Decision-making anxiety & managing uncertainty in doctors
Every shift doctors are making clinical decisions. You have to decide what to follow up, who to admit, who to discharge, what referrals to make, when to escalate and more. Often you’re making these decisions with gaps in the information, with unknowns, having to just follow the best guess based on what you know. For those who have a tendency to catastrophise and worry, making decisions when there’s uncertainty like this can be very anxiety provoking.
It can feel as if you’re just ‘being conscientious’ when in reality you’re been driven by fear rather than reality, and all the worry, checking, reassurance-seeking, and replaying scenarios in your head is making the job really hard work, and making you really exhausted.
It may be that this only comes up at work for you, but for many it also shows up in their personal life, the overthinking, the risk adverse approach to life, and the difficulty with decision making.
Coming up in this article:
- Anxiety as a doctor
- The problem with worry
- Understanding intolerance of uncertainty
- The anxious behaviours
- Decision making paralysis
- Anxiety in your personal life
- How therapy can help
- Therapy with me & Next steps
Topics explored in more depth
There’s a few topics I felt deserved an article in their own right.
Therefore I’ve written 5 additional articles on topics regularly explored in Therapy for Doctors.
The links for these are at the end of this article.
- Therapy for Doctors (an overview)
- Burnout in Doctors
- Therapy for Junior Doctors
- PTSD in Doctors
- Return to Work Support for Doctors
1. Anxiety in Doctors
Research consistently shows that doctors report higher levels of anxiety and stress than the general population, with trainees and those in acute specialties particularly affected.
You’ve spent your career learning to analyse, to problem solve, to think ahead. And that skill is really useful… most of the time. But unfortunately, there’s a tipping point, when you’re using the skill in situations it’s not helpful in, when you’re getting yourself trapped in ‘what if…?’ doubts and questions, never able to switch off from work, becoming increasingly risk adverse, and the job is starting to feel too much.
It’s common that anxiety steps up a notch at certain points in your career when responsibility increases – when you first start F1, when you first start S1, when you finally get your Qualified or Consultant role. So if you already had a tendency to worry, these might be the points when you notice the anxiety becomes unmanageable.
2. The Problem with Worry
Worry can feel as if it’s helpful. As if it makes us better prepared, as if it helps us to plan, or as if it can prevent bad things. It might be that you see your worry as a sign that you care, a sign that you’re conscientious. In reality worry is on the whole an unhelpful process. Because 99% of it is about hypothetical situations that haven’t happened and might never happen.
A useful rule of thumb is this: helpful thinking leads to learning or action. Unhelpful worry goes in circles. You revisit the same possibilities without gaining new information, and you still don’t feel any more settled at the end of it.
The problem is you’re worrying about the worst-case scenarios, not the most likely ones. You’re assuming you’ve done something wrong, missed something, don’t know enough, that something catastrophic and career ending could happen at any moment.
Worrying is a joy stealer. The worries come up at the most inconvenient times – on your days off, when you’re on holiday, when you’re trying to get to sleep, when you’re trying to relax with your family. Worrying make enjoying your job really challenging. And make it much more difficult to enjoy life as a whole.
Worries tend to snowball too. You start off thinking you didn’t do something (that you did), and before you know it, in your mind the patient is dead, you’re at coroners court, you’re in the press, and your life is over. The snowball is rapid.
Therapy can help you to learn how to stop the snowball, to learn when thinking and doubt is valid, and when it needs to be ignored, and learn how to finally swich off.
I’m ready to find out more
Chat with Hannah – http://hannahpaskintherapy.co.uk/book-now/
3. Understanding intolerance of uncertainty
Medicine doesn’t offer certainty. It offers best guess based on the information you have, and the experience you’ve gained. There’s no guarantees of how any patient will respond to any treatment, or of what surprises are in store for you that might change the plan. But when there’s a possibility of life and death, this reality of uncertainty can feel uncomfortable. You’ll likely find yourself doing anything you can to gain certainty, or avoid uncertainty – a futile mission unfortunately.
The more you try to seek certainty or avoid uncertainty, the more our anxious brain learns to be fearful, and the more and more difficult it becomes to cope with the realities of the job and patient work. You effectively become intolerant of uncertainty. Our job in therapy is to increase your acceptance and tolerance of uncertainty. To better equip you to not get pulled into the thoughts of ‘but what if…?’
4. The Anxious Behaviours
Anxious behaviours can be split into 2 categories – the extra things we do, and the things we avoid. Here are some common examples from doctors I’ve worked with over the last few years.
Extra behaviours
Over documenting/excessively detailed notes
Ordering extra tests
Making ‘just incase’ referrals
Double & triple checking that you’ve done something
Creating lists for yourself
Reading guidelines to check (again)
Seeking reassurance from colleagues & seniors
Staying late at work routinely
Ringing to check on clients on your days off
Logging in to patient notes to check up on them on your days off
Following up with patients
Avoidance
Avoiding discharging
Avoid putting yourself forward for cases
Delaying decision making until you have more information
Avoiding delegating
5. Decision making paralysis
Decision-making becomes heavy when anxiety attaches to the idea that there is a single “right” choice and that getting it wrong would be catastrophic. In reality, most clinical decisions are about choosing the best available option with imperfect information.
When intolerance of uncertainty is high, decisions can feel stuck. You might notice yourself delaying, going back to the same options, seeking multiple opinions not because you need clinical input, but because you’re trying to get rid of the uncomfortable feeling of uncertainty. The irony is that this often increases anxiety rather than reducing it.
Over time, this pattern can erode confidence. You’ll start to trust your judgement less, not because your judgement is poor, but because anxiety has started to convince you you don’t know what you’re doing.
6. Anxiety in your personal life
The same patterns that show up at work can also show up in your personal life. The catastrophising about the worst thing that could happen, the avoidance of change or situations with unknowns. The constantly seeking information and reassurance. This can come up with small things – worry about running late, worry about choosing the wrong gift, worry about forgetting something, all sorts of different things. It can also come up for bigger issues like relationships, health, finances etc.
The common themes are: you are over-estimating the likelihood of a problem; you’re trying to problem solve the hypotheticals; & you’re under-estimating your ability to cope. Sleep is a common casualty. When your brain is used to staying alert for risk, quiet time becomes when worry gets louder. Bedtime can turn into a mental review session. Over time, this can leave you feeling permanently switched on and exhausted.
7. How therapy can help
It may be time to seek help if:
- You spend significant time ruminating about decisions outside work.
- Checking and reassurance are increasing, not decreasing.
- Sleep is consistently affected.
- You dread shifts mainly because of fear of getting it wrong.
- You feel you can’t trust your judgement without external confirmation.
- A specific incident has triggered a noticeable change in how you practise.
Therapy can help you to deal with your anxiety and worries in a different way. It can teach you how to approach uncertainty differently. It can help you to build your self-confidence. It can enable you to find the job more doable, and life more enjoyable.
8. Therapy with me & next steps
I’m a BABCP-accredited CBT therapist and I work privately with doctors across the UK online via video therapy, and in person in Cheshire.
My style is straight-talking and structured.
Read more about Hannah – http://hannahpaskintherapy.co.uk/about-hannah-paskin-therapy
Therapy options
I offer private therapy for self-funding clients.
I also provide limited availability for funded therapy under the Practitioner Health scheme (via OneBright). Message me to find out more.
Next steps
1. Book a free discovery call (this is optional)
2. Book your therapy assessment appointment
http://hannahpaskintherapy.co.uk/book-now/
Links for 5 more articles in the series
- Therapy for Doctors (an overview) – http://hannahpaskintherapy.co.uk/therapy-for-doctors
- Burnout in Doctors – http://hannahpaskintherapy.co.uk/burnout-in-doctors
- Therapy for Junior Doctors – http://hannahpaskintherapy.co.uk/therapy-for-junior-doctors
- PTSD in doctors – http://hannahpaskintherapy.co.uk/doctors-with-ptsd
- Return to work support for doctors – http://hannahpaskintherapy.co.uk/return-to-work-doctors
