Fatigue introduced by long or overnight shifts is well understood by radiologists, with recent studies quantifying the effects. Decision fatigue is different. Decision fatigue is not a physical state of fatigue (like working an overnight shift) but refers to the deteriorating quality of decisions made by an individual after a long session of decision making. Radiologists make more clinical decisions per day than perhaps any other medical specialty. To make matters worse, we also burden them with decisions regarding which exams to read and in what order they should be taken.
There are 4 primary effects of decision fatigue, and they all result in reduced quality of decisions. The four effects are:
* Reduced ability to make trade-offs
* Decision avoidance
* Impulse decision making
* Impaired self-regulation
In a radiology practice, reduced ability to make trade-offs can impact how one might determine if a personal call to a referring physician is warranted. Decision avoidance can cause a radiologist to avoid an exam they might not want to read, hoping someone else will pick it up. Impulse decision making can result in "Cherry Picking" an exam that should not be read next, but provides that quick sugar rush of RVUs. Impaired self-regulation can result in making the poor decision to keep working when a break is needed.
In the article, This One This Is the Enemy of Willpower. Here’s How to Avoid It, written by the popular influencer, Jeff Haden, Haden gives a few tips on how to accomplish tasks that you rather not. Not all the tips relate to radiology and decision fatigue, but a couple do.
To tame decision fatigue, Haden advises people to first Eliminate as many choices as possible. Haden writes,
“We all have a finite store of mental energy for exercising self-control. Some of us have less, some have more—but we all eventually run out of willpower steam. That’s why the more choices we need to make during the day, the harder each one is on our brain, and the more we start to look for shortcuts. (If you like, call this the "Oh, screw it" syndrome.) Then we get impulsive. Then we get reckless. Then we make decisions we know we should not make...but it's as if we just cannot seem to help ourselves.
In fact, we often cannot help ourselves: We have run out of the mental energy we need to make smart choices. That’s why the fewer choices you're forced to make, the smarter the choices you can make when you do need to make a decision.”
When a radiologist is constantly returning to their worklist to pick the next exam, we are adding one complex decision to every exam they read. To make this decision, radiologists consider exam type, referring physician, department, site, customer, modality, etc. A smart worklist frees the radiologist from returning to their worklist, reduces decision fatigue and saves time. A smart radiologist will use some of that time to take a break, recharge, and get back to the important clinical decisions that only they can make.