How to make difficult decisions in a crisis

We are making decisions the whole time.

Tea or coffee?

Netflix or news?

Sit on the chair or the sofa?

Scratch that itch with the left hand or the right – or not at all?

Many of these decisions are unnoticeably small, and their consequences are slight.

Other decisions may seem small but can have enormous consequences (‘Can I overtake that truck before the bend?’)

But what about when we or a loved one are facing a crisis related to our health that might have very serious consequences? How do we make the best decision and not let our fear and anxiety take over?

 

Decisions and choices- what’s the difference?

People often use ‘decision’ and ‘choice’ as if they’re the same thing: I’d argue that decisions are focussing on a mental event, whereas ‘choice’ is more about what you actually do: for instance, I often decide to go to the gym, but choose to sit on the sofa and drink tea instead.  Here we’ll be talking about the ‘deciding’ part of this – what goes on in your head – but we’ll also bear in mind that ultimately it’s what we DO that counts more than we  tell ourselves we’re going to do. A bit like me going to the gym…

In addition to the consequences, big or small, the very act of making decisions appears to have some benefits from the sense of control it gives. Humans (and many other animals) generally dislike feeling helpless and lacking in any control over events. I could point to the current political fashion for seeing choice in services (be that hospitals or TV channels) as being more important than their quality. Or, we could look at the number of lottery and similar gambling activities where the punter is given lots of choices to make (e.g. choosing numbers), when in reality all selections have exactly the same probability of success.

These may simply be reflections of the need for control and for predictability.

Yet, just as people differ in how much information they want about a bad situation, they also differ in how they want to be involved in decisions.

 

Patients are now encouraged to make informed choices for themselves

In healthcare, we’ve tried to move away from what gets termed ‘paternalism’ – the doctor, for example, simply making a decision on behalf of the patient  ‘in their best interests’ (though obviously, there will be some circumstances where the patient “lacks capacity” and cannot make a decision for themselves, e.g. they are unconscious).

In theory at least, the ultimate decision usually rests now with the patient, with the professional’s role being more one of providing the information which allows the patient to make an informed choice.

And here we meet the question of individual differences again: some people really like that way of making decisions, where they have complete control. For some, though, this feels much less comfortable; colleagues of mine often hear variations on the line ‘You’re the expert, Doc: I want you to make the decision’, or ‘What would you choose if it was you / your child / your mother in my position?’

And you can see the point: these can be quite literally life-and-death decisions, and people may feel that, even with plenty of information about the pros and cons of different options, they just don’t have the background to make a judgement.

Perhaps the way to look at this is not that people are avoiding a decision, but rather they are making a reasoned choice to delegate that decision to their doctor. Actually, given that the person ultimately has to give consent to any treatment, the final decision will still be theirs, even if that is only to accept or reject the recommendation they are given. And despite recent public resentment of, and rejection of “experts”, when we personally are facing a life-changing event, expert opinion is still what we usually seek.

And as with information choices, people can differ in how much control they want over decisions, some wanting more autonomy, others less.

There are no hard-and-fast rules about who will prefer which, though there is some research suggesting that people who are younger and better educated are slightly more prone to want more personal control 1. Crucially, though, people are not fixed in all this; on one day, for one decision they may want total control, and on another day for another decision, want someone else to take charge. And it’s not always the case that people struggle more with big decisions than small ones; people will frequently make some of the biggest decisions (e.g. whether or not to go ahead with risky surgery) far more quickly than they’d be able to choose a meal from a take-away menu.

So it’s not some stable personality trait to be a keen or reluctant decision-maker.

 

Top tips when facing an important decision

• Check that it is actually your decision to take.

• Try to work out what outcome you want to achieve, and what you’d settle for if that’s not possible.

• Some of us like to take decisions more than others; and some tend to be more comfortable choosing risky options. If you know what your tendency is, you can reflect on whether you’re actually making the best decision, or just the one that’s most comfortable or familiar.

• Don’t just weigh up the pros and cons of a decision, allow for how likely each is, and then consider what other key people think you should do (whether or not you agree with them). Look carefully at how far you think you’d be able to manage each of the options. And then reconsider each, because your gut decision may not be the right one.

• If there’s no way of knowing how events are going to turn out, is there a ‘next step’ that would suit all the possibilities?

• Consider which of your choices sits best with your Values. These are simply the ways of being that you want to stand for in this life, for example ” being caring”, ” being curious” or ” being loyal”.  Remember that different people will have different values.

• Sometimes, different Values point to different choices. You may have to choose one, but make sure you do something else as well that ‘serves’ those neglected Values.

• Even though you’re mainly concentrating on getting through each day, occasionally give some thought to things further ahead to keep you heading in roughly the right direction (remember the cowpats and field gates).

• Be wary of making irrevocable decisions early in a crisis about what will happen later on; your ideas about what you want to do may very well change.

• If a decision turns out badly, but was the best you could make at the time, there’s no point beating yourself up about it. By all means try to learn from it, but don’t automatically assume that you’re bad at decision making; that way can just make you feel helpless or guilty, and function less well.

 

This blog post is based upon Chapter 5 of “Facing the Storm” by author Dr Ray Owen, in which he seeks to give advice to people who are facing a major personal crisis. You’ll find more details on all these tips in the book.

You can buy this book here, or why watch his FREE workshop recording, Facing the Storm – building resilience when your world’s falling apart.

Facing The Storm book by Dr Ray owen

References

  1. Ende, J., Kazis, L., Ash, A. and Moskowitz, M. A. (1989) ‘Measuring patients’ desire for autonomy: Decision making and information-seeking preferences among medical patients’, Journal of General Internal Medicine, 4, 23–30.

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