Clinical decision fatigue: strategies to support better decision making

Physicians make an average of 13.4 clinically relevant decisions during each patient encounter, most commonly related to defining the problem, evaluating test results, and evaluating drug therapies, according to a 2018 cross-sectional study in BMJ Open. Factor in all the documentation and administrative tasks physicians also handle, and it’s easy to see how “clinical decision fatigue” might occur.

A 2025 systematic review and meta-synthesis in Family Medicine and Community Health summarized the literature on clinical decision fatigue and defined the phenomenon in three parts:

• “a multifaceted cognitive and motivational process affecting a physician’s DM [decision-making] ability,”
• “driven by contextual and individual factors” (including high patient volumes, time pressures, inadequate support, and the organizational culture),
• “leading to a circular relationship with psychological distress and increased risk of errors in healthcare” (i.e., distress may lead to errors, leading to distress, and so on).

While the experience of decision fatigue may be common, a 2025 study in Communications Psychology presented “reassuring” findings that decision overload does not inevitably lead to deteriorated decision quality. It found no difference in decision making quality depending on fatigue among health care professionals, perhaps because “high motivation … may help people overcome fatigue even after bouts of cognitive activity.”

However, "high motivation" may not be a sustainable strategy. Researchers agreed that organizations should support health professionals in managing decision fatigue by employing effective strategies that help them deal with the increasing pace and complexity of their responsibilities.

1. Standardize standard things, using workflows and decision trees to automate or simplify routine decisions so you can focus on what matters most.

2. Use checklists, similar to how pilots use pre-flight checklists and surgeons use safe-surgery checklists to carry the cognitive load and keep them from missing key steps in a complex process.

3. Approach each patient encounter as a miniature research project and apply the scientific method: start with a problem, develop a hypothesis, collect and analyze data, and then confirm or reject your hypothesis.

4. Delegate tasks and decisions that don’t require your level of training and licensure.

5. Use simplified shared decision making, because often the best decisions are made in partnership with patients.

6. Have a quick e-consult if you’re wrestling with a decision and need another opinion.

7. Leverage AI tools. There is simply too much information for humans to manage in health care, and AI tools can help decrease the cognitive burden on physicians.

8. Don’t try to multitask. Instead give your full attention to the task at hand.

9. Put on your own oxygen mask first, taking small breaks during the workday to attend to your own physical needs, which can help you feel more clear-headed.

What works for you? What strategies would you add to the list?

— Brandi White, managing editor of FPM

Posted on Sept. 30, 2025