Decision Fatigue

Do you suffer from Decision Fatigue?

Dr. Geoffrey Mount Varner

Who or what suffers when you are fatigued?

    The parents called 911 to have their child, let’s name him Robert, taken to the emergency department for evaluation by an emergency physician for flu-like symptoms. There were torrential rains with flooded streets everywhere so it was challenging and time-consuming for paramedic crews to respond to calls.

    The paramedic protocols require providers to assess the patient and then transport the patient to the closest appropriate hospital. Meaning, if the patient is having a heart attack the provider is expected to take the patient to the closest hospital that has a cardiac team even if that means bypassing other hospitals. A good example would be if you are at work and your colleague slips and falls and stabs themselves resulting in the pen being lodged in the eye. The most common reaction would be to take the patient to the closest ER. But if the ambulance were called the responding paramedics would take the patient to the closest trauma center -even if that means passing many hospitals. One final example, if the paramedics have a pediatric patient with an acute life-threatening injury they are going to transport the patient to the closest pediatric hospital even if that means bypassing several closer hospitals.

 Back to the story, the paramedic team arrived at the patient’s home to awaiting and ready to go parents. The crew evaluated the child and assessed a few mild respiratory issues. Reportedly the child did not “look too bad”. Hence, the crew decided to tell the patient’s parents to monitor the patient and to make sure that the patient stayed well hydrated and thus NOT transport the patient to the hospital as per protocol. Again, the established standard was to transport anyone and especially vulnerable populations (very young, elderly, homeless, etc.) to the emergency department once evaluated by the responding emergency medical technician, EMT or paramedics.

  As a result of the bad weather, the crew had already worked a double shift. They had already made several thousand decisions prior to their arrival at baby Robert’s house. The crew was mentally and physically exhausted, to say the least.  

   Twelve hours later the same crew was called back to the house for a “sick child”. It was the same child. But this time the child appeared clinically much sicker.

  The patient was quickly transported to the pediatric emergency department using the ambulance's lights and sirens. The patient was pronounced dead several hours after arrival. It was determined that there was a delay of care.

  The bottom line is that the providers were suffering from decision fatigue. The declining of one’s ability to make good decisions as the day goes on. Often as a result of many and multiple mundane decisions made prior. 

Decision fatigue is omnipresent, it is not unique to the healthcare environment. Can you think to examples when you suffered from decision fatigue?

  Our brain is similar to a muscle. For instance, when we physically exercise our muscles at some point, they become tired. And when your muscles become fatigued, they do not function as efficiently. A real-life example would be marathon runners. Early in the race, their pace is strong, consistent, swift, naturally flowing and effortless. We have all seen footage of marathon runners as the race progresses and towards the end of the race, the runner’s stride is not optimal, inefficient, forceful, graceless and requires a lot of energy – unless you are a well-trained marathon runner which 98% of the world is not.

   The brain functions the same way. Early in the day your brain is not fatigued and has plenty of energy. It is able to maximally process, synthesize enormous amounts of information and thus make reasonable and thoughtful decisions.

 In short, as the day progresses the brain experiences decision fatigue, which is the declining of your ability to make good decisions as you spend more time mulling over other decisions during the course of the day. The greater number of decisions both big and small the more swiftly and your brain functions less optimally.

 In other words, the more daily decisions you need to make as the day goes on you become worse at weighing all the options and make educated choices.

 There a few famous people who live and act upon the concept of decision fatigue.

1.     Former President Obama – Obama states, “You’ll see I wear only gray or blue suits; 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…” Obama went on to explain, “the act of making a decision erodes your ability to make later decisions”.

2.     Mark Zuckerberg – echoed that he has to serve a billion people and therefore does not want to waste energy on minor decisions when there are larger impactful ones he needs to make. Mark wears the same grey t-shirt

3.     Steve Jobs – wore the same blue jeans and black turtle neck every single day.

 An Israeli study looking at parole boards showed that convicts who appeared in front of the parole board earlier in the day were 65% more likely to be paroled compared to those who appeared later in the day and charged with similar crimes. The study re-enforced the importance and impact of decision fatigue. 

Debra Cassens Weiss of the American Bar Association sums the study up well, … the study found that board members were more likely to grant parole at the start of the day and after breaks for food. The problem, researchers said, was “choice overload.” When faced with too many decisions, people are more likely to opt for the default choice. In these cases, the default was the denial of parole.”

There was another great study done at the University of Kent. The study had two groups. One group had to engage with a strenuous computer program for 90 minutes. The other group had to watch a brain neutral video for 90 minutes. Then both groups had to get on the exercise bike and peddle until they were fatigued enough to stop. Each group was allowed to choose their own resistance level.

  One hundred percent of the time the group who was not mentally drained (watched the neutral video) outperformed the mentally drained group. But what was more interesting is, each group chose the same resistance level for the bike ride. What that means is we are not very good at knowing when we are cognitively fatigued. Otherwise, the brain-tired group would have chosen an easier resistance  Do you know when you are experiencing brain fatigue? Do you have strategies for preventing brain fatigue?

  Top 5 ways to decrease decision fatigue:

1.     Make fewer less important decisions- delegate more.

2.     Appropriate daily rest- if it is a long day consider a power nap.

3.     Be sure to eat. Always have a sugar supplement available in case you find yourself feeling hungry.

4.     Exercise – a few quick pushups, sit-ups, or walking the stairs can rest your brain and boost your energy.

5.     Do not second guess yourself. Unless presented with new information your first choice is probably the best option.

 But more importantly, having a framework in place to prevent brain fatigue and to assist when your brain is fatigued is essential. In the next article, we will discuss the TLC framework for split-second decisions.

 T – time constraint

L – lack of information

C – critical consequences.

 For more information on split-second decisions go to splitseconddecisions.com.

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