Decisions, decisions, decisions… Some tough, others easier, some made, others to be thought of, some to be acted upon, some to…
Decision-making: it is everywhere and is possible at any time. A person at work or home does it, a person without work or home does it. From how you are dressing up to who you want to marry, from how you eat and sleep to how you behave and talk, from your next big move in a game of “Jenga” to your next big move in life. U do it, I do it. Personally speaking, viewing back, one of the main goals of medical university was just that, expand and better our decision-making skills to health problems.
And, indeed, my decision-making skills are not perfect at the moment but that is eventually OK. By asking colleagues with more experience or finding solutions to the problems yourself, you learn, you take it in as you go, and eventually you feel comfortable enough to make better decisions for your patients and their quality of life. Plus, it is always good to know that studies exist for some cases that can back up your reasoning.
Working on a Stroke Unit, for patients who have actually suffered from a stroke, you find yourself making important decisions about significant problems. The most important are 5 in my opinion (mainly because the rest is basic vital sign stabilisation with pretty straightforward solutions, recommendations and protocols):
1. Does the patient have a brain bleeding or an infarct?
2. If the patient has a bleeding, is (s)he eligible for an operation?
3. If the patient has an infarct, is (s)he eligible for thrombolysis (=breakdown of thrombus, aka blood vessel clot)? If yes, what kind of thrombolysis option would be the best?
4. Does the patient take an anticoagulant? If yes, shall it be stopped?
5. Does the patient need anticoagulation therapy? If yes, which?
When your day is filled up with making decisions, especially when that concerns other people’s lives, you might not wanna burn out early in  the day, for you never now when a hard problem will need tackling.
That leaves us with the following questions:
⦁ Why do we take the decisions we do?
⦁ How can we make better decisions?
⦁ How do we avoid early “decision-making burnout”, so that we make good decisions at the right time?
Αποφασίζω (decide, translated into Greek) = (α) πό (χωρισμός, απόσταση, distance from) + φαίνω (φωτίζω, light up, present), to distance yourself from other possibilities in order to light up, show the way you commit to go on.
Decidere (decide, latin roots) = de (from, off) + caedere (to cut), to cut yourself off from other possibilities by committing to achieving a result.
Eventually, based on what do we decide? Is it a) logic, b) habits and automatisation, c) beliefs, or d) all of the above? Also, is no decision, a decision?
Lately, I have been reading and listening to a lot of Tony Robbins. In this TED talk and through his books, he explains how our decisions are based on 1 magical equation, in which FOCUS = FEEL. He goes on to say that all the important “life-changing” decisions in our lives are driven by our emotions and ultimately by our limbic system. He states that E-MOTION provokes MOTION, ACTION.
⦁ Think about it: What do you want to focus on? On losing weight or do you want to stop smoking? Do you want to change careers or have a family? Do you want to make more money or travel the world?
⦁ Once you find what you want to focus on, you will find the feeling and the why. After all, CLARITY = POWER.
⦁ NFS: If you cannot find the why’s or if you want to find more of them (therefore, probably more feeling and commitment to your decision) do it like in business management and problem solving; ask yourself “why” 5 times. I always imagine a little child pulling my dress and asking “why” continuously 😋 -yes, it can be frustrating at times but it works.
⦁ Even Simon Sinek, an English author and motivational speaker, in his TED-Talk “⦁ How Great Leaders Inspire Action” elaborated on what he calls the “Golden Circle of human motivation” and how inspirational leaders can lead better if they are clear on the “why” and “how” they do what they do. If they lead with that, instead of the “what”, they will lead better. And if they can resonate that with others, including their colleagues and customers, they will be more successful than ever. Those in advertising and marketing know this for years already! This is how they “manipulate” us every day into buying I-phones and cars… This is how Pepsi “used” Michael Jackson’s energy and image in the past to increase sales and profits in a time when Coca Cola was numero 1.
⦁ It is funny -funny as in weird… As I was preparing to write my thoughts down today, I received this in my e-mail:
⦁ “The Management Tip of the Day from Harvard Business Review:
⦁ Whether people change is largely determined by why they change. And they are most successful at changing when they choose to change. This is where coaching can create problems, because it’s often imposed rather than invited. When we feel something is being imposed on us – even if it’s for our own good – our natural reaction is to resist. So if you’re trying to help someone change, your first consideration must be to approach him or her in a way that enhances, rather than dampens, motivation. Focus on asking more questions and giving fewer lectures. Your job is to help people uncover and strengthen motives they already have, so they’re more inclined to take action.”
⦁ So today I ask you: What do you want to focus on?
⦁ And just like a little child I will tap on your shoulder, pull your trousers, skirts or dresses and ask frantically:
⦁ “Why? Why? Why? Why? Why?”

How?
How do we decide what we decide?
I feel that some of my everyday decisions are based on habits or automatisation. These “decisions” are made without me even realising it, making me actually doubt if I should even call them decisions anymore… To me a real decision should ultimately take more energy and focus so that a significant result is achieved. But here is the catchy part: What if I decided not to go through my morning plan, which is made up of my regular habits? And weren’t my today’s “habits” my past’s “decisions”?
Indeed, it took conscious effort and, therefore, serious decision-making for me to establish specific habits of mine. Some I am committed to, others still need work. Some were easy to establish, others I find harder and, hence, still struggling with.
For example, a good habit I had read somewhere was to drink 1-2 glasses of water once you wake up. I let it sink with me for some time and a few days later, during one of those summer mornings, I observed my mom, who had woken up and half-naked dragged herself to the kitchen to have some water. And then it hit me: My mom has been doing this since I’ve known her.
It seemed easy, effortless, logical, and one of the healthiest tips I had never thought of. I saw something being executed, liked it and until today I do it like my momma: water is the first thing I look for when I open up my eyes. I was so into it, I wrote a list with more reasons why I should drink water first thing in the morning. I googled facts about it, read a book about it, watched educational videos about it, its significance and healing powers. Guess what? That list reinforces that belief and strengths my decision and action to wake up and drink water every single day, today more than ever before. If you feel that you need to take up a habit or stop one, I suggest making a decision and listing the reasons why you choose to do what you want to do. Go through it every day! It takes some time, but it is worth it in the long run. And if you love life’s journey, as much as I do, you want it to be a marathon and not a 200m sprint.
As far as harder decisions go, decisions that need more contemplation, there are several techniques out there. People in the business world know them the best. One of my fav’s is the so-called ORAPAPA, because it is easy to remember. It is basically an acronym [adore!] stating the 7 keys to consider when making a harder decision. Works for me so far, hope it works for you as well.
ORAPAPA
O – Opporunities: What are the positive consequences, the benefits you get if you make the decision?
R – Risks: What are the negative consequences, the drawbacks, the possible  “Oh, no! That happened, now what?” moments?
A – Alternatives & Improvements: Are there any? Can you make some things happen to avoid or minimise the risk? Where and what can you improve?
P – Past experience: Ask around. Has someone been in your shoes once? How did they handle it? Use caution: Keep your mind open because not everyone is benevolent, especially when it comes to business or people you barely know.
A – Analysis: Take all the info in, categorise, prioritise. Check for gaps.
Advice:
If you are a leader, don’t take forever with this step. The more you analyse, the more you postpone. Someone needs to make a call. If it is -or needs to be- you, make it; right or wrong, you will probably never know.
If you are a follower, you play a key role with giving the correct info and thinking ahead for any gaps or concerns. Speak up.
P – People: Consider opinions, goals and what will happen to other people; your family and friends, your coworkers, your customers.
A – Alignment & Ethics: My first priority if I were to prioritise this acronym. Think simply: Does this align with who I am and who I want to be? Does this fit to my standards, my code of conduct, my mission?
Hopefully, if you ever need to take some decisions, you can trust your own system or use what I mentioned above. The more decisions you make, the more confident you will feel with them. The more decisions you make, the more easily exhausted you become though.

One of the people that takes important decisions most of his day is President Barack Obama. In a “Vanity Fair” article in 2012, Michael Lewis mentions some of the president’s habits for better decision-making. You are probably thinking, “old news”, but just because it is old does not make it of any less significance. So enjoy! 😉
1. Prepare for tomorrow, today night. Plan what needs to be done and if it takes less than 10 minutes, do it! i.e. check and send email, prepare notes, read drafts.
2. Minimise decision-making burnout by limiting your options on insignificant things. For Obama it is wardrobe and meal options. For Sabrina, it is food shopping – once I have found something I love, I stick to it. I reconsider if the price, quality or competition have changed.
3. Filter the news as much as possible. Just like any other person, there is no journalism without subjective emotion brought into it or some kind of other influence or censorship. Personally, I do not own a TV, although I find it luxurious to watch occasional football games or videos on a big ass screen. I’d rather, however, focus my time and money on more interesting things for me; talk to friends with different opinions over a cup of tea, read magazines on business and health, travel.
4. Exercise. Obama works out in the morning for 45 minutes. It gets him focused and allows him to be more productive during the day. He also plays basketball with the BOB at times. Vasilios D. Kosteas of Cleveland State University, reports that engaging in vigorous exercise (running, aerobics, sports) at least 3 times a week is associated with higher wages, nearly 7% for men and even more for women. After all, exercise is linked to higher energy, well-being and productivity levels.
5. Schedule personal time with yourself and your loved ones. The people you cherish in this world got you where you are right now, so make the time for them no matter what. Plus, keep time for yourself and your growth, your sanity and reflections. Otherwise, you will sooner or later drown in your own thoughts and decisions.
And this article is perfect for illustrating bad habits for bad decisions. So, make sure you have a look 🙂

Pain of others suffering
I entered the room. A lot of people, hustle and bustle. They were his loving relatives. I asked them kindly to go out because I had to examine the patient. So they did.
“You are very popular, Mr. X”, I said smiling.
All of a sudden he broke out in tears. I started worrying…
“Is everything OK? Do you have any pain?”, I asked immediately.
“Yes”, he uttered.
“Where?”, I continued with an emotion of urgency.
“In my soul”, he replied.
Within milliseconds, he broke me; we were both crying like little kids, whose treasured game had been broken…

Pause
Day in and day out we play the “pause” game.
In the clinic we “pause” medications and sometimes we stop them.
When the day is just overwhelming, you just pause to wonder or to take a breath -or  you simply go on holidays.
When you suddenly wanna pee, you just pause the movie you have been watching for the past 60 minutes to go to the looloo.
You can take all the pauses you want, but the matter of the fact is:
Life knows no pause.
Energy always transforms itself.
No matter if you are pausing or not, time is still running…
So, use your pauses wisely & enjoy each day to its fullest 🙂

I was working during a night shift. It was mostly quiet. It was time for the rounds, and as usual I were to visit “problematic patients” and ask the nurses on each floor if they had something new to report.
It was indeed quiet, scary quiet; I felt as if I were the main actress of a thriller movie waiting for something exciting-scary to happen at any time. I was done with my rounds and nothing had happened to my slight disappointment. I thought of chatting for a while with the French nurse of the floor I was responsible for in the past month during the day shifts.
She started complaining about the new computer program and the inadequecy of the management to solve the most banal problems. It was nothing new, they seemed the most popular conversation topics during that time. I apologised for the time-consuming program -as if it were my fault- but it seemed to work; she stopped complaining and smiled at me. I was puzzled as to why but didn’t give any more thought to it. We were soon talking about other things and started laughing, quite louder than usual.
“Mr A!”, I exclaimed suddenly. It was my Don Juan, a 90 year old -or so- patient with a lung tumor and pneumonia I had admitted two weeks ago. He was looking better this week after the antibiotic therapy, the tumor and the Parkinson’s considered. I greeted him and asked him how he was doing and why he was up wandering about at 10 o’ clock.
“I must go to my wife. She has Alzheimer’s and I am worried. The doctor told me that I can go at 10.”, I managed to understand after many repeptitions. You see, people with Parkinson’s disease do not talk clearly, something we physicians  document as “dysarthria”.
“I know the problem with your wife and I understand it is worrisome. But it is 10 o’ clock, Mr Juan… 10 o’ clock at night…”, I replied smirking and thinking to myself “Sundowner again…”.
“Night?!”, he looked at me with a confused smile guessing I might be playing a joke on him.
I nodded yes and showed him the dark moonless sky.
Then, I turned to the nurse and asked her if he was planned for discharge the following day. She looked at me troubled and started going through the archived files trying to find the information.
He was still looking at me, my Don Juan, with a broader smile this time, or at least this is how I chose to interpret it considering what we physicians document as “hypomimia”. You see, patients of Parkinson’s show a decreased facial expression, as if they are wearing a mask or as if they have undergone botox injections.
I smiled back. I told the nurse to check his vitals and I ran a quick physical examination on him. The amazing thing when admitting and already knowing the patient is that in a case of a new symptom, one can clearly state the differences. You see, confusion shall not be taken lightly in the medical practice. It may be a sign of something more alarming ranging from low blood glucose or oxygen, a new infection, a seizure, a brain tumor, a stroke, medication, a heart problem, and the list goes on… Once his vitals and physical were as usual and the patient himself realised it was indeed night, I splitted my sides confirming my first thought.
“Mr. A, let’s get you to bed, shall we? You need a good night’s rest today. Tomorrow, when the sun comes up, you can talk about your discharge with my colleague”, I said and turned my head looking at the nurse. As she was escorting him back to his room, he paused and returned.
“What is it, Mr. A?”, I asked getting more worried this time.
“You see doctor, I am glad I got up. I got to see your beautiful smile.”
I laughed and blushed. My heart and brain were relieved.
“Thank you! Good night Mr.A!”, I replied parting the conversation.
I slept well that night dosing off to the meaning of compliments and honest laughter.
Mr. A was discharged as I heard 2 days later, being content and relieved to go back to his wife.