Hey guys, welcome back to the podcast. I'm Amanda. I'm Laura. I'm Kendra. And today we're going to be diving into a topic that affects many of us, especially professionals who are used to structure in our careers. When it comes to making personal or life choices, even those of us who excel in high stakes decision making at work can sometimes feel paralyzed.
We will, in this podcast, explore why indecision happens, the impact it has, and some practical ways to overcome it. And we will explain the psychological side of indecision and then share some real life experiences. that we've experienced while facing this challenge. So thank you for joining us. Yay. Okay.
So yes, indecision, that is in itself, probably several podcasts, but let's just talk about why it's so common, even amongst professionals whom seems like we, you know, most of us, especially gone into medicine had that very clear cut decision like maybe as far back as like, I mean, for me, it was like seventh, eighth grade.
So it was like high school. I was focused college. I was focused, all going down the path from, school and all the steps. That seemingly I didn't really have to make a choice about maybe just like, which school, where I was going to live, like, which residency, but it was very clearly mapped out.
So there wasn't a lot of things to decide. However, as you go through the steps, you know, there are a few decisions, but for the most part, it's pretty clear and mapped out. So. , then once you're finished with everything and you're like, Oh, shoot, what's next? Oh, no. Now what? Right? You're in attending now.
What? And I think, Amanda, you talked about this before he jumped on air that, , some of our clients, they just, , get to that point where you kind of, maybe you're not board certified, you're board eligible, you've graduated, you've done all the steps and you're in attending and you're just like, Oh, now what?
So, and. Yeah. That can be sometimes an insidious, like, 1st experience of maybe some burnout, or maybe it contributes to the burnout feeling. It's that stuckness and just the inability to, , make a next step or make a decision. So, . Things like, when you become an attending or picking a job, is this a good job?
Is this really what I wanna do? Do I wanna be in the busy academic center or community hospital? Do I want, you know, to take call Q2 or Q six seven? You know, will my call be a 24 hour call that I maybe get a few calls a night or will I be up all night actually at the hospital with. You know, one case after the next, I don't know.
But sometimes once we get into it, we can really spiral into a vortex and just a lot of thoughts convince us of a lot of truths. And really there's only one truth and that is you just have to take the next right best step. One, one decision, the next best right step for you. So sometimes in decision has etiologies based in things like fear of failure.
I mean, perfectionists, we do not like to fail. Sometimes we don't even want to try because there's a consideration of failure, right? So we don't even get out there. We don't even try. Maybe it's something new. We talk about how imposter syndrome a couple of podcasts ago, we talked about how that kind of has an insidious onset and that can be just.
Starting a new job, going from residency to attending hood and you're like unsure as to if you can even handle this and then you just have a low self confidence because it's just new. It's a new environment. You're making all these decisions, you know, based on like patient care, medical decision making and then to even decide something about your own life can really kind of bring, Fear comes out, really.
It's just overt fear. And then, where do we get our information? Well, we talk to, , our mentors, we talk to our peers, our significant others. And so are we getting enough information? Do we have the right information? Is this a credible source? Like, You know, two people could work in a hospital and have very different perspectives on how that hospital runs.
Right? And so now, are we, do we have the right information? Are we getting what we need to make a decision?
And no wonder some of us kind of have, what do we say that analysis paralysis, right? So we just cannot make a decision. And So, out of that fear and out of just not even being able to make a decision we can just stay stuck. So, NA TEDx Talk, Nawala Walsh has a few suggestions, and so we're going to kind of go into that.
And, There are three kinds of distortions that indecision arise from. She talks about a proportion distortion. And so that's when the decision feels overwhelming or too big. So I know one of the things I think that I battled with, I think y'all have heard us all talk about, we're two physician households, so I have a significant other, a husband that is also a physician, and so when we were considering where we were living there, it seemed like.
We had been kind of vagabonds or gypsies for the last, whatever, six years. Cause we were going from med school to residency, to fellowship, all the things, and you just were ever settled. And for some reason, my mind, it was like a huge decision, like where are we going to land because it's forever. Right.
And nobody says like, that was, that was my thought that was just going to be forever roots were getting planted and then we could never move again. And so just really that whole. Am I going to make the right decision to live where I'm going to be forever? And who really says that? It isn't forever.
Things change, right? But because I felt like, oh, this is our first job out of training or our first place to really be planted, it seemed like, oh, this is the only place, this is the only option, or, or we have to make it together because it's, Like forever, right? And so that's not really the case. Then she talks about a temporal distortion.
So this is like, more of a time. So it seems like it's too far in the future. So, you know, making a decision. I know I just sent my oldest off to college and it seemed like just yesterday we were talking about college and it was like, oh, but that's, but you're a freshman in high school. Do we need to talk about that?
And it's funny because. We were just talking on the phone about what she's going to do when she graduates College i'm like we just took you there, right? So it seems too far And like do we really need to make a decision about that now? Yes, we can gather in evidence and information now but we don't you don't need to go to the job fair and land a job like Right, but it does seem kind of overwhelming if it's too far in the future.
And so the other thing about that is, too, is just you can think about that. It's so far in the future, like, 4 or 5 years from now, and then not gain information. That's a flip side and just. Be like, no sense of urgency and just wait and just continue to ruminate on it. So that's another part of the distortion that affects indecision.
And then there's the old emotional distortion. So feeling feelings, right? When it feels too hard, because it's linked to fear, or it's linked to some sort of quote unquote, negative emotion. We don't really like to qualify, classify our emotions, positive, negative, because then we don't want to feel those negative emotions.
Emotions, but it's good to feel all the feelings, right? We talked about that, but disappointed disappointment and regret are 2 that are considerably uncomfortable and may kind of factor into when you're deciding something because not a lot of us like to feel disappointment, either to ourselves, disappoint ourselves or others.
And we. Definitely don't love regret. And so, and that can come back really to haunt you because then if you felt like you made the wrong decision or it didn't turn out how you want, then that regret just gets watered and fed and it just grows like wildfire. So, I shared a couple of examples in my life.
What do you guys think? You have any of these distortions when it comes to making decisions? Well, I know for me, when I was experiencing severe burnout early in my career, and you know, we didn't have resources like we have now to really, to help with it. I knew that what was going on was not sustainable for me and I was so miserable.
It took a long time for me to decide to make a change. And I think, you know, like, especially in medicine, we identify so much with being a doctor that we can get, you know, we can feel trapped. It's like, once we get into it, then that's what we're doing for the next. 30 years or somehow we become less of who we are.
And that's just, I don't know, I wish I could talk to my younger self about so many things pertaining to that, but that's one of the things that really was tough for me , to make a decision about. And finally I did and you know, it was good, but there was a lot of suffering in between. Yeah, for sure.
The whole thing like when I ended up doing the Integrative Medicine Fellowship, that was after it got so painful that I had to make a decision because I thought I was going to continue to get plagues. But the whole proportion distortion, I had that bad, like I put all of this time into becoming a doctor In emergency medicine, and my brain was telling me, like, I'd have to start over from scratch.
You don't have to start back over with kindergarten. You might have to trade another couple years in something, or go to trade school, or go to something else, but it's like, I was acting like everything I had done up until now would have been trash and I would start over. That's not accurate. I wouldn't have to re go back to college.
I wouldn't have to re go back to, especially if I'm not doing something in medicine, I wouldn't have to re go back into medical school. So, I don't know. Brains just make things sound I mean, they are really focused on the status quo and you staying safe. So, risk. They are risk averse. Oh, my goodness.
That is the understatement of the year. Like, something different, we're gonna die. Yes, exactly. So it is helpful to just kind of like, oh, yeah, I've got a proportion distortion or I'm making this sound like I don't need to make a decision. And so that means I'm just going to stay in this miserable spot. I guess forever.
I don't know, because I'm going to stay scared to try something new. I don't know. Brains are just. Brains are wild. And then when you just make one decision, like one small decision, like, you're like, Oh, okay. Yeah. Not so bad. When the plagues happened, like I had this whole thing of like, if I ever tried to do something else, I'd have to leave my family because there wasn't something to train in, in Springfield, Missouri.
And then my family would fall apart and, and like, it just would catastrophize and escalate into like, my life is ruined somehow. I mean, wow. Yeah. Then I like, I had a weekend where I was like, no, I have to, I have to do something. And then it was like, oh yeah, I guess, I guess I could take this class online.
That's interesting. Not dramatic at all. Yeah. It's our favorite meme that says, wow, that escalated quickly. Yes. I love that one. No one. It's actually not a big deal. No. Weird. Yeah. And in life, you know, we think if we make a decision and we feel scared about it, that something has gone wrong or we're doing something that we shouldn't be.
And unless you have stepped into an abandoned house at like 10 o'clock at night. You probably, it doesn't mean that something went wrong going into the abandoned house at 10 o'clock at night might be a bad decision, but when we feel scared, a lot of times it just means that growth is about to happen.
And that's a good thing. That's a good thing. So now that we've identified the problem. Let's talk some solutions reframing you know, we do a lot of reframing with our clients. Reframing is so, so powerful. Here are some techniques that you can consider using if you're struggling with indecision about something.
So if it's a big decision, you can break it down into smaller parts. If you know, for instance, if you want to make a career change and the career change requires a fellowship, I have a client right now, I'm thinking of that. She wants to make a career change and it would require a fellowship. Well, the first step is to gather some information and to talk to people and we can get frozen in the state of, I, I'm afraid that I'm going to fail at this new thing.
And I don't know, I don't know how I'm going to make it work. And it's so funny how our brains often get so spun up and I don't know how I can make it work. We don't even get the basic information about what the facts are about the situation. So it might be, there are some fellowships that you can go to part time and double the time that you're there and still keep working your current job and do, you know, a little bit in the fellowship and get additional training that you want to make a transition.
So getting that big decision can be broken down into just little steps. So just start focusing on that next reasonable step and limiting outside opinions. I want to say like, it's a lot of times a good idea to limit outside opinions. It's so important for us to get grounded in who we are and what we think about ourselves, especially as we're trying to make a change that we think will.
Make life better for us and the ones we love if we want opinions it's best to just like keep that in your closed circle and Then if you get feedback or information that doesn't align with your values or what you think will work for you, then just discard that. But if you get information that's helpful, then you can use that to inform your decision.
Okay. So the second one is challenge the temporal distortion. So for decisions that feel like too far away. Remind yourself that delaying action could mean missing out on months or years of happiness. So one example would be if you haven't started investing in your 401k or if you haven't started some kind of retirement plan, it might feel far away if you're 30, however, that time will creep up.
And so this might be a good time to just start thinking about it. , if we know that we're going to stay in our current job. For another six months or another year, it's not a great idea to think all the time how much you hate it and how you cannot wait to leave it and think about trying to find a new job.
Or if you're not sure if you want to leave it, it's not helpful to think about it. all the time. It just burns up so much mental energy, like thinking about how this job is awful and how I need to find a new one, but I'm not ready to find a new one. A great thing to do or a helpful technique to use would be to just set a deadline for yourself or set a date in the future that you're going to start thinking about that again.
So if you know that you're going to be in this job for another year, at least you're not sure if you want to leave it or stay. It doesn't hurt to say, okay, I'm not even going to worry about this for another three months. Put it on your calendar. Three months. I'm going to start evaluating. Do I want to stay or do I want to leave?
And it will free up so much mental bandwidth to not be thinking about that all the time. It'll help you feel better too. The third one is to reduce emotional distortion. So if a decision feels too hard, remember that emotions that come with decisions like shame and disappointment, they are temporary and they're things that we can work through.
And as we mentioned earlier, a lot of times when we're feeling discomfort, it doesn't mean something wrong is happening. It may mean that growth is happening and something important needs to happen. In fact, most of the best things in life are, happen on the other side of some discomfort like that.
So if something feels terrible and you can't imagine doing it, but you think you need to do it. Think about some options between the extremes. So for example, if you're in a relationship and things , are not going great, it doesn't have to be stay together or break up. , there can be other options like going to therapy or a trial separation.
, there was one couple that I heard about who had a separation and for a few months only communicated by text. So they. But make sure that they were being as kind and true and thoughtful in their communication with each other as possible and could avoid responding when they were triggered.
There's so many different options. Or probably any decision that we may be struggling with, it doesn't have to be either or there can be something in the middle that could be considered. So and many paths can often lead to a good outcome. That's important to remember to a cognitive distortion that we might have is that there's only one right way that we can be doing things for us to have a good outcome.
And that's just not the case. We're here to learn and grow and we can do that many, many different ways.
I was just going to add a little bit to the temporal distortion is like, just pick one. But you may need to gather information to be able to make a, this isn't a just be reckless and pick one, but some of us will self indulge with the information gathering period of time. It might be decades, right?
Yeah. What reasonable person need if they were really committed to deciding how, how much time do you really need to make to get the information you need to make a decision and then hold yourself to that so that you don't just prolong that information gathering period forever. You just need to make a good enough choice and then set that deadline when you're going to revisit it.
And then brains like to freak out. Like I'm stuck with it. Listen, if a non negotiable, a deal breaker happens, then, then you have new information and you can reassess at that time. Like brains just like to think like once you make a decision, you're stuck to that forever and it make it so dreaded. Oh, yeah, and you're going to wind up a non insignificant amount of our clients like have this fantasy of winding up in a ditch and sub and eating cat food.
I don't know more than one person is true. And so dramatic. Yeah, like, or you would just go back to the previous job or you would just, you know, whatever. Who knows? You, you know what you would do? You'd figure it out. That's what you would do. Yeah. Okay. We, yeah. And I would say too, sometimes it's ironic because we make decisions at work every day.
Like that's what we do. We're problem solvers, right? And so you have to like acknowledge that actually you do know how to make decisions. Cause I think we can talk ourselves even out of the fact that we can even make the decision. Like we convince ourselves, Oh, I just can't, I can't. And you go to work and you make how many decisions?
How many decisions in the ER do I make in five minutes? Well, if it's crazy, I'm getting interrupted every 30 seconds. I've got a chart, four charts open in front of me, and I've got like someone screaming, like someone pick up the line and take this transfer, you know? Right. And so I just made 16 decisions and,
90 seconds. So sometimes we just have to remind ourselves, actually, we do know how to make a decision. We do it all the time and that is even like comforting in itself, right? Yeah. Well, and honestly, this is where working with a coach is really helpful because it, when I'm talking to a coach about something like this, they just cut through all the crap and they're like, okay, no.
Like, when are you getting this done? And yeah. Let's put it on the calendar and let's stop, you know, the indulgent information gathering or whatever it is, just like, what do you want? What do you want? Do you want to keep being stuck and stagnant in the same place or are you ready to move forward? And if you're ready to move forward, let's move forward.
Perfect. So, at the end of her TEDx talk, , Nuwala Walsh talks about three questions she asks herself when she finds herself getting stuck in that rumination phase. And I, surely I'm not the only one that has ever been in this scenario. Should I stay? Should I go? Is it worth it? What if this happens?
What if that happens? Well, I don't know, but then will I regret it? So she asked herself these three questions. Number one, what's the worst that could happen if I made this choice? It is. Interesting that we, by asking ourself that, like, a lot of times we're afraid to even consider that, and so it's this nebulous fear of something, something might happen.
So, what's the worst that could happen if I make this choice? Number two, what's the likelihood of that worst case scenario happening? A lot of times it's minuscule. And number three, Okay, worse, let's just go with it. And if it did happen, how would I handle it? So just acknowledging the worst case scenario can sometimes help you realize that it's manageable.
So my example is there was some stuff that went down in my marriage that I had never expected. I, I felt very strongly before it happened to me that I would know exactly what I was going to do, but it turned out when it happened. I was confused. Not all of the information was lining up with what I thought, my decision was going to be, plus I had some small kids, and so to stay or to go, I was spinning out on to stay in my marriage or leave my marriage forever.
I had this classic thing, one foot in, one foot out, not fully ready to commit to staying, but yet not leaving either. And. I had to ask myself, , this sort of questioning did help me tremendously. What's the worst that could happen if I choose, what I ended up doing was choose to stay? What's the worst that could happen?
Well, the same BS would happen again. Okay? What's the likelihood? I don't know. That I googled and it was like every, Every professional is like, well, it all depends. So I don't know. There's a non zero chance. Yeah. I mean, I don't know. I like, but my brain was so in fight or flight and like my limbic system.
Like, it just, it needed certainty in a scenario where there would never be certainty, and that was, I don't, I don't like that, turns out. Yeah, no, none of us do. Yeah, but number three, if it did happen, how would I handle it? Well, if it happened again, I would feel pretty comfortable leaving, like, it would be okay, and no one died, but you know what would be a slow, painful death, is not either committing or leaving.
That. Is what the slow painful death would be so Just like facing these fears head on and like, all right Well a lot of our clients like should I stay should I go? Well, what if I stay and then I end up, you know I'm, like what's the worst that could happen? Like I don't know get fired. Oh, yeah. Well, you're already thinking about leaving Anyway, it's like oh, yeah, I guess it's not Oh, yeah.
Huh. Okay. Well, here we go.
And some of us are like, walking into work like, am I getting fired today? And just wishing for the decision to be made for us. I know. Is today the day? I don't know.
So, in all humor, we laugh about these things because sometimes the uncomfortable is better dealt with in humor instead of tears. So, let's recap some of our main points. So, we talked about indecision and we talked about where it comes from fear of failure, lack of confidence. Of course, our loving personality trait is physicians, perfectionism.
So we see where it's coming from. . We recognize there's some things our brain offers up. There are the distortions we talked about these lovely, facades that our brain wants to help us make these decisions through and whether it's too big of a decision, whether the decision's far away, whether it seems too hard basically, it can just give us that awareness of our indecisiveness and just say, listen, like, actually, if I take a step back, the facts are that I can make a decision and I just need to cut the crap, like we said, leave the drama on the table and just get to the facts, right?
Even if you have to write him down, meet with a coach. That's what we're here for. Like sometimes you do just got to have someone there to like pull out the facts and have that awareness or that focus on the facts. Like this is how we're going to make this decision. We make decisions in the ED all the time because we have facts like risk stratifying and we know what will happen if we don't resuscitate a septic person, you know, right.
We know the consequences of that. And so we choose to. You know, follow guidelines and protocols like we can do the same thing here. And then we break down the decisions. We set deadlines, we reframe the expectations. We can overcome this feeling of stuckness by just reframing and whether it needs, whether if it's too big, we break it down.
If it's too hard, we set a realistic expectation. We remind ourselves we can do this and then we go from there. And like we said, we really just need to. Do the next best step. So what's the next best step? How do we go from not stepping to the next step to moving forward? Cause we just want progress here, people, right?
Just progress in any direction is progress, right? And then we talked about the 3 questions that Amanda said, and we'll include these all in the show notes and the link to the TEDx talk. But those 3 questions to ask yourself, what's the worst that could happen? What's the likelihood of the worst happens?
And if it did, what am I going to do? Like, how am I going to handle it? Right? So those great conversation today about making decisions. And if it did help you, please don't forget, leave us a review.
We're asking just for five stars. That's it. And a few words so that other physicians can find us. And after all, it makes our ripple a little bit bigger. And we want to tell you about a new free video that we put out. It's called how to crush physician burnout for good without cutting back hours, quitting medicine or sucking it up in silence.
So scroll down in the show notes, click the link and check it out today. So until next time you are whole, you are a gift to medicine and the work you do matters.c==63)if(c=a.charCodeAt(d+3),!c||c==61||c==38||c==35)break a;d+=4}d=-1}if(d<0)return null;c=a.indexOf("&",d);if(c<0||c>b)c=b;return decodeURIComponent(a.slice(d+4,c!==-1?c:0).replace(/\+/g," "))};function W(a,b,d,c){function e(){--g;if(g<=0){var l;(l=a.GooglebQhCsO)||(l={});var q=l[b];q&&(delete l[b],(l=q[0])&&l.call&&l())}}c=c===void 0?[]:c;for(var g=d.length+1,f={g:0};f.g
