Decisions, Decisions

Professor Allan Gaw, from the National Institute for Health Research - Clinical Research Network, shares his top ten tips for making effective decisions.

We all make decisions every day. However, that doesn’t mean we all find it easy. As new doctors, this is probably the first time you will have to make decisions about the management of patients.

Indeed, the ability to make good decisions can make the difference between success and failure. There are some simple things to consider when making any decision and putting these into practice will help you avoid some of the most common problems.

Here are the top ten things to think about:

1. Understand your own decision-making

   We all use a mixture of three approaches to decision making — we think rationally, emotionally and as part of our social network. Each method brings its own biases and we each favour a different combination. 

2. Be rational...when you can

   Some decisions are effectively made by weighing up the ‘pros’ and ‘cons’. Here you identify and quantify the consequences of different decisions and reach a conclusion based on hard facts. Of course, this isn’t always possible and even when we think this is how we’re deciding, we may not be as rational as we hope.

3. Be aware of your in-built bias

   We pay more attention to information that’s readily available, and we tend to give more weight to memories that are more easily retrievable – usually because they’re vivid. Also, we often rely on information that supports our already established views.  These biases can lead us to make the wrong decision, unless we’re aware of them.

4. Listen to your gut...sometimes

   A ‘gut feeling’, where you ‘just know’, might be discounted, but it’s actually the result of a complex mental matching game – comparing circumstances to previous experiences. So, your gut can be very useful, but it’s better at some decisions than others. It’s important in making the big emotional decisions, like finding a partner and lousy at choosing which dose of a drug to prescribe.

5. Recognise the role others play in your decisions

   The social world we inhabit strongly influences how we make decisions and our choices are often dictated by what is seen to be the right thing to do, the legal thing, or even what everyone else is doing in the same circumstances.

6. Understand risk

   Decisions are often made to minimise harm and offset hazards. But, sometimes we have very distorted views of what the risks really are. It’s important to appreciate the true magnitude of relative risks to make the best decisions.

7. Avoid decision traps

   Often we’re trapped by how a question is framed. If we look at the same problem from a different angle, new options may present themselves.

8. Realise that any decision is usually better than none at all

   We might never have enough information to make the right decision. In such cases, we make the best decision we can. When deciding, the best thing you can do is the right thing, the next best is the wrong thing and the worst is nothing.

9. Learn from your mistakes

   We all make mistakes and with time get better at making decisions. Mark Twain said, “Good decisions come from experience. Experience comes from making bad decisions.” True, but it also depends on reflecting on those bad decisions and learning whatever lessons they can teach.

10. Don’t waste time on trivia

    Important decisions are seen as the most difficult to make. A consequence of this way of thinking comes when we turn it on its head – a decision that feels difficult we perceive as important. This is most apparent when we are confronted with an unexpectedly difficult decision and our minds force us to spend unnecessary time and effort on something that’s really trivial.

Find out more

• Learn how to facilitate effective decision-making on a Medical Protection ‘Mastering Shared Decision-making’ workshop.
• For continued advice, read our handbook Supporting you through your foundation years