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Decisions, decisions....

As physicians, we are trained to make dozens of decisions quickly each day. Yet, we aren't necessarily taught how to translate those methods into our personal lives. There are many methods, tools, and techniques out there that help business leaders make decisions. Some are very applicable to the personal world, and others- not so much.

Before I launch into my techniques for decision-making, compiled from many mentors over the years, I want to explore the issues around decisions first.


The problem. When we have unmade decisions, they swirl in our minds and add to the mental load of our days. As a result, they are burdensome and lead to more stress. I've heard it said, "Delayed decisions clutter the mind," and it's true.  Now, that's not to say that we should be hasty in our decision-making; but too, it's best if we don't procrastinate unless we are "procrastinating on purpose."


Rory Vaden discusses this concept in his book of the same title. Procrastinating on purpose means you delay tasks (and decisions) to when they are more appropriate. For instance, currently, in November, you can procrastinate on purpose your Easter dinner menu to a more appropriate time - when you know if Costco has the rack of pork, when you know who will be joining you, etc. There is no pressure to decide today what you're making for Easter dinner. The caveat is, procrastinating on purpose requires you to free up the mental space in your thoughts. No more time is devoted to it now.


The more common procrastination we are guilty of is knowing (or suspecting) now is the appropriate time to make a decision, and yet we don't. This typical procrastination of decision-making prolongs the unnecessary mental chatter that frankly doesn't serve us. There are three common scenarios when this arises.   


  1. When we are afraid of making the wrong choice. Oh, the pressure that comes with believing there is only one correct answer. It's paralyzing at times. Sometimes, we secretly hope the decision will go away, or perhaps someone else will make it for us by default. Then we aren't to blame if things don't go as we like. We find ways to not think of it, but it's still there, taking up room and adding pressure.


As an aside: Clinically, in family medicine, especially, we often have to shift from diagnostic certainty to a hypothesis informed and refined by more information yielding a working diagnosis. The approach to the clinical reasoning pathway is one in which the "goal is not certainty, but reduction in diagnostic uncertainty sufficient enough to make optimal decisions about management."  That flexibility is more aligned with reality, and It reduces the unrealistic standard of the absolute diagnosis at the point of care each time. 


  1. When we convince ourselves that we don't have time for the necessary steps to make the decisions. The delay causes extra spinning in our minds, which adds to the feeling of having too much to do. The thought of having too much to do leads to restlessness which often leads us to go and just do, do, do without focus. It's like driving aimlessly instead of pulling over and typing the new location in the GPS. 


  1. When we suspect our decision will disappoint others. This just prolongs the agony. We suffer for days or weeks or longer, not wanting to make the decision we know is right for us because we don't want to be the cause of letting anyone down. So, instead of the quick ripping-off-of-the-bandage, we stretch out the mental torture on ourselves.


The last issue about decisions I want to explore, before we unpack ways to facilitate decision-making over the next two weeks, is one I learned from a discerning friend and mentor.  Years ago, I was spinning in indecision and feeling the pressure of career decisions. My wise friend kindly pointed out that it was a "self-made crisis." That's right. I had no time-limited opportunity in front of me, no significant reasons to make a career change, and no goal I was chasing. I had simply followed a random thought, and then suddenly, I felt as if I had to make a decision right now. By just hearing the term "self-made crisis," it released the pressure. I gained perspective and found contentment in the "right now." Now, when I find I am demanding a decision of myself, I question if it's really a necessary decision at all.


So this week, do a quick self-assessment. Are there decisions you are avoiding? Why are you avoiding them? Can you feel the extra mental load they're causing? Write them down. Which can you delay on purpose? Which do you need to prioritize time to make? Are they a self-made crisis?  Next week, I'll give you my personal approach to decisions.  Until then…


Have a joy-filled week!  Tonya

Residency programs can benefit from our Flagship 6-week hybrid coaching course for resident or faculty groups - short teachings on fulfillment and wellness topics, group coaching, and one-on-one coaching. Learn more here.


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