Fresh perspective for financial success

Being More Decisive: The 4 Villains Of Decision Making

In the previous article in this series, I told the story of how a colleague asked for my thoughts about a decision she was considering—whether or not to close her practice and become an employed physician. Like many professionals, I listened carefully, asked a few thoughtful questions, and then rendered an opinion.

While I discussed a number of flaws within such a method of decision-making, I have not yet shared how we might improve decisions by implementing a process. The most common “process” in use today is the pros-and-cons list. You likely have used this technique or had a mentor recommend it.

I recommended it for years in medical education as my students decided where they wanted to pursue the next stage of their training. I would ask my mentees, what were the most important aspects of a training program for them? For some it might be a job near family or a collegial environment, while for others it was the ability to train at a center known for a particular field of medicine. I was basically asking my mentees to rank order their most important factors for the next stage of training.

I would then tell my mentees to make a three-column list that might look like the one below, and complete it after each interview. The thinking was that after all the interviews they could look at each training program and make an informed decision based on the pros and cons of each. Given that these interviews take place over several months, my thinking was that the biggest bias would be the “bright shiny object syndrome,” or the tendency to be attracted to what is in your most recent memory.

Pros Factors Cons
Work Environment  
  Housing Cost  
  Board Pass Rate  

History of the Pros and Cons List

While I had no idea before reading “Decisive” by Chip and Dan Heath, the pros-and-cons list has an incredible historical pedigree. Benjamin Franklin wrote about the pros-and-cons list in 1772 while providing advice to a colleague. In addition to what I advised my mentees, he offered a weighting system that he termed moral algebra:

“If I judge some two reasons Con equal to some three reasons Pro, I strike out the five; and thus proceeding I find at length where the balance lies; and if after a day or two of farther consideration nothing new that is of importance occurs on either side, I come to a determination accordingly.”

– Benjamin Franklin

However, while such a process is likely better than the advice I genuinely offered to my colleague, research in decision making over the last 40 years points out that the pros-and-cons list is filled with flaws and biases. If we want to make better decisions, than we need to learn what the biases are and how to address or even avoid them.

The 4 Villains of Decision Making

The following four biases are the villains of decision making and need to be understood and avoided if we are to improve our decision making process:

  1. Narrow Framing. Have you ever heard an adolescent ask a friend “should I break up with my girlfriend or not?” Frighteningly, this seems very similar to my colleague asking me if she should close her practice or not. Instead of asking how she might keep her practice open or improve the environment, she went to a binary decision. My colleague “spotlighted” her alternatives, and I failed to shift the spotlight and help her see that there might be other options.
  2. Confirmation Bias. While we may think we are using the pros-and-cons list to make a systematic decision, the confirmation bias points out our tendency to want to follow our guts. We tend to seek out information that supports the quick belief we developed. We really want reassurance, rather than the truth. Human nature leads us to spotlight what we want to be true and seek out information that supports our gut feelings. We then think we have made a thoughtful, scientific, reasoned decision when we really have not.
  3. Short Term Emotions. Emotions sometimes get the better of us, especially when it comes to money and family. I have heard more than one resident agonize over this job or that job, and it often comes down to tensions over work-life balance. It can get so emotional that my mentees are nearly paralyzed about what to do. What they need is to develop better perspective in order to deal with this “analysis paralysis.”
  4. Overconfidence. Young doctors often think they can predict their futures and I am always shocked at how surprised they are when their futures do not always unfold as they think. I cited studies in the previous article that show how medical students who are confident in their patient diagnoses are mistaken a significant percentage of the time, despite years of clinical training and expertise. It’s no wonder that they can’t predict the rest of life’s circumstances and events. When we shine the “spotlight” narrowly we make faulty conclusions based on that information.

This article reviews the biases and flaws found in the most common decision making process in use today. My next installment will introduce a framework that might have helped my colleague make a more informed decision about her future.

Previous article in the Being More Decisive series:

You’ve Got to Make a Decision, But Do You Trust Your Gut?

Dr. Pat Bass

Dr. Pat Bass is a physician, writer, educator and scientist that cares for both adults and children. Currently an Associate Professor of Medicine & Pediatrics at Louisiana State University Health Science Center in Shreveport, he participates in an active clinical practice, medical education activities and health literacy research. View full bio on authors page