3 Steps to Manage Decision Fatigue: A Doctor's Perspective

What does a day in the life of a doctor look like to you?

This is a question I often pose to friends not involved in the medical profession. More often than not, their responses illuminate just how little is understood about the nature of our work.

Describing a day as a doctor, I'd say it's akin to decision-making on steroids. As a medical registrar, my day begins with determining whether a patient referred from the Emergency Department requires inpatient management, or whether their condition can be managed with oral medications in the community.

If a patient requires hospital care, I must then decide on the relevant investigations needed to guide the diagnostic process, considering the patient’s underlying health conditions. This is followed up by formulating the appropriate management plan, organising any necessary follow-up investigations for the next day (like arranging for blood tests), and deciding whether we need to discuss any pertinent information with the patient's family members.

In truth, every single moment as a doctor is spent making decisions. This intensity remains consistent throughout the 8 to 10 hour shift, and while there are times when the shifts can be relatively relaxed, these are exceptions rather than the rule.

This constant decision-making leaves doctors, including myself, highly susceptible to decision fatigue. Understanding decision fatigue is crucial, as it plays a significant role in our daily lives and takes on a heightened importance in professions like ours, where decisions can be a matter of life or death.

As a doctor, I've found that decision fatigue can severely impact performance. It isn't just about the sheer number of decisions one has to make, but also the gravity and complexity of these decisions. The unyielding onslaught of decision-making can be both overwhelming and exhausting, leading to a decline in decision quality over time. It's important to remember that decision fatigue doesn't discriminate between professional and personal decisions. When fatigued, we are all prone to making poor choices, whether in our professional lives or personal habits.

To manage decision fatigue, I've developed the '3A' approach: Acknowledge, Automate, Assess. This isn't a universal solution for overcoming decision fatigue but rather a starting point, based on my personal experience and observations. I hope that it gives those struggling with decision fatigue a place to start, and encourages a greater awareness of when we're fatigued and not at our decision-making best. It's also a reminder that there are decisions we can delegate or automate, capitalising on both human and technological resources.

1. Acknowledge and awareness
   Reflecting on our life experiences is an exercise I cannot emphasize enough. It allows us to comprehend what worked and what didn’t, and this knowledge in turn guides us on how to improve and avoid repeating mistakes. Each week, I take time to sit in quiet reflection, running through the events of the past days. I pay particular attention to two aspects of the decisions I've made - their outcomes and the processes that led to them.In the event of a less-than-desirable outcome, I delve into two main components of the decision. These can generally be grouped into internal or external factors. Internal factors, such as gaps in knowledge or a lack of caution, are relatively straightforward to identify and address. External factors, on the other hand, while influencing internal ones, require a more nuanced approach. This is where the concept of decision fatigue comes into play.For instance, I’ve noticed that when life gets particularly hectic, my work performance can be affected. The speed and quality of my decision-making may wane. This, in essence, is decision fatigue in action. Recognising its presence and accepting that it's a natural occurence under certain circumstances is crucial. Remember, awareness is the first step towards improvement.

2. Automate and delegate
   One of the most effective strategies to combat decision fatigue, I believe, is automation and delegation, especially within the context of decision making. I've noticed that automation plays a pivotal role in reducing the volume of daily decisions we need to make.Here's a list of tasks that I've either automated or delegated:It's vital to remember that the primary goal of automation at this point is to diminish cognitive load. The time saved is merely a beneficial side effect of the process. When you begin to automate simple tasks that may save just a small amount of time, you might feel that automation isn't yielding results. However, when you look back and evaluate how much cognitive energy you've conserved, and how it has allowed you to focus more on what truly matters, you'll realise its significant impact on managing focus. This brings us neatly to the final, and perhaps most important, point.

   1. Bill payments - Living in Australia, we thankfully have the convenience of direct debits.

   2. Money transfers between my various accounts - This is mainly how I manage my finances with different pools of money.

   3. Information collection, including highlights when I read, through Readwise so that I can easily review them in Notion.

   4. Routine tasks like lawn mowing and dishwashing are organised in advance.

3. Assess
   When it comes to implementing any changes, the process of reflection and reassessment is paramount. It's important to remember that there is no one-size-fits-all solution. Individual circumstances and needs vary greatly, meaning what works for one person might not work for another.A critical part of this process is continuously evaluating our cognitive capacity. By acknowledging and assessing our decision-making capacity, we become more aware of how it's influenced by our daily lives. This mindfulness is key in recognising when it's time to delegate tasks or take a break to recharge.In a nutshell, learning to adjust to changes involves a continuous cycle of assessment. This introspective process is crucial in understanding our mental bandwidth and how it's affected by various stressors. It's this enhanced awareness that will guide us in deciding when to delegate tasks or when it's necessary to pause and recuperate.

As a doctor, I'm offering you a glimpse into the world of decision fatigue and providing avenues for you to improve your navigation of it. However, it's crucial to understand that what I share is not an all-encompassing solution, but rather a starting point in mitigating the effects of decision fatigue. There are myriad other strategies to explore, including prioritizing regular breaks.

In the medical field, decision fatigue is not a stranger. It's a persistent shadow that follows us in the corridors of hospitals and clinics. Based on my experiences and collaborative efforts with colleagues, I've observed that decision fatigue can lead to errors and, in emergency scenarios, a mental block. This is why I emphasise the management of decision fatigue. When I was a medical student, I wished for someone to emphasize that while medical knowledge is crucial, maintaining a sustainable cognitive load for decision-making is equally, if not more, important in our field.

Improving our capacity for decision-making is a multifaceted journey with varied strategies to explore. What I've shared is not a definitive guide to overcoming decision fatigue, but a helpful starting point for those grappling with it. Two essential components in avoiding decision fatigue are recognizing and acknowledging our fatigue and understanding that it's probably not the best time for us to make decisions. Moreover, we can delegate or automate some decisions by utilizing human and technological resources.

I'm curious about your experiences. How does decision fatigue impact your daily life, and how do you cope with it? I invite you to share your stories and struggles with me.