beginning?
Do you feel mentally drained at the end of the shift and feel that you “can’t make one more decision”?
Have you ever prescribed an antibiotic to a febrile child when you really felt it was a viral process?
You Are Not Alone!
Decision fatigue centers around making deteriorating quality choices after a long session of decision making. Sounds familiar? As physicians, this is an all too common scenario. Compound the fact that our choices carry a heavy burden as we are possibly making life-altering choices for our patients on every shift.
Decision Fatigue is All Around Us
The researchers at Cornell University estimated that we make approximately 35,000 conscious decisions each day. Approximately 27 choices each day on just food.
While decision fatigue is prevalent in medicine, it is also seen across multiple industries. It is especially exploited in marketing and sales. As an example, have you ever wondered why sweet sugary snacks are placed in the check-out aisle of your local grocery store? Or, think back to when you bought your last vehicle. After spending time at the dealer, it has been shown that buyers will more likely purchase add-ons toward the end of negotiations (i.e., rustproofing) rather than the beginning.
Decision Fatigue and Time of Day
To highlight what we intuitively know, a 2011 study reviewed the parole rulings of 8 judges over a ten-month period compared to the time of day. The reviewers, amazingly, found the likelihood of a favorable ruling is greater at the beginning of the day or immediately after a food break compared to later in the sequence of cases (see figure below).
The proportion of rulings in favor of the prisoners by ordinal position. Circled points indicate the first decision in each of the three decision sessions; tick marks on the x-axis denote every third case; dotted line denotes food break. Because unequal session lengths resulted in a low number of cases for some of the later ordinal positions, the graph is based on the first 95% of the data from each session.
Also, a 2014 article in JAMA Internal Medicine found a similar trend of decision fatigue related to antibiotic prescribing practices and the time of day. The authors reviewed over 21,000 patients presenting with symptoms of acute respiratory illnesses across 204 providers in 23 different practices. The authors found that the provider is more likely to prescribe an antibiotic as the day progressed.
It seems simple to say but hard in practice. I am not suggesting making fewer decisions at work related to your patient’s health, but I am recommending making fewer decisions on things that don’t matter. Plan (and Simplify) Your Wardrobe First, simplify your work clothes. For me, as an emergency physician, it’s straightforward–scrub bottoms and a T-shirt. In fact, some of the highest performers take this to the next level. As an example, President Barack Obama only wears grey or blue suits. In a 2012 Vanity Fair article, he mentions: “You see I wear only gray or blue suits’ [Obama] said. ‘I’m trying to pare down decisions. I don’t want to make decisions about what I’m eating or wearing. Because I have too many other decisions to make.’ He mentioned research that shows the simple act of making decisions degrades one’s ability to make further decisions.” Plan your Meals Ahead of Time I have recently written about Mealime. It’s a straightforward meal planning app that can provide you quick and easy meals for the whole week. Each meal can be completed within 30 minutes, and Mealime also creates a grocery list for you. You can just print and take it to the grocery store with you. Better yet, head over to Instacart and have the groceries delivered right to your door. Very importantly, have healthy snacks in your white coat or office desk. Don’t complicate this. Some of my favorites include:
- Rx Bars
- Dried fruit
- Dark Chocolate
- Beef Jerky
Steer clear from the vending machines. The sugary options are a) unhealthy and b) will provide you a “crash” far worse than before you ate it. Make your most important decisions first There is truth in the common phrase “sleep on it.” Your cognitive function is greatest in the first 1-3 hours of the day. According to a recent study, most change their decision-making throughout the day. In the morning, we are more methodical, meticulous, and creative. As the day goes on, we may make risker decisions. Use the morning to focus on the most critical tasks first and move on with your day.
As first seen at Medicine Revived. For more information and resources on how to learn the peak performance habits to grow professionally and thrive personally, go to Medicine Revived (www.medicinerevived.com/getstarted)
Author: Dr. Harry Karydes is a board-certified emergency physician and medical toxicologist who is the Founder of Medicine Revived-an online platform that coaches medical students, physicians and advanced practice providers to grow professionally and thrive personally using peak performance habits.
Note: Many of the links on this page are affiliate links, meaning if you choose to make a purchase, I may make a small commission (this is at no additional cost to you). That said, I only recommend resources that I have tested and found them effective and useful. Please do not spend any money on these products unless you feel they will help you achieve your goals.