Careful assessing is better than second-guessing

Several years ago, I made a “decision” that I needed to figure out a better way to make decisions.

We all struggle with decisions whether big or small. We all sometimes delay making difficult decisions, or revisit the decision once it is made again and again. For me, difficult decisions can vary from deciding what treatment to recommend for a cancer patient, to determining how best to structure a new cancer research program, to deciding whether I should attend yet another meeting. There are times when I feel overwhelmed by the sheer number, the potential consequences and the variety of decisions that need to be made, particularly if I put off the difficult ones and let them build up.

So my solution to making better decisions involved coming up with three simple questions I ask myself when I am faced with a difficult decision. These won’t work for everyone, or for me every time, but they help.

1)      Do I have all the information I should have to make the decision?  If additional data would be helpful (and is available), have I used it?  Have I consulted a colleague, gone to the medical literature, or sought additional input in other ways?

2)      Do I understand the perspective I will use to make the decision? Patient well-being takes priority, as does being truthful, and as open and collaborative as possible. Determining how to balance the likelihood of severe side effects versus the chances for cure, short-term success versus long-term promise, the diverse opinions of two respected colleagues, or the balance among multiple worthy opportunities is more difficult. Deliberately thinking about the perspective I want to use as the basis for a decision often helps me cut through the fog.

3)      Am I in the right frame of mind to make the decision? There are some decisions that should not be made when angry, tired, frustrated, or, for that matter, elated.

If the answer to each of these questions is “yes” then I try to move ahead with the decision right away, and not allow myself to procrastinate even if the decision is a difficult one.

When talking to patients about a potential approach to cancer treatment, I like to talk through these three questions with them, as well. Does the patient have adequate information to make a decision, are they making the decision from the right perspective given their overall health and the potential pros and cons of therapy, and are they in the right frame of mind to make the decision?

We all have the tendency to second-guess difficult decisions even after they have been made and implemented.  This can be exhausting.  When I have gone through my three questions, I find I second-guess myself less often.  If new information becomes available, reassessing is vital.  However, in the absence of new data, if the decision was made based on the right information, the right perspective, and in the right state of mind, there is little value in dwelling on it.  I think my patients find the same is true if their decision was well-thought out in the first place.

Needless to say, as an oncologist and in my other roles, I know that the best-made decisions can turn out badly.   If the decision made was made for the right reasons it makes accepting negative outcomes easier.   I still look back to learn, but not to second-guess or criticize myself for having made a mistake.

None of us makes the right decision every time.  Carefully assessing instead of second-guessing helps me make the right decision more often, and live with the decisions that, in retrospect, prove to be the wrong ones.