A Two-Step Strategy to Reduce Decision Fatigue

As hospitalists, we make thousands of decisions each day, and often hundreds just for one patient. What is surprising is how those decisions impact us. In a famous study about the impact of decision making, published in the Journal of Personality and Social Psychology, researchers asked some participants to make choices between consumer products. Other participants only had to consider and contemplate the products without making any choices. The researchers discovered that those who had to make choices had less persistence when completing simple arithmetic calculations compared to those who didn’t have to make any decisions. Researchers also found that the decision-makers had more instances of procrastination and lower quality of work.

This research, along with other recent studies, has been used as evidence for what is called “decision fatigue.” It’s just as it sounds: the more we have to choose, the more we end up exhausted and drained, leaving us depleted at the end of the day. I’m no stranger to this. Every time I come off service, I try to be deliberate about observing myself and how I am feeling. More often than not, I found that I was simply tired; tired after yet another long day of decision making. While there is definitely more to why we hospitalists go home feeling exhausted each night, decision fatigue is undoubtedly a contributing factor.

For me, a big part of tending to this exhaustion came from finally recognizing that making choices was a part of it. If people had lower work quality and endurance after sifting through grocery products, imagine the result of thousands of high-stakes decisions that we go through? By recognizing decision fatigue, we can take conscious, deliberate steps to address it. To start, here are two reflections I want you to process to help you assess your level of decision fatigue:

  1. How many decisions did I make today? Consider how many decisions of tremendous importance you made today. And how many easier decisions did you stack on top of those? It is estimated that the average American makes 35,000 conscious decisions each day. The greater your responsibility (and hospitalists have a lot), the more decisions we are faced with. Each decision is guided by impulse, assessment, risks/benefits, prioritization, and sometimes avoidance and deflection. It can be exhausting! 
  2. Ask yourself: How can I minimize the number of decisions I need to make when I’m off?  How can you turn that decision fatigue into decision recovery? The idea is to potentially simplify and reduce the number of things that you have to make decisions about when going off service so that you can get the rest you need. Things like when you will schedule restorative downtime, what meals you’ll eat, and what you’ll be doing with family or friends can all add to decision fatigue. When trying to rest, it’s all about making sure you don’t have to continue to go through the cognitive process of making a decision. When we can simplify the number of decisions we need to make when we are off service, we can rest and recuperate so that we’re ready to make decisions again when we come back. 

Some decisions are unavoidable but can be minimized by doing a little work up front. For example, every weekend you can make a dinner menu for the week ahead, that way you always come home knowing the decision of what to eat has already been made for you. From now on, I encourage you to reflect on your decision load and just be observant of how decision fatigue affects you. Over time, you will notice more and more ways to decrease the choices you make every day. Once you give this a shot, come back and share your story in the comments below or on Linkedin or Twitter.

About the Author

Mark Shapiro, MD is a hospitalist for Providence Medical Group in Sonoma County. He is also the host and producer of Explore The Space, a critically acclaimed national podcast that examines the interface of healthcare and society. You can find him on LinkedIn and Twitter.


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