By Frederic Bahnson, MD, FACS
This column is meant to be a question and answer column – open to career, life, and education questions. For this first column… there were no readers yet, and no submitted questions. The topic was left to me, with one note from the Editor-In-Chief: “a piece on making decisions in the face of uncertainty (COVID-19) would be a timely read…”
Indeed.
We live in uncertain times. It feels like we should have extra support, extra time, and extra consideration for making big decisions and long term plans right now. Students and residents who are in their last years have some big decisions to make. It can feel like the resources to support these decisions aren’t adequate right now. There aren’t many career advice books out there with a chapter on starting your career during a worldwide pandemic and national economic shutdown.
So, what should we do? First, we should stop trying to treat this as different from decision-making at any other time. Don’t get me wrong. There are new and important things to consider with education and career decisions right now. However, these things do not change the process for arriving at the best possible decision.
There are a couple of important pieces of background information here.
First: We always live in uncertain times. Coronavirus didn’t create uncertainty. Coronavirus is confronting us with what forecasters, decision theorists, and planners call a high-impact low-probability (HILP) event. Although many have warned about a coming pandemic, nobody could have predicted it would happen this year in this way. But this type of event is not new.
Many of our grandparents or great grandparents lived through two world wars. The first of those overlapped with a worldwide pandemic (influenza) that killed between 17 million and 50 million people. There was a massive economic depression between the two world wars. Many people I know and work with made their major life decisions between nuclear attack drills throughout the Cold War. When my parents were college-age, 2.2 million men in the United States were drafted into the military during the time of their lives they otherwise would have been advancing their education or starting their careers. More recent impacts have come from tsunamis, nuclear power plant meltdowns, a couple of major economic crises, local devastation and worldwide medical supply interruptions by hurricanes. The list is long.
We don’t have to debate what does or does not belong on this list. The coronavirus pandemic is unique in our lifetimes. But, it is not unprecedented for an entire generation to be making major life decisions during local or global upheaval. In fact, it may be more common to be making decisions during or in the immediate aftermath of world-changing events than in times not immediately affected by such events. So yeah, times are tough. But it turns out that’s not new, or even all that unusual.
This is not meant to be a “suck it up, think of how hard your grandparents had it” treatise. The fact that the world is frequently in upheaval turns out to be quite reassuring… in context.
Second, also about context: It’s important to realize that uncertainty in decision-making isn’t limited to those starting out or at recognized transition points in their education or career. Important decisions happen throughout life. Using myself as an example – I’ve changed jobs within one major career, then completely changed careers. At my current job, I’ve taken on and shed different roles over the past several years. Many of these decisions have significantly altered my life path – career development, family time, gain and loss of other options both at work and outside of it. The health system I work for was (and is) in the midst of a major reorganization when COVID-19 hit. I made some decisions just before the pandemic was recognized, and will make more over the next 18 months, that will alter my career in many ways. How those are playing out has been radically changed by coronavirus. My work, my spouse’s job, the jobs of many close friends, the education and travel plans of my children – all have been upended. All need to be re-envisioned for a near future that remains uncertain but is clearly significantly different than any of us would have predicted even six months ago.
So, to summarize so far: (1) this isn’t as unprecedented as it feels, and (2) you aren’t alone.
Why is it good news that (1) and (2) are true? Because the process for making good decisions hasn’t changed. We know more now about risk management, bias, what makes people happy and fulfilled, economic prosperity, research and career success, health and wellness than at any other time in history. And, because that knowledge has been gained and developed across a history full of high-impact low-probability events, the fact that we now have to make decisions in the midst of another such event doesn’t invalidate the knowledge. Times like these are exactly what the best decision-making techniques have been honed for.
So for my first column, I offer you this:
1. Perspective is healthy. Our times are unique, but living in times of uncertainty is not.
2. None of us are alone right now. Sure, we’re all one-ofa- kind, but we’re a lot more like one another and those before us than we are different.
3. Having certainty would be reassuring, but it would be a false reassurance. One of the lessons of history is that, in important ways, the future does not resemble the past. The differences are often due to events (or our responses to them) that are unpredictable in any useful and time-specific sense.
4. And finally: any good advice on decision making from before the coronavirus pandemic is still good advice.
The nature of good decision-making is that it sets us up for the greatest chance of success. It also gives us realistic expectations of resilience (or even anti-fragility). In an uncertain world, the biggest decision making error available might be to try for (or pretend we have achieved) certainty.
Instead of seeking a certainty that is either unattainable or illusory, put your energy into making decisions that have the best chance of good outcomes – despite the uncertainty we can’t control. Align your decisions with what gives you the best outcomes in the domains that matter most – your own health, your impact on those around you and the world, your happiness and wellbeing.
Due to the nature of this journal, publication of this column will be infrequent. But questions and challenges around career, financial, life and goal planning are constant. With that in mind, I am launching a website at multifarion.com to ease and encourage engagement in these topics.
I am not a researcher of decision science. I am a practicing surgeon, a former engineer, a parent, and a mentor and coach to students, residents, and professionals – both in and outside of medicine. I am a long-time student of decision science. I integrate research from across this broad field into advice and methods for real-world use. This has made me a better physician and helped me grow outside of work as well. I want to share this knowledge and ongoing pursuit with you. I hope it helps you make the best educational, career and personal decisions you can. I hope it helps you reach a level of comfort with your decisions that you might not otherwise find – or at least helps you get there sooner and more easily.
Please send me your questions and comments at questions@multifarion.com. You can visit my website at multifarion.com to find more articles, and subscribe to get notified when new Q&A’s or articles go up.
Frederic Bahnson, MD, FACS
Community General Surgeon
questions@multifarion.com