Tuesday, September 25, 2012

Decision Fatigue

Doctors taking care of patients who are hospitalized make a lot of decisions every day.

Here is a very conservative estimate for a common hospitalized patient on their first day of admission:

Each medication: Is it necessary? how much? how often? what route? hold parameters?
x10 meds = 50 decisions
Each lab result: Is this normal? If not, do we need to do anything? What should we do?
x15 lab results =45 decisions
General work up of hospital illness -should we treat? do we need more diagnostic tests? do we need a consult?
x3 med issues =9

1 patient = >100 decisions per day

x5 patients = >150 decisions per day

or if you're the senior resident or attending x20 patients = 1000 distinct decisions in a day!

Thus, after a call day, when a friend asks you where do you want to go for dinner -your response: anywhere, as long as you decide!

I think this decision fatigue is an under recognized but significant cause of fatigue, stress, and burn out in the hospital for residents. I know many of these decisions become much easier over the years, but they are still distinct decisions, for which you are accountable for in a court of law. Not so easy in my opinion.

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