The Modern Equine Vet
June 2024
Vol 14 Issue 6 2024
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Practice Management

Equine Veterinarians Face the Perfect Storm for Decision Fatigue

By Paul Basilio

If you do anything 35,000 times a day, chances are good you eventually will get tired of it after a while. According to multiple sources, however, that’s how many conscious and unconscious decisions that the average person makes every day—and it’s not exactly something we can stop doing.

Decision fatigue, a term coined by social psychologist Roy Baumeister to describe the feeling of emotional and physical fatigue that results from making an overwhelming number of decisions, often occurs alongside generalized burnout.

In a presentation at the 69th Annual AAEP Convention in San Diego, Cara Wright, DVM, MS, explained that common causes of decision fatigue can include general fatigue, sleep deprivation and low blood sugar.

“Veterinary medicine is the perfect storm for all of those things,” said Dr. Wright, a veterinarian at Merck Animal Health. “We have unpredictable days, a substantial lack of downtime, and we’re making demanding, stressful, and life-altering decisions.”

If you find yourself staring blankly at a vending machine, completely frozen and unable to decide what type of chips you’d like, there are ways to decrease your fatigue and gain control of your brain once more.

Block Your Time
For the high-volume decision makers, Dr. Wright recommended setting aside time for making a block of decisions.

“Set aside time for communications with your staff,” she said. “Instead of having them ping you all day, give them 20 to 30 minutes to ask all of their questions. This gives you the ability to focus on what you’re doing without constant interruptions for the rest of the day.”

She added that staff members with a good amount of autonomy will likely start solving some of those problems on their own, in the event that you are not there to immediately provide answers.
Administrative time is the same way. Set a block of time for paperwork, etc., and hold yourself to it.

“Statistically, you are more likely to get it done on time with fewer mistakes if you set aside a time instead of squeezing it in whenever you can,” she said.

Delegate, Delegate, Delegate
Empowering your staff to make decisions based on their strengths is a good way to decrease decision fatigue and make your staff feel valued at the same time.

“This involves setting up crystal-clear systems and protocols,” Dr. Wright said. “Once those are set, it should make your life a lot easier.”

She gave the example of a veterinary clinic in Arizona that empowers staff to report issues over email. If there is an issue, problem or idea, the staff member will write up an email that states the problem, lists the steps that have been taken, and then provides their proposed solution.
“Then they send that to the practice owner,” she explained. “Instead of her having to go through all of the steps of solving the issue, the staff has already done the legwork.”

Trust the System
Creating and deploying systems for specific recurring issues can save time and mental exertion.

“Nobody should be asking you how many doses of SMZ [sulfamethoxazole] that need to be ordered, or when they need to be ordered,” Dr. Wright said. “Figure out how many you use in a month, put it in the computer, and be done with it. That is not a question you need to answer every day.”

Along those lines, using templates for prescriptions, record-keeping, and discharges can increase decision-making efficiency.

“You should only have to write up discharge instructions for a hoof abscess 1 time in your life,” she said. “If your system does not have the ability to create templates, put it in a Word document and you can just copy and paste.”

Think Harder, Earlier
Studies have shown that our brains tend to work less efficiently as the day goes on. Make the harder, more complex decisions earlier in the day, when possible. Callbacks, bloodwork discussions, and anything that gives you stress should be done as early in the day as possible.

“I switched to doing my pre-purchase write-ups first thing in the morning, and it was a game-changer for me,” Dr. Wright said. “Before that, I used to sit and stare at X-rays for hours, asking myself, ‘Is that mud or an osteophyte?’ and ‘Whose horse is this, anyway?’ Do what works for you and change things around.

Don’t Forget to Eat
“If everything in your day is the worst, if every problem you encounter is insurmountable, and if every single person you talk to is getting on your nerves, think about whether you have had something to eat,” she said. “All of the data points to the fact that our executive functions and emotions are difficult to control if we’re hungry. Don’t be ‘hangry.’ Eat your snacks.”

She added that most decisions in life are not permanent. They can be changed. The trick is to decide something and move on, and you can always re-adjust.

“That is a very easy thing for me to say out loud, but it is a very hard thing to do in life,” she said. MeV

Decision fatigue is widespread across many industries.

A study that looked at bank loan officers found that loan approval rates dropped in the afternoon when compared with the morning hours. The study concluded that saying “No” to a loan is typically the safer option, since no one can default on a denied loan.

“The bank found that they lost almost $500,000 in 1 month due to lost fees and interest because of the easy choice of saying ‘No’ to a loan,” Dr. Wright said. “That’s a huge financial hit.”

In 2019, a study of German car buyers found that as consumers made their way down the list of potential options and add-ons, they tended to pick the default option more often without giving attentions to the extra offerings.

And in human medicine, a Scottish study found that nurses made progressively more conservative, more expensive and less efficient decisions as the time and number of decisions they made increased from their last rest break.

A 2019 study involving ER physicians found that decision fatigue led to lower inpatient admission rates, fewer task orders and shorter patient length-of-stays.

“That sounds kind of good, until you keep reading the paper and realize that patient revisits and mortality also increased,” Dr. Wright said.


A social psychologist coined the term “decision fatigue” to describe the feeling of emotional and
physical fatigue that results from making an overwhelming number of decisions.
Cara Wright, DVM, MS