When Thinking is Hard: Managing Decision Fatigue
Although decision fatigue seems to affect nearly everyone, those of us who work on an ambulance are especially vulnerable.
In other words, they had good habits.
You see, if a certain action is a habit, then it doesn’t drain any self-control. This is both intuitively true and demonstrated by the research: Thoughtful, complex analyses require an investment from our internal reserves, but rote memorization or execution requires none. So, the more of your daily activities that you can lock into a fixed, unchanging routine—something you simply do, every time, without debate—the more mental energy you can conserve. Should you clean off the stretcher? No need to ask, you’ve already done it. It may seem like you’re creating more work for yourself, because in some cases you’re doing more than is necessary. But the real “work” is weighing the risks and benefits, burdening yourself with the choice.
We tell ourselves it’s how we perform under pressure that counts most, but the sum of who we are as professionals is just as much determined by the everyday habits which make up our work. Are you the paramedic who always takes a clean set of vitals, or are you the paramedic who sometimes does and other times doesn’t bother?
I am a strong advocate for intelligent field providers who can use their judgment on a case-by-case basis, but much of what we do simply needs doing, not debating, and all of those things can be automated by turning them into habits. And in creating some mental slack for yourself by placing the mundane stuff on the back burner, you free up resources for the things that actually need your attention—like the complex work of field diagnosis, or managing unexpected emergencies.
You can even try to habituate some of the non-clinical, non-operational choices during your day. We all need occasional variety, but you can control how much of it you introduce and keep the rest of your routine tightly locked-in to avoid sapping your resources with a 10-minute debate over where to buy lunch. Take the same roads to work or to your post locations, follow the same morning routine each day, put your pen back into the same pocket it came out of. Keep the easy stuff easy so the hard stuff is possible.
Exercise your adult capacity to plan ahead. Much of what we deal with is predictable, and can therefore be dealt with in a managed way. If there are things you don’t want to do, do them early—before you’ve started running low on self-discipline—because if you put them off, you may do a lousy job or never address them at all. Go talk to the supervisor first thing, shine your boots now, fuel the rig or give it a wash. Procrastination is bad in two ways, because not only does it push your problems back into the worst part of the day, it also stacks them up so you end up doing everything at once. Do you think you’ll write better reports if you complete them after each call, maintaining a steady pace throughout the day, or if you let them accumulate and have to write six in a row? Rather than procrastinating, grease your path downhill so your shift gets easier and easier as you become less and less equipped to deal with it.
Nutrition can help as well. Although it may be tempting and occasionally helpful to turn to quick carb-rich snacks when our self-control dips, a diet of real food, which maintains a steady blood sugar, is a better choice than riding the glucose roller coaster. It also won’t promote diabetes, which is itself associated with impulsiveness and moodiness!
Finally, just try to keep tabs on your mental state and know when to bow out. Try as you might, sometimes you’re going to end up in a bad place. If you’re aware of it, you can avoid dangerous situations while you’re vulnerable. Let your partner tech the call or have your supervisor talk to the irate staff member—and if you find that you’re consistently getting burned out, consider shifting your schedule or cutting back your hours.
