How to make the best decisions

0:00 Welcome to the Clinician Researcher podcast, where academic clinicians learn the skills to build their own research program, whether or not they have a mentor. As clinicians, we spend a decade or more as trainees learning to take care of patients. When we finally start our careers, we want to build research programs, but then we find that our years of clinical training did not adequately prepare us to lead our research program. Through no fault of our own, we struggle to find mentors, and when we can't, we quit. However, clinicians hold the keys to the greatest research breakthroughs.

0:40 For this reason, the Clinician Researcher podcast exists to give academic clinicians the tools to build their own research program, whether or not they have a mentor. Now introducing your host, Toyosi Onwuemene. Welcome to the Clinician Researcher. Oh, let's start again. Just make sure that my audio is where it needs to be. The sound is exactly where I want it to be. Yep. Hello, hello. Hello, hello. It absolutely is. All right, let's get started. Hello, everyone. Welcome to the Clinician Researcher podcast.

1:21 I'm your host, Toyosi Onwuemene, and it is such a pleasure to be talking with you today. Today I'm going to be talking about one of the five keys to your success in 2024 and for your entire life. And today it is decisions, your decisions. Last week we talked about your thoughts, and today we're talking about your decisions. And I'm excited to talk to you today about the importance of your decision making, which I think you know is important. But I'm going to just talk to you about five ways to think about it. I think that, I don't know about you, but when it's getting to the end of the day, those are the most challenging times to make decisions.

2:04 And to be honest, it looks as if emails are always flowing into my inbox daily. And the email that has 324 complexities to it flows into the inbox right at 430. And it's the kind of email that you don't want to turn off your email and turn off your computer and go to bed and like think about that email all night. You want to address it right there and then, but you're exhausted, you're tired, it's not the right time to be angry or to be making your decisions. Yeah, decision fatigue is real. And that's why today I'm going to be talking about five strategies, five things to think about actually as you are making your decisions.

2:48 So the very first thing I want to talk about is the importance of analyzing your decision framework. And okay, so there's a whole discipline around decision making, and I'm not necessarily going into any of those, but these are thoughts that I've had and I just want to share with you. So the first thing I'm talking about is really analyzing your decision framework. And without going into any like specifics, I really am just thinking about what has driven your decisions in the past. Like go back to the decisions you've made, especially the major life decisions you've made and think about what has driven, what has been the driver for those decisions. What has been the driver for those decisions?

3:29 For example, you went to medical school and you chose a medical school. So okay, even if in residency and fellowship, we say you had no choice, it was the match. You always have choice and to some extent you made choices, but let's go to medical school where you actually did choose the school and say, what got you to that place where you made a decision to go to that school? Who was involved in the decision making? What were the feelings that you had in making the decision? What led you to that big decision as to where to take a medical school? And for some of you, when you go to medical school, for some of you, you'll say, well, I was desperate.

4:12 They were the ones who took me. That's why I went. And that's the decision that you made that you only had one option and you took that one option because you also made a decision to go to that option. You didn't make a decision to say, you know what, I'm not doing this medical school thing. I'd prefer to hold out for a different medical school. You didn't make that decision. You've made certain decisions over time. And what I'm saying is in analyzing your decision framework is to go back and say, well, what were the strategies I used to make decisions up until I've used to make decisions up until this point? And for some people, maybe you don't have a decision framework. You just are like, well, I don't know. I don't know what it is. Well, you have one because you're clearly making decision and the results that you've produced in your life are a result of the decisions you've made.

4:59 So even if it's not a decision framework that's explicit to you, it exists. And that's why the very first thing I think that's important is to really go back to your major decisions. How did you choose who to be a partner with? How did you decide that you were going to have children or maybe you didn't decide and life decided for you? I don't know. What are the major life decisions you've had and how did you get to those decisions? And the reason why it's important to analyze your decision framework is that there is a pattern in your life for decisions being made. Going back to the example of going to medical school, like even the decision to become a physician, for some of us, those were decisions that were made by our parents before we even started life.

5:44 It was just, hey, your grandfather was a physician. I'm a physician. Guess what you're going to become? For many of us, that was the decision. A parent made a decision for us. Whether that was implicit or it was explicit or there was just an expectation that you grew into. There are some of those decisions that you can trace back to authority figures or even coming closer, because so many of us are so far from medical school, coming closer to residency. How did you choose where to apply for residency? How did you choose finally what program to be in or how did you choose what the final residency program would be?

6:25 There are decisions that you've made in making those decisions or even in the decision as to where to practice, where to pick a specialty, where to go as an academic faculty member, what your area of specialization as far as research is concerned. There are decisions you've made. And if you go back and look at those decisions, you have a sense of who is making these decisions for me? What are the drivers of the decisions? What are the authority figures that I defer to in my decision making? When have I made decisions that I was not happy with? You have that feeling in your mind that you're like, oh, I don't want this thing, but you don't want to upset the person beside you.

7:08 And for that reason, you're like, okay, I'm not going to make that decision because I don't want people to be mad. And those are all parts of your decisional framework. And so the first thing to do is just to figure out, hey, what kind of decisions have you been making and what is the driver for them? And that brings me to number two, which is to visit the root of your decision making, your decisional biases or your decision making. You want to visit those roots because for some of us, the roots are in the fear of missing out. Like, well, all my friends were going to med school, so I said I wasn't going to not be the one to go.

7:51 And that's how you ended up in med school. And that's how you're a physician. You've kind of been going with the flow all along. And that's important because what it helps you to recognize is that you are someone who's greatly influenced by the people around you. That's so important because if you don't like the choices that you have made in your life up until this point because of the decisions you've made, and you can trace it back to the community that has led you in that way and how strongly affiliated you are with your community, how much affinity you have such that you are willing to put your life in a challenging place just so that the community is happy with you, that's important.

8:35 Because then the question is, does it make sense to upgrade your community or does it make sense to put in boundaries so that the community is only so much involved in making decisions for you? And so that's one of the things that is helpful in going back to the root of your decisions to understand what are the drivers for my decision making. Let's use another example. Let's say for example, you're like me or you're like I used to be. Actually, I'm still kind of working through it where I have grown out of a people pleasing place. I like to make people happy and I feel so bad if people are not happy with me even when they're being happy with me means that I'm being hurt.

9:24 And I think it's a socialization thing for many people who identify as women or who identify as underrepresented in the academy. I think there's this sense of you move forward because people like you and they like you when you behave a certain way. And the more of that you produce, the more like you get. And so maybe many of your decisions are based on people liking you. And that has been a big challenge for me and some of the work I've needed to do and to be honest still continue to do is really in saying, am I making this decision because I want this person to like me? And it's so important because it helps me. It means every time I'm going to make a decision, I pause and I ask the question, wait a minute, is this your decision or is this a decision you're making to make somebody else happy?

10:13 Because every time you are when you're aware of your decision making habits, when you're aware of your decision or biases, then it allows you to stop and question your decisions. And that's important because otherwise you're an autopilot. Otherwise my autopilot has to say yes. And so when it's someone I really like, oh my gosh, it's so hard for me to say no, because I'm like, oh, what if this person won't like me again? And it's so subconscious. I'm not even always aware of it. It's just this feeling that I have and I am in decision paralysis. And I don't recognize that that's what's going on until I pause and say, well, why is this decision so hard?

10:55 Clearly the answer is no. So anyway, so you want to understand the root of your decisions, what's driving them, and you may be able to change them as in changing the community or at least expanding your community so that one community is not the most dominant. Or it could be that you are making changes and maybe moving into another community or decreasing the pull of a certain community. So ultimately revisiting the root of your decisions helps you because it allows you to become intentional as far as how you address those roots and how they're driving your decision making.

11:40 So that's number two. Number three is to upgrade your information sources. And that comes from the fact that we have certain biases and that kind of speaks to the root of our decision making. And those biases, and you know that having a bias doesn't mean you're a bad person, right? It just means you're human because all of us have grown up with a certain worldview. We've grown up with a certain perspective and those inform our biases. So we're all biased in some way, but it's recognizing what are the sources of information that drive the bias. For example, when I was growing up, I had and do have a beautiful smile. And people would look at my smile and they would say, wow, your smile is so beautiful.

12:23 You should become a flight attendant. And this is nothing against anybody who's a flight attendant. It's just saying that in that pool of people, and these were my teachers in school actually, there were a lot of them that would say this, in that pool, there was just the sense of like, well, this is the direction for you. This is it. I mean, there wasn't even like, oh, you could be a flight attendant or you could be a police person or you could, there wasn't a list of options. It was just, oh, that smile is the smile of a flight attendant. And so that was one community, my teachers at school, my parents didn't, I don't think they associated my smile with being a flight attendant.

13:07 So that was not something that was reinforced for me at home. But I bring that example up to say that, you know, for whatever reason, my teachers, or at least this group of teachers that felt so strongly that I needed to become a flight attendant, had a bias as to what a woman with a beautiful smile looked like. And it doesn't mean their recommendation to me was wrong. I mean, I'm glad I knew and understood that there were many, many options to me, including being a flight, becoming a flight attendant. But you know, for them, it was very much like, this is it, this is it. And that's based on their biases, right? And even now, I think about, you know, society, societally and the things we think, you know, women should do or shouldn't do.

13:52 And it's still funny to me, my name is a unisex name, if you don't know. My full name is Uluwa Toyosi. And actually, Toyosi is unisex as well. It's Yoruba from Nigeria. And you can't tell by looking at my name, whether I'm male or female. You know, there are some names that are more, there are some names that are more commonly associated with women than men. But you can't tell my name, and it's actually intentionally unisex. But even in the United States, since I moved here, people look at my name and see that there's a doctor before my name, and they immediately assume I am male. Immediately, like there's just no question. And so many times I've had conversations by email with people who I end up recognizing that they were calling me he all along.

14:39 I guess this is why it's very important to clarify your pronouns, right? Because people can't tell on even no matter what your name is, right? Whether it looks like it's a name for one or not, they can't tell. So anyway, I think I say that to say that there are certain biases people have as to who are the doctors, right? Who are, especially if it's not obvious to them, whatever obvious means, there are biases that people have. And you have biases too. I have biases too. And there are some biases that are unconscious and some biases that I am aware of, fully aware that I think that people who are Nigerians are the best and the brightest.

15:22 Okay. Yes. Coming back home. So I'm just talking about like, I'm aware of some biases that I have, but I'm not aware of all of them. But my biases are driven by the information sources that I've had growing up. And same for you. Even if you went to wherever you went to school, you have biases driven by where you went to school, where you grew up, what your parents believed, what your family of origin believed. And the more information you get, the more you can directly address some of those biases, at least the ones that are more conscious. But the ones that are subconscious, you probably do need to do a little bit more work to get them out. And that's why the more information you get, the more opportunities you have to be exposed to people who are of different backgrounds and diverse.

16:12 And the more you approach people respectfully, because I think that sometimes you can be exposed to people of diverse backgrounds and come away still feeling as biased as ever. And some of that is really approaching learning from other people in a way that is respectful so that you can upgrade your information sources. Where you're like, oh, I didn't know that all tall guys didn't play basketball. Okay. I am now informed. Okay. But upgrading your information so that you upgrade the source of the information that drives your decision making. We're still talking about decision making, not so much biases. But yes, you want to make sure that you upgrade your decision making.

16:57 All right. Number four, automate your trivial decisions. And so maybe trivial may not be the right word to use, but automate decisions that are not the most important, most critical. For example, I will give you an example. I wear dresses all the time. For people who've noticed, they're like, is this a religious decision? When somebody asked me once, I was like, religious decision? Really to wear a dress? I'm clearly unaware of some of these things. But anyway, but I do consciously only wear dresses. And the reason I do is because it's a very easy decision.

17:38 There's no mixing and matching, no pairing. It's just one decision. I'm wearing that dress and I don't necessarily wear a jacket over my dress. Sometimes I do, but I have very limited numbers of jackets compared to the clothes that I have, the dresses that I have. So for me, it's an automated decision. And if I take it a step further, actually, I don't take it a step further, but someone I know who's very dear to me takes it a step further where she'll lay out the clothes for the week. Like Monday, this is what I'm wearing. Tuesday, this is what I'm wearing. Wednesday, this is what I'm wearing. And you know, just for the whole week, she's got the dresses laid out. She's not making decisions on Monday morning about what to wear. She saves herself time.

18:18 And so is it a trivial decision to decide what to wear? I would think not, but she's automated those decisions. She did it earlier, earlier in the week so that she doesn't have to think about it anymore. And so in just thinking about your life, where can you automate decision making? Maybe it's in how much you save every month, how much you put towards retirement. Don't decide every month how much you're going to do. Just decide upfront and then automate it. If you're thinking about, okay, I'm submitting a journal, a manuscript or a journal, and this is my top tier dream pie in the sky journal and a couple of, you know, and you know that there's a high chance of rejection because it's a really high impact journal, automate the decision as far as what the next journal will be.

19:07 Don't wait until you get the rejection and then you're like, ah, I really want to get in there now. Where will I go? Just have a plan. Just have a plan of at least three journals, maybe even five to say, okay, it doesn't get in this one. This is where we go next. And it just, it automates the decision. So when the rejection comes, which stings, by the way, even if you knew it was a high tier journal that was out of reach for you, it stings. And instead of like wallowing in the sorrow, you're like, well, there we have a plan. Let's go on to plan B. And so that's what I'm talking about, automating some decisions that if you don't automate them when you're strong and happy and healthy, when you're tired, weak and discouraged, they become even harder decisions to make.

19:52 So think about the decisions in your life that you're making consistently that you know you're going to have to make. For example, what grants are you going to write this year? Just make those decisions now. There may be opportunities that arise, but most of the time the opportunities that you're going to go for are already known. So you want to make that decision. How many grants are you submitting this year? What are the manuscripts that are in your pipeline? Don't like every Monday sit down and say, what manuscript am I going to write this week? Have a plan for your writing. So those are the decisions that you automate so that you can free yourself up for the big decisions. Okay. So now let's talk about the big decisions. You want to optimize for major decisions.

20:35 You really want to optimize for major decisions. And by that, I mean, you know, you know, by the end of the day, you're tired. You know that the end of the day is not the best time to make decisions. You don't want to leave major decisions until the end of the day. Or if the decision comes down to the end of the day, you want to defer the decision making until you are your most optimal, until you are at your, at your best. So if I'm a morning person and I am, and I know that I make the best decisions in the morning, then any major decisions, no matter how angry I am about them, if I'm being rational, if I'm being lucid, I will defer them till the morning.

21:20 Now there are some of those emails, some of those things that come up that make you so mad that you're like, I must respond now. I must tell you exactly how I feel. And wow, what a great temptation to avoid making the decision in that moment to send the email or not to send the email. And what works for me, what helps me, what I'm going to do. For me, what helps me is to defer the decision because I'm tired and I'm cranky, but in the morning my head is clear and I know exactly what to say. So you want to optimize decision making for your, your best time. And if you're an afternoon person and in the morning you can't think straight, don't open your email in the morning and start looking through when you're not ready to respond to those emails that you know are coming optimized for your decision making.

22:05 Another way, and this is something that I do, is that I, I told you earlier, I have a people pleasing tendency. I want people to be happy with me. And so I need space from every decision to be able to sort out how much of this is what I want to do versus making you happy. And so the more distance I have between the request and the decision, the better it is for me. Now, life doesn't always give you those long opportunities, but even a couple of seconds or a couple of minutes of stepping away and taking time to think about it is helpful to me.

22:47 For that reason, if I'm going to optimize decision making, I defer the response to the request from the request. I separate them by as much as I can. So let's say something's like, well, I need this answer urgently. I'm like, can you give me 10 minutes to think about it? Or if I can wait till the next day, I'll say, I will get back to you by tomorrow. I need to sleep on it. And so that's what I've been learning and practicing. Because to be honest, this doesn't come easily. But that optimizes my decision making because then I'm not making decisions when I'm tired. I'm not making decisions when I'm not at my best. And that allows me to make decisions that are really high quality. Okay. So those are the five things that I shared with you today.

23:29 And the first one is to analyze your decisional framework by going back to the decisions you've made and seeing what were the sources of those decisions. Number two, visit the root of your decisional biases. That's make sure that you understand where you're coming from, why you think the way you think, why you make the decisions the way you make your decisions. And then upgrade your information sources. You make certain decisions because you think a certain way, because you have certain information about maybe certain groups of people or certain types of things. Like for example, you know, grant writing is hard. Okay. And it's a skill that you can grow.

24:11 And so you need to upgrade your decisional information sources, right, by going and figuring out from the people who have, you know, have grown into grant writing, not that it becomes less hard, but that they have a skill that they've gotten good at, right, and you can too, if you, you know, put in the reps and put in the work and get the feedback that you need. So getting the information that allows you to recognize that it's a learned skill and you can learn it too is helpful. So upgrade your information sources. Automate trivial decisions and they don't necessarily have to be trivial. Decisions that you're needing to make over and over and over again, automate those decisions. And then number five is optimize for your decision making, especially your major decisions.

24:54 You want to make sure you get enough rest. You want to make sure that you are in the right place. You know, the things that you need to do, you have space time away from that decision to be able to make the right decision. Okay. So those are the five things I want to talk to you about in the importance of your decision making and the things that you should think about as you're moving into the year. And this is pertinent to every area of your life and certainly as you're thinking about what manuscripts am I going to, you know, publish this year? What are some of the grants that I'm going to put forward? What are some of the conferences I want to go to? Just, you want to make sure that you have a framework for moving forward in making good quality decisions.

25:36 All right. It's been a pleasure talking with you today. Please, please, please share this with somebody else. You know, leave us a review. If you've been listening for a while and you feel like, oh, this podcast is really, really helpful to me. And you think, huh, this is a five star worthy podcast. Leave us a five star review. We would appreciate it. And other people would appreciate being able to find us too. All right. It's been a pleasure talking with you today. Thank you so much for listening. I look forward to talking with you again the next time. Thanks for listening to this episode of the Clinician Researcher Podcast, where academic clinicians learn the skills to build their own research program, whether or not they have a mentor.

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