The daily flood of decisions can be exhausting. Lisa MacLean, MD, a psychiatrist at Henry Ford Health, shares how to overcome decision fatigue.
By Sara Berg, MS, News Editor
From the moment we wake up, we are seemingly bombarded with choices—what to wear, what to eat, which emails to answer first. By the time we’ve navigated our morning routine, our mental energy has already taken a hit. And as the day wears on, the sheer weight of decision-making can start to take its toll, often without us even realizing it. Making decisions day in and day out can be exhausting and cause people to feel overwhelmed, anxious or stressed.
This is known as decision fatigue, which is a state of mental overload that can impede a person’s ability to continue making decisions. You have probably all experienced decision fatigue at some point in your life, such as during the COVID-19 public health emergency when advice about how to keep ourselves safe evolved with our scientific understanding of SARS-CoV-2.
The AMA’s What Doctors Wish Patients Knew™ series gives physicians a platform to share what they want patients to understand about today’s health care headlines.
For this installment, Lisa MacLean, MD, a psychiatrist and chief wellness officer at Henry Ford Health in Detroit, took the time to discuss what patients need to know about decision fatigue.
Lisa MacLean, MD
Henry Ford Health is a member of the AMA Health System Program, which provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.
It’s mental and emotional fatigue
Decision fatigue is “the idea that after making many decisions, your ability to make more decisions over the course of a day becomes worse,” said Dr. MacLean. “The more decisions you have to make, the more fatigue you develop and the more difficult making decisions can become.”
“Every day, both in our work and personal lives, we are making a ton of decisions,” she said. “When you add up all these decisions, it’s no surprise that after a long day of making decisions you may feel tired and exhausted, and you just don’t want to have to make any more decisions.”
“In a study on the impact of decision making published in the Journal of Personality and Social Psychology, researchers found that the more choices a person made the more likely they were to give up, lose willpower and struggle with endurance,” Dr. MacLean explained. “So, imagine the impact of decision fatigue on your ability to support your teams and be present for your families and friends at the end of a long workday.”
“Our time off won’t be restful or rejuvenating if we don’t address the decision fatigue we experience at the end of the day,” she said. “We need to consider the number of decisions we make every day from … what do I eat, what do I wear, what do I do with my day, especially on a day off.
“All of these decisions can create stress,” Dr. MacLean added, noting that “by the time the average person goes to bed, they’ve made over 35,000 decisions and all of those decisions take time and energy, and certainly can deplete us.”
Life has gotten more complex
“When we came out of the COVID-19 public health emergency in 2023, many believed making decisions would be easier,” Dr. MacLean said. “Unfortunately, life only seems like it has gotten more complex.”
“Now instead of deciding whether to get vaccinated or wear a mask, many are thinking about bigger world issues involving political turmoil, raging wildfires, hurricanes, acts of terrorism and school shootings,” she added. “In health care, workplace violence is at an all-time high. It can feel like this stress will never end.”
“All of this adds to the burden of decision fatigue,” said Dr. MacLean.
Decision fatigue leaves you drained
“A person with decision fatigue may feel tired, have brain fog or experience other signs and symptoms of physical or mental fatigue,” Dr. MacLean explained. “The phenomenon is cumulative so that as the person makes more decisions, they may feel worse or more drained as the day progresses.
“The more choices you have to make, the more it can wear on your brain, and it may cause your brain to look for short cuts,” she added, noting that “there are four main symptoms: procrastination, impulsivity, avoidance and indecision.”
“You are either putting the decision off until later, making a rash decision based on little evidence, avoiding the decision altogether or battling back and forth between various choices,” said Dr. MacLean. “The psychological effects of decision fatigue can vary, potentially leading to difficulty making the right decisions, impulse buying or other avoidance behaviors.
“If your brain is worn down, it may cause you to become more reckless with your decision making or not think things through,” she added. It can also “cause you to simply do nothing, which can cause even more problems.”
Additionally, “you might notice that you get angrier with colleagues and families, splurge on clothes, or impulsively buy more junk food,” Dr. MacLean noted.
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Streamline your choices
One way to overcome decision fatigue is to “make fewer decisions by streamlining your choices,” said Dr. MacLean. That means “avoid random decision-making by making lists. This way when you are at the grocery store, you don’t have to decide what to buy.”
Another example is to “pick your clothes out the night before and automate your decisions by setting up automatic bill paying,” she said. “Even using GPS can help you to easily find your way by not overtaxing your brain.”
Additionally, “simplify your life by cutting out things that aren’t important,” Dr. MacLean suggested. “Having fewer tasks and activities will lead to fewer decisions, and help you to feel restored and have more control over your life.”
Try to delegate decisions
If you are experiencing decision fatigue, try to “delegate decisions. This means stop micromanaging and let others in your life make some decisions,” said Dr. MacLean. “There are times your co-workers can pick the lunch spot, your kids can choose the playlist, or your friends can pick the restaurant.”
“By delegating, you also empower people by showing them that you trust them,” she added. Additionally, “set deadlines to space out decisions such as creating micro-deadlines for bigger projects, so you aren’t forced to make too many big decisions at the end. This will allow you to use your best judgement.”
Make big decisions in the morning
“Research shows that the best time to make decisions is in the morning,” said Dr. MacLean, emphasizing that “the morning is when we make the most accurate and thoughtful decisions, and we tend to be more cautious and meticulous.
“We hit a plateau in the afternoon and by evening our decisions may be more impulsive,” she added. “So, definitely don’t make big decisions when you’re tired or hungry.”
Stop second-guessing yourself
“Avoid rehashing decisions and stop second-guessing yourself,” said Dr. MacLean. “Just let go of that perfectionism—you’ve narrowed it down to those two or three things.
“Make the choice and be happy with the choice because we waste additional energy worrying about whether or not it was the right one,” she added. “Remember, you made the best decision in that moment with what you knew and don’t keep going back to it because that’s going to add to the fatigue.”
Develop daily routines
When someone can “develop daily routines that put less important tasks on autopilot, it can make a big difference,” said Dr. MacLean. For example, “set your wake-up time and stick to it.”
Additionally, “instead of debating about working out or not, make it part of your daily routine,” she said. “And if you like cereal, eat it every day to minimize decisions of what to eat for breakfast.
“Another idea is to have a handful of go-to outfits planned out to further minimize decisions made,” Dr. MacLean added. “The bottom line is, look at all the big and little decisions you make every day and think about how you can simplify your life.”
“By changing your habits and setting up the right routines, you can decrease anxiety and conserve your energy for the decisions that really matter,” she said.
Seek help if symptoms worsen
While decision fatigue doesn’t warrant a trip to the doctor, “if you notice burnout symptoms like exhaustion, cynicism and low self-efficacy or are struggling with depression and anxiety, you can consider seeking help,” said Dr. MacLean. Decision fatigue “is a phenomenon that could make other issues worse.”
“We will always have to make decisions, but by establishing routines, we can decrease the number of decisions we have to make,” she said.
