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    How making numerous choices can lead to mental brain drain

     

    If there is one thing we ophthalmologists do a lot of, it is making decisions. In most ophthalmic subspecialties we have learned to be very efficient in our clinics, allowing us to see more patients per day than do most of our physician colleagues (probably dermatologists and otolaryngologists are up there with us). And seeing more patients with eye problems translates into our making more decisions:

    -       Does this patient need surgery?

    -       Which IOL should I use?

    -       Given the cost and (possibly) other differences, which anti-VEGF agent should I recommend for injection into this person’s eye?

    -       Is this angle occludable?

    -       Is the change in this visual field from last visit sufficient to cause me to declare this patient to have progressive changes justifying glaucoma filtration surgery or can I hold off?

    I point this out because of the body of research indicating that human beings can make only so many high-quality decisions per day. After a while, we develop “decision fatigue.” This phenomenon occurs because “no matter how rational and high-minded you try to be, you can’t make decision after decision without paying a biological price. It’s different from ordinary physical fatigue – you’re not consciously aware of being tired – but you’re low on mental energy. The more choices you make throughout the day, the harder each one becomes for your brain and eventually it looks for shortcuts.”1

    Psychologists have carried out many experiments that show that our judgments are affected by whether we have recently been forced to make a substantial number of decisions. We have less self-control (we can tolerate having our hand in ice water for much shorter periods), we have less will power and we can sometimes make snap, impetuous decisions that we regret later.

    Peter J. McDonnell, MD
    He is director of The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, and chief medical editor of ...

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