Beyond the daily decisions of what to eat, what to wear, how many times to hit snooze on the alarm, there are many big impactful decisions that affect each of our lives. 

But even though these big decisions may seem more important, small decisions over time can impact the future too. 

Check out episode 32 of The MedEdWell Podcast to hear about what goes into good decision making, personally and with patients. 

Then get your work done faster with 10 tips from my free PDF guide, Maximize Your Clinical Efficiency! Click to get your guide NOW!

Today’s sponsor: White Coat Investor courses – Get CME and financial, wellness education today!

Above are the episode show notes and below is the transcript. Some episode transcripts have been edited more than others, but they are up in the meantime to help those who would rather read and for searchability on the web. Extensive editing has not been prioritized as I seek to both produce regular content and maintain my own wellness. See the website disclaimer if you have questions, since this is all for your education and entertainment only. Enjoy!


Beyond the daily decisions of what to eat, what to wear when to wake up, how many times to hit snooze on the alarm, there are many big impactful decisions that affect each of our lives. But even though these big decisions may seem more important, small decisions over time can impact the future too. Stay tuned to, or more about making decisions big and small.

Thank you so much for joining me here on episode 32 of the MedEdWell podcast. Thank you so much for subscribing or listening for sharing these episodes. If you’re looking to increase your efficiency and get work done sooner to support your wellness, check out, maximize your clinical efficiency, my free PDF guide with tips to help you in your workflows. Check out the link in the show notes You’ll also get weekly emails with an additional story or reflection. In addition to a preview of that week’s episode today, we’ll be talking about decision making and the things to think about both as you make decisions yourself, and as you walk patients through decisions in a shared decision making model.

But before we get into the rest of today’s episode, let’s hear from today’s sponsor. Getting a financial education seems daunting until you realize that you did way harder things in medical training. The white coat investor has been promoting financial literacy for doctors since 2011 and has great courses to help you make a financial plan value. CME is included on some of the courses, making them a perfect fit for those unused professional funds. I have personally taken the fire, your financial advisor course and found it super valuable in my own financial education. Click on the link in the show notes and your podcast player to check out the available courses. All right, now, back to today’s episode.

So this episode comes out right around when rank lists are due for fourth year medical students looking to match for residency. And it got me thinking what goes into making big decisions for me, for others in medicine. What about smaller decisions that add up over time? Are those less important? It doesn’t mean that I have it all together, that I have it all figured out or that everyone thinks or makes decisions in the same way. My wife, for instance, when looking at a restaurant menu, sometimes it’s difficult to choose between two different entrees. Sometimes she gets my opinion, sometimes the servers, and for me, I once caused an argument with my wife by taking too long, to choose my ice cream flavor. These are small examples, but still ended up with thoughts, feelings, and emotions in the decision making process. The few decisions in life are as simple as choosing ice cream. So let’s first examine decision making in a personal context, let’s explore something like applying for residency.

You could also look at specialty choice, for today’s discussion will limit it to the residency application process. For me, I finally narrowed to categorical pediatrics after having considered family medicine and internal medicine, pediatrics combined training. Then with many pediatrics programs across the nation, which ones should I apply to first, I had to survey my options in pediatrics. There are lots of programs, some of the combined pediatric programs, such as emergency medicine, pediatrics, they only have a few programs where you may apply to most or all of them with maybe a backup with emergency medicine or categorical pediatrics. This also is similar to some of the surgical sub-specialty. So with lots of programs, what am I looking for? Is it a large program, a medium program, a small program? Is it an academic center or more of a community setting? Are there lots of fellows around there may be more opportunities for complex patients that maybe the fellows do more of the procedures in making these big decisions?

It’s also important to get input from others. Maybe it’s mentors, other faculty looking online, maybe others that are interviewing at these same places. My brother was actually a med student in Indiana at the time. And he told me about a program there that I haven’t even applied to at the beginning. A couple weeks later, I added it to my list. It’s also important to remember that in a particular situation, there may be more reasonable options. And you initially thought getting that input from friends, family, mentors, significant other can be really helpful. It’s important to consider how different options fit into your values, your priorities, your long term goals. And you have to know what they are before you can take them into consideration. For me, looking at residency programs, global health opportunities were important as we’re good clinical exposure and opportunities for mentoring. My interviews started with small programs, similar to the one where I rotated during my third and fourth year of medical school.

And I had a good experience there. But as I interviewed at larger programs that had larger clinical volumes, I saw that mentors were still available if I sought them out. As you continue through decision making other things to consider that would include looking at the pros and cons of both doing and not doing whatever this case residency program or in your case, it may be some other big purchase, big life decision. It’s also important to look at the opportunity cost both of time and money that you could use elsewhere. Would you have significant regret for not trying something or are the options about equal? Maybe you just need to choose one and go for it. Lots to keep in mind in these situations. So for me, I ended up at a large program that I didn’t even initially apply to, but it turned out to be a great fit.

So first decision-making personally, but then there are also opportunities daily to walk patients through decision in making, as they care for their own health. After getting to a diagnosis, then comes the plan. Just as in the personal example, you have to survey the options. Maybe it’s the prognosis medications, surgical options. You look at the pros and cons, the risks and benefits side effects that may come out sooner. In some of these discussions, it may depend on whether it’s canned some chronic illness, something acute, something new. These all will change how you approach these discussions, walking patients and families through these decisions requires deeper questions and insight since big decisions like these will require incorporation of values and priorities that may not reflect what you would choose, whether it’s weighing the risks of chemotherapy or a particular medication on future fertility, maybe it’s the low likelihood of eradicating a particular brain tumor, and maybe opting for palliative care.

You as the physician may want consultants input, maybe the patient wants a second opinion. It’s important to consider what are the patient’s values, the patient’s priorities for them as an individual, maybe their family, their cultural background. There are lots of things to keep in mind and to explore with patients, not just what I think is best, but in shared decision making, by empowering the patient, valuing who they are as a person, person who has autonomy, but at the same time, respecting them as an individual enough, go through all the things, even if it’s not what they want to hear, but at the end of the day, respecting what they do decide, even though we might disagree with them, these are all part of shared decision making with your patients. So I want you to take a moment and imagine with me, if you took action based on this episode, how would this give new structure to your own decision making?

Would you be more confident, more free having explored all these things? How would it help you walk patients through decisions about their own treatment plans to help them see that a reasonable decision could include less intervention depending on their goals? How would this help your professional wellness knowing that you were providing patient-centered care and showing respect and honor to your patients as individuals?

Take that next step today. Thank you so much for joining me here on episode 32 of the MedEdWell podcast. If you haven’t already please subscribe, share this episode with another physician who, if you haven’t, please take a moment and review this podcast. Wherever you’re listening, really helps get the word out. Also get your free clinical efficiency guide to get home faster by visiting You can also check out a course from the white coat investor at the link in the show notes, and please know that you are doing really important work caring for others, and yourselves. Thanks so much for all you do. Please come back and join me on another episode and have a great day.