EP210: The Curiosity of Choice: Understanding Decisions and Fatigue

Decision Fatigue, Perception, and Making Better Choices

This compilation episode of The Girl Doc Survival Guide explores metacognition, limits of explaining perception, and how fatigue affects decision making. Dr. Claudia Mello-Thoms notes that while cognition can be studied, perception cannot be directly accessed; eye-tracking shows clinicians’ explanations often come after perception, which matters for visually based diagnosis in dermatology and dermatopathology. She suggests difficulty deciding can signal the need to step back or ask for help, and cites mammography research where cases not recognized within 5–10 seconds are best set aside and revisited with “fresh eyes.” Dr. Bulat Ibragimov reports fatigued users overlook more and make faster decisions with less information. Dr. Mary Steffel emphasizes delaying important decisions if you are not fresh, while warning that opting out is still a costly decision; she also notes decisions are social and delegation/support increases choosing. The episode closes with advice to involve others and stay curious and open-minded in complex problems.

00:00 Decision Making Overview

00:10 Perception vs Metacognition

02:21 Fresh Eyes Strategy

03:32 Decision Fatigue Signals

04:52 Don't Avoid Choosing

05:41 Decide With Others

Transcript

Christine Ko: [00:00:00] Welcome back to The Girl Doc Survival Guide. This episode is a compilation of the metacognition of how we make decisions, decision fatigue, and how to make better decisions. First off, Claudia Mello-Thoms, in episodes 192 and 1 93, really surprised me by noting researchers have not really been able to precisely study perception, visual perception being vital to diagnoses in medicine, especially visually based specialties like my own dermatology and dermatopathology. Here's Dr. Mello-Thoms:

Claudia Mello-Thoms: Metacognition is a well established process. It's watching yourself think, but there is no way you can watch yourself perceive. We can't find a way to access it in the brain. We found tons of ways of accessing cognition. After like 50 years of research, we still cannot access [00:01:00] perception. So what we do is we unobtrusively monitor the radiologists' eyes as they are inspecting different types of medical images, and sometimes we ask them about what they are doing, and you can observe a disconnect between what they're actually doing and their explanations. So you can tell the explanation always comes after the fact. It's like their brain has to jump up a level, go into cognition, into language, and try to explain what they did five seconds ago when perception is already way ahead.

Christine Ko: Applying that to dermatology and dermatopathology, we cannot truly explain how we come to a [00:02:00] diagnosis, based on eye tracking. We like to think we can explain, but the explanation comes after perception. So this really applies to any time I am making decisions based on my perceptions, like when I make a decision based on how I feel since emotions and feelings are also part of my perceptions.

Coming back to making decisions based on visual perception. Dr. Mello-Thoms suggests that difficulty in decision making might be a signal to either take a step back and put the decision aside or perhaps ask for help.

Claudia Mello-Thoms: One thing that we've shown in the past was that for mammography, if a radiologist didn't look at the mammogram and knew within five, 10 seconds, whether the case was normal or it had an abnormality, the best thing to do was to put the case [00:03:00] aside, read a bunch of other cases, then come back to that case, what we called fresh eyes. Because sometimes for whatever reason, your mind is not connecting to the case, and so it's better to put it aside, look at other things, and give the case a new chance.

Christine Ko: A signal to wait on making a decision, therefore, is if you can't immediately come to a decision. However, making decisions rapidly can also be a sign that your decision making is suboptimal. Dr. Bulat Ibragimov says in episode 201.

Bulat Ibragimov: The more tired you become, the more you tend to overlook things. If a user is fatigued, we surprisingly found that they made decisions faster. Faster maybe not in the way of time, but they needed less information to make a conclusion, like a satisfaction of search.

Christine Ko: [00:04:00] Ultimately, it is important to recognize when you are tired. Dr. Mary Steffel says in episode 204 that fatigue affects our decisions.

Mary Steffel: There's actual scientific research showing that both in the medical profession, judges in judicial settings, often will make different decisions at the end of the day when they're feeling fatigued than they do when they're fresh and bringing everything to the table to make those decisions, and I think recognizing when you're feeling fatigued, might be good to ask yourself a question, Can this decision be made tomorrow? Can I carve out a designated time to revisit this decision when I am feeling fresh?

Christine Ko: Given decision fatigue, it is better to put important decisions aside for a time you feel fresh. However, it is also important to make a decision. We should not delay forever and not make a decision, when the decision is important. [00:05:00] Dr. Mary Steffel explains that difficult choices sometimes lead to foregoing choosing altogether.

Mary Steffel: A core insight from decision research is that when decisions, whether big or small, feel difficult, people often respond by opting out of choosing altogether. Doing nothing is still a decision, and it's often a costly one. When choices are hard, especially when there are many options or real trade-offs, people tell themselves, Well, I'll just wait, or I'll come back to this later. But waiting isn't neutral. Opportunities expire, defaults take over. Stress accumulates, and the decision rarely gets easier with time. The cost here doesn't come from necessarily choosing the wrong plan, it comes from choosing nothing at all.

Christine Ko: In addition to putting a case aside in dermatopathology or putting a difficult decision aside in life for a prescribed amount of time for important decisions, Dr. Steffel explains that it helps to include others in the decision making process.

Mary Steffel: One of the common misconceptions about decision making is that it [00:06:00] happens entirely inside of our heads. It's a solitary, rational exercise. We weigh the options and act independently. In reality decisions happen in a social context. We can seek support and advice from people around us. We found that people are actually almost twice as likely to choose something when people were explicitly offered the opportunity to delegate the decision. 

To me, this is powerful evidence that giving people the opportunity to have access to someone who can help them navigate a difficult choice can be a really powerful way to make sure that they don't leave the table empty handed. You don't have to make every decision entirely on your own.

Christine Ko: So this comes to important advice from Dr. Toya in episodes 173 and 174.

La Toya Luces-Sampson: Not only can you not do it all alone, you were never supposed to.

Christine Ko: So stay curious about how you are making decisions if you are fatigued, when it might be better to delay and when it might help to involve others for advice. Dr. Oksana [00:07:00] Babenko says in episode 200 that the world is increasingly complex and the problems we are dealing with are complex. We need to take the time to understand the space, stay curious and open-minded, and not take things for granted. We need to ask why and talk to people in other fields because they have wisdom or can see things from other angles. So that was her final thought, To stay curious. And I'm sorry I couldn't put her recording in here. For some reason it , work.

Let's stay curious. Thank you for listening and I hope you're willing to share this episode or others, and rate the podcast. Thank you.