Prismatic & Pragmatic

I was seven or eight years old, sitting in my bedroom with an 1800-piece box of Knex®. The building set was a luxury at the time. I remember a daunting feeling come over me as I reviewed the designs I could make, followed by an eagerness as I started to sort through the pieces: gears and connectors in red, yellow, blue, green, white, grey, and black. From that disorganized box, which was overflowing with a variety of loose and partly-assembled pieces, I separated and consolidated each type of piece into separate bags, making it easy to find the parts I needed for my chosen design. Over the course of a weekend day, including several interruptions, I was able to assemble a magnificent Ferris wheel!

Imagine the disarray of those eighteen-hundred pieces in that box. I had learned how to create small objects without going through the extra step of organizing the Knex® pieces, but the task of creating that Ferris wheel seemed more fun having first prepared my building set (and my mind). Not only that, it was natural to do so.

Creativity in the form of innovative building design was not my forte then. Neither is it now. I preferred following a well-thought-out pattern, much as I preferred playing classical piano to pop or jazz. However, the skill of being able to organize myself would prove to be useful. Years of playing with building sets demonstrated that disorganization and chaos do not preclude creativity and practical design. Rather, they are a normal, necessary precursor to creation. Through play, I generated a deep, intuitive sense of what was possible. This has guided me ever since. Yes, the complexity of the world still overwhelms me at times. Yet, it does not prevent me from believing that problems can be solved or envisioning enhanced systems for living and creating.

Over the years, this appreciation for organization and mental models supported me through my medical education and training. I remember reading a textbook chapter on the renal system and integrating the concepts with my class notes; I generated a pictorial representation of the nephron, including the key physiological processes and clinical correlations, on a 3-feet by 2-feet piece of paper that I kept rolled up and used as a reference for years. All of those pieces of data were organized and then used to create connections to understand medicine.

In order to organize myself in my coaching, I continue to expand my repertoire of frameworks and mental models, and my understanding of distinctions and paradoxes. Different from when I was young, the organizational schemes I use now possess a few more limitations than the simple mode of organization I used in building. Still, whether I am coaching myself or my clients, each idea, feeling, action, and outcome that are shared are naturally integrated into models that allow me to more deeply understand the complex individual in front of me, and to help them develop the awareness and skills toward improved personal leadership.

I have appreciated the pragmatic aspect of this skill, in order to help people make decisions, set and achieve goals, improve relationships and self-confidence, and to be more emotionally resilient. I also know that there is a prismatic component to my coaching, which lets me see what is possible for those individuals whom I coach, even when they present with a singular view of their identity or future. Like a prism, where a beam of white light can separate into a spectrum of light including all colors of the rainbow, I similarly imagine a spectrum of possibility for each individual I work with. Also, I see that each person has this possibility within them already. With guidance, they are able to expand their own self-perspectives and life-perspectives, and then have fun intentionally choosing a path that they haven’t been on before in order to create a result or personal transformation they desire.

First steps to make the “right” decision

You may notice that as you go about your day, at some point your brain offers you a story of “right vs. wrong” to give meaning to what is happening in that moment.

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Example #1: I go to a coffee shop and stand in line to order a coffee. Seeing at least ten people in front of me, I pull out my phone and start to browse my e-mails and social media. After a few minutes I look up, and a new person has just stepped in front me… Well, actually, I’d more likely think “they cut in front of me.” In my mind there is a rule that people shouldn’t skip other people in line. My brain says they did something wrong.

(Interestingly, the flip of this story may be discovered if we imagine what was going in the other person’s mind. Perhaps they looked at me, and said, “She obviously isn’t paying attention, and if she wants to get coffee, it’s her job to keep moving with the line. There’s no problem with me jumping in now. I’m going to keep the service moving.” He/she/they may think I did something wrong.)

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We create stories of “right vs. wrong” all the time. There could have originally been a social or survival advantage to doing this; it is definitely one way in which we communicate, create groups, and move our causes forward. But sometimes this specific binary approach to looking at the world can hold us back.

Creating a judgment of right vs. wrong may be helpful in some instances, and not helpful in others. When it comes to decision-making, I think we’re often misplacing this judgment.

Here’s a simple description of what making a decision may commonly look like given the above framework:

Life happens. –>

We identify an opportunity or a problem. –>

We engage in decision-making, often wanting to make the “right” decision (or not make the “wrong” decision). –>

Feeling uncertain, we become stuck, stall, and ruminate. –>

Ultimately, we make a decision and observe its impact.

 

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Example #2: I’m currently an employee with a moderately enjoyable job. I’m used to the routine I’ve created. One day my friend tell me that there is an interesting job opportunity at their company. In that moment I’m faced with an option – to either pursue that opportunity, or not. I spend days thinking about what to do, not wanting to make the “wrong” decision and end up in a job that I don’t enjoy.

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Notice how we aim to make the “right” decision. The truth is, there really is no right or wrong decision. (Who determines that?) There are only desirable or less desirable outcomes.

However, the outcomes we think we care about are not always the outcomes that truly matter most to us.

Take the last example: I think that one of the jobs, either my current job or the opportunity at that company, will make me happier. The truth is, neither of those jobs determine my happiness – my thoughts do. If so, then solving for my happiness by selecting the “right” job will be frustrating and possibly never-ending, because I’ll find reasons to like and dislike both options.

If our goal in making a decision is to increase our likelihood of a certain outcome, we need to very clearly distinguish between the emotional outcome and the experience we want to have. The way we will feel may be influenced by the consequences of our choices, but not necessarily dependent on it.

We can acknowledge that certain situations may contribute to an easier time being happy – but that’s not usually because of the situation itself, but because we were able to get something that we wanted.

So, if you’re facing a tough decision, take time to write down:

  1. the deeper wants or needs that you want fulfilled
  2. the most important immediate outcomes you predict, as well as some of the downstream effects for each choice you have

Intuitively, in which of your choices do you think your needs or wants will be best met? What do you most want to experience?

If it’s difficult to decide, you’ve probably got a good chance of being happy either way. In this case, if it’s difficult to move forward, pick a priority or a value that is important to you. See if honoring that helps you make a decision.

We also misplace the “right” vs. “wrong” label in decision-making in the following way:

We are often so focused on taking action and finding a right solution that we don’t stop to ask ourselves if we are solving the right problem in the first place.

Here’s a simple example to illustrate this point: If a patient seeking care presented with hypokalemia (low potassium) on their labs, the clinical team would likely not just treat the low potassium without addressing the root cause (e.g. some syndrome of diarrhea and vomiting). Addressing the symptom alone would be an incorrect approach and harmful to the patient. Instead, the clinical team will look at that problem of hypokalemia as a symptom of the deeper problem.

In the same way, if you’re faced with an opportunity to apply for a new job, instead of deciding whether you should take that job or not, ask yourself why you’re thinking of making that decision in the first place. Is there something that you’re not currently satisfied with in your current job? What is it? Are there other ways of relieving that dissatisfaction without having to find a new job?

What I’ve described is a core part of doing a Root Cause Analysis (RCA), which is used in various fields for process and quality improvement. You can use this concept in your personal and professional decision-making to find practical solutions. This also relates to the “thought-work” we do too, because ultimately the root cause of any problem is a set of limiting thoughts or beliefs.

Complex Decision-Making 101

TRENDUP –

See yourself and the world more clearly.

Commit to what you want to experience. 

Execute powerful decisions.

Face uncertainty with confidence.

Make your impact, with more ease and fun.

My family and I are moving next year.

Was it an easy decision? In some ways yes, and in other ways, no. We’d be leaving our familiar community and friends, a region of the country with amazing cost-of-living, and proximity to a city that offered so many activities – sports, theater, music, arts – that I looked forward to sharing with our son.

Reflecting on my path through medical school and residency, I realized I hadn’t fully taken advantage of experiencing each of the locations I had lived in. I had finally reached a stage in life that I was ready to do this…but the COVID-19 pandemic had struck, delaying most socialization and opportunities, and we were thinking of moving.

Most importantly, we’d no longer be within driving distance to our parents and extended families.

You may have had to make a similar decision in the past, or maybe you’re facing one now. It may be a decision that you can’t immediately take back if you change your mind, or one where you see there’s a lot at stake.

 

Complexity Results in Uncertainty – This is Okay

These types of decisions – the ones that have us staying up late or posting anonymously on social media (hoping for some miraculous piece of advice), or where family and friends observe us saying the same thing week after week, “I don’t know what to do….” “I don’t know what’s best…” – are challenging not just because of the stakes we perceive, but because of the fact that there are complex considerations and elements of uncertainty involved.

Let’s pause and consider that for a moment. It’s important to do this because we must accept that uncertainty will inevitably be a part of a complex problem, and in many ways it’s something we can’t control.

However, when it comes to complex decision-making, one of the tendencies I’ve noticed in people is the persistent effort to try to anticipate and control for every potentiality.

The challenge in this is that we cannot know everything that will happen independent of us, and the contributions we make to a complex situation will undoubtedly have some unknown consequences as well. 

So much energy and time is wasted on trying to predict and control the future.

 

If you’re making a complex decision, one of the aspects of the approach then will be to simply determine:

  1. What is it the deeper want or need that you have as you resolve the problem (or as you lean into the opportunity?) [Pick your top 1-3 priorities.]
  2. What is it that you really want to avoid? [Pick your top 1-3 priorities.]
  3. What is within your control?

Another aspect that is not so much an approach, but rather a skill to develop, is the ability to handle uncertainty when making a complex decision. With my clients, I teach numerous strategies on how to do this effectively. I practiced processing uncertainty as I left my employed clinical position; as I considered the choices related to COVID-19, and long-term impact of the pandemic; and as I made my decision about moving across the country. The self-confidence gained through this skill is priceless when it comes to making complex decisions.

 
The Impact of Uncertainty

Perceived uncertainties will often activate our fight-or-flight response, creating confusion, fear, worry or overwhelm to keep us safe.

Let’s look at the emotion of confusion specifically, because this feeling is notorious for getting us stuck and by itself doesn’t inherently help. There are some things to consider as you look at the emotion of confusion.

 

Confusion – Some Remedies

First, notice that confusion is a surface-level emotion. If you really explore this more deeply, you’ll notice that there is another emotion underlying it. This emotion is commonly fear (worry about a perceived immediate threat) or some version of it – doubt or anxiety for example. Being able to identify these deeper emotions helps cue you to the deeper concern, and potential dangers, you are trying to address.

Also, notice that feeling confused is not a problem in itself. Allowing yourself to act from a place of confusion, however, can create undesired results – or lack of them. In this case, shifting your mindset to one that is more productive is helpful.

Third, another approach to dealing with confusion could be to take action in order to gather data.

Each major decision we have is actually a multitude of smaller decisions. Instead of feeling overwhelmed by the size of the problem in front of us, if we can identify the next most important decision we need to make, and then to take action toward that, we can gather real information and decide what works or doesn’t work. We can see, for real, whether we are heading to where we want to be.

The lesson here lies in complexity again – in complex situations, it is impossible to create a master plan, to execute it, and to think that with things will go a certain way. Trying to create a refined, specific blueprint is a waste of energy, because often the feedback you get from the world as you execute your plan will change your situation and require a reassessment anyway.

What does this mean then?

  1. Start by simply identifying the outcomes you absolutely want to create, as well as those that you absolutely want to avoid.
  2. Having considered your situation and the facts available, and from experience, determine a reasonable general path to creating your result.
  3. Then, identify the next 1-3 steps you must take.
  4. Execute, gather data, and then reassess to refine your plan.

Interested in powerful decision-making? More to come later this week….

P.S. If you want me to help guide you through a high-stakes decision, e-mail me at  ashwini@physicianwellnesscoaching.com to let me know what’s going on for you. We’ll schedule a call to chat and talk about how my 1-month decision-making intensive can help you make a thoughtful, confident decision about that major thing you are working on, as well teach you the skill of mastering uncertainty. You can apply what you learn to all your future decisions.

References:

  1. Zimmerman, B., Lindberg, C., & Plsek, P. E. (2001).Edgeware: Insights from complexity science for health care leaders. Irving, TX: VHA.
  2. Shane Parrish offers various his articles on decision-making through his blog fs.blog
  3. A contact introduced me to the concept of simple, complicated and complex decisions in context of the Cynefin framework — check out some intro information here — Wikipedia article on Cynefin Framework