Uncertainty in medicine is inevitable. From your first day as an intern, you may have felt uneasy about making decisions, but as an early career doctor you had senior colleagues to consult, a safety net to support your judgement. As you step up and transition into the role of consultant, that safety net fades. You become the ultimate decision maker. It is therefore vital to have developed and strengthened the skills that underpin confident, sound decision making.

In our most recent resource in this series, we raised the concept of building your ‘decision making muscle’ through undertaking the workout plan. We now take this one step further and focus on using tools and a clear structure to help you build confidence when you need to make a decision you are uncertain about.

Feeling uncertain is not a sign of incompetence. You will not always have complete or perfect information and will often need to make the best decision possible with what you know. It is important to create a psychologically safe environment where uncertainty can be discussed openly, supported by leaders who model this behaviour and challenge the unrealistic expectation of certainty.

One useful tool is to find a decision-making framework which works for you.

A simple framework is: Pause, Assess, Act and Reflect (PAAR)


1. Pause:

If you find your stress levels rising or feel you are unable to make a decision stop and take a moment (or even just a breath in an emergency situation).

There are many different micro-mindful or calming exercises you can implement. Keep trying different things until you find one that works for you.

 

2. Assess:

Ask yourself some key questions by formulating a list which is most relevant to your role. For example:

  • Is this my decision to make?

  • What do I know?

  • What am I uncertain about and why?

  • What do I need to know and how can I find out?

  • What is within my control?

  • What is not in my control?

  • What support can I seek?

 

3. Act:

Being able to adapt and act in a timely manner is often more valuable than being certain in many medical scenarios.

Cultivating psychological flexibility to navigate uncertainty and adapt rapidly in complex clinical environments to make timely, patient-centred decisions is a professional asset.

It is also an asset to your own psychological wellbeing. Be ready to adapt your strategy

4. Reflect:

Learn and debrief. Medicine is a career of continual learning. This learning means you continue to grow. Refer to our workout plan which recommends keeping a work diary and use the debrief prompts suggested.

It is also important to reflect on your mindset and to track your progress and confidence as suggested in our workout plan.

Establishing a trusted group of colleagues, mentor, or a coach to debrief with is another important tool in becoming more comfortable with decision making.

PAAR is one of many tools doctors use to support them with decision making. Another extremely useful methodology is to use your decision making and reflection as a teaching tool for others. If you can be comfortable doing this, your confidence and skill in making difficult decisions will rapidly improve.

If you would like more support in developing decision making confidence, we are here to help. The best starting point is to schedule a career call or email our team at [email protected].

You may benefit from engaging a coach to help you navigate this important career transition. Explore our six and 12 month Professional Coaching Programs here.