Can't Make Up Your Mind? It Will be Better in the Morning! A Look at Decision Fatigue.

braincomboI go to the front door of the lab to let the Fedex guy in with our 3:30 delivery. He appreciates a moment of warmth and I can use the stretch. My back has stiffened while I have been looking at a continuous stream of prostate biopsies for the past few hours. It has been a steady flow of glass slides, each with their linear array of pink and purple stained tissue. Benign, benign, cancer, benign. With each 10x field I look at, I make another decision. I trust that via my training and experience I have a mental “memory picture” of every pattern that prostate cancer might take and will recognize it when I see it. But as the afternoon ticks by, it gets harder and harder to decide. Is it  benign or malignant? In fact, it gets more difficult to make any decision at all. I tell myself I should order some deeper sections, or special stains, or just look at this case first thing tomorrow morning. All  logical steps, but what I am really thinking is that I just can’t make one more decision today.

I hear it from Barb, too. We have been working on our house for more than a year and a half now. The series of decisions has cascaded: Should we move, should we build, where should we build, who should build. And then there was the layout phase. Bedroom here, mud room there. Most of those decisions we made together. But once the details of design began, from muntins on the windows, to knobs on the cabinets, it has been almost all Barb. She has found some great help along the way, but the yea or nay comes down to her. All those decisions can just wear her down.

A little research shows that we are suffering from a condition known as “decision fatigue”, a real condition that even has a biological cause. My afternoon inability to pull the trigger on a cancer case fits the classic description–as the day progresses, decisions become harder and harder.  Barb’s housing issue is more of a chronic variety that we can shorthand as CDF or Barb Syndrome.

Decision Fatigue has been reported at least since Ancient Rome and the Empire, overcome by Julius Caesar when he decided to cross the Rubicon River– a decision he probably made in the morning. You can temporarily fight DF with a calorie jolt, particularly with a hit of glucose. No word on the benefits of caffeine. A good night’s sleep is what it takes to restore our ability to make sound decisions.

So my desire to hold of on some cases until the morning is a smart one, even if it slows down the turn-around time on my cases. Bedding down today will help me separate the benign from the malignant tomorrow. My patients will benefit from any slight delay. Waiting till morning will even lead to a better job of proofreading this blog.

As for Barb and her more chronic variety of Decision Fatigue, a solid night of sleep will help her out too–but only when she finally gets that night of sleep in our perfectly designed and decorated new home!



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photo credit: Ars Electronica <a href=”″>Pathfinding in the Human-Computer Medicine / Fraunhofer Institute for Medical Image Computing MEVIS (DE)</a> via <a href=””>photopin</a> <a href=””>(license)</a>

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