Doctors changing careers – decisions – part 3 of 4

People make decisions in different ways. We each use various rules to make decisions, and these rules change depending on the importance of the decision at hand and the current circumstances. As doctors, we like to think that we take a rational scientific approach to all of our decisions – but we don’t always. So it is appropriate to consider different ways decisions can be made so that while you ponder your situation you are aware of what internal processes may affect your ultimate decision.

The importance of a decision regulates how much mental resource and time we give to addressing it – obviously the more important an issue the more thought we usually put into the decision process, and the longer it will usually take until we ultimately make the decision. Deciding whether or not to make a career change from medicine is clearly a decision of such major importance such that the it can take years until we can be satisfied we have thought about it enough.

Often there is pressure on us to make decisions. Urgency in our circumstances occurs when we are required to make a decision before a certain time e.g. Do I change career now or wait until after the baby is born? Do I accept my new contract or do I make a career change now? Sometimes it is a less well-defined period of urgency, such as needing to make a career-change decision before menopause, or before my wife leaves me, or before the children go to college. Sometimes urgency can lead to poor decisions especially when the decision is complex. Urgency also tends to favour the less risky option.

Your mental state affects impulsivity, concentration, rationality, and risk-aversion to a great degree. Mood and anxiety disorders need to be recognised and accounted for before making a final career decision; although, indecisiveness about career change may be a perpetuating factor in the disorder itself. In general, psychiatrists advise people that they should not make major decisions while experiencing mental illness. Of course, your mental state does not have to meet DSM-IVR criteria to affect your decision-making!

With these elements in mind we can look at some broad decision-making processes. There is a great deal of psychological research about these processes which I will not go into, but I just wish to present the concepts that are relevant to us. There are 8 different decision-making processes we all use from time to time.  It is important to use a decision-making process that suits the importance and urgency of the decision to be made.  It is also important to know what styles of decision-making we tend to fall towards.

1. Calculated process (Expected utility model) – This is the process we often use when making important non-urgent but ‘simple’ decisions, such as buying a new house or where to vacation. We weigh up the pro’s and con’s with each possible outcome in the decision and take the one that comes up with the highest ‘score’.

2. Sequential elimination – When we use this method we eliminate options until only one left.  Sometimes we exclude a particular decision because it possesses an undesirable quality, for example we might find a BMW convertible for a bargain price but having a lime green paint-work may cause us to reject this car purchase. Similarly, making any career change that would require me to move cities is automatically out for me.

3. Normative process – Based heavily on perceived normal choices that either self or others make, eg ‘doing what everyone else does’. However it is not necessarily as simple as this – the way by which we evaluate what is ‘normal’ is affected by what we base that judgement on.

4. Threshold process – Often when people are searching for something (whether it be sunglasses, sunblock or iceblocks) they have minimum criteria that must be met before they will accept a particular option. For example, the sunglasses must be mirrored (so 1980’s!); the sunblock must be SPF30+; the iceblock must be lemonade. This process usually relates to un-important non-urgent decisions.

5. Least resistance – Choose the option that requires the least conflict or effort.

6. Intuitive – Based heavily on emotions/feelings without much evaluation of rational basis, eg ‘gut feeling’.

7. Dependent – Relying on other people to make the choice

8. Whimsical process – For the small stuff, I don’t waste time considering too many aspects of the decision. If I want a coffee now, I’ll make one. If I feel like going the scenic route home, I will. Not too many people make important decisions on a whim, but sometimes when there is some urgency, decisions can made on quite superficial grounds.

You can see that these 8 concepts are in fact along a spectrum from calculated to whimsical decision-making. Obviously, some people have a greater tendency to making whimsical decisions while others tend to more calculated decisions. While some decisions never make it past a whimsical consideration, others move back and forth along the whole spectrum according to your current circumstances. For example, although you may draw up benefit-risk analysis for a career change, it may actually be on a whim one day that you decide, “I’ve had enough – I quit!”. So, it is important for us to realise that important decisions are dynamic processes and woe be to the career-changer who makes their decision while telling the CEO that he/she is a $&#@

Click here to go to the fourth and last article in the series will be about what options Drs changing careers might look into.


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