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MEDICAL PRACTICE
STRATEGIES & ISSUES

sion. For any decisions I am part of, I always assume I should make our decisions. be ruthless! Remember the principle of Kahneman
the decision! However, I am often not the best person to make the and Tversky that we easily assume our past experience is compre-
decision. victor vroom demonstrated that if the ones who have to hensive data when it is really only a single data point, and a biased
implement the decision are not part of it, then they are less likely one at that.
to care whether it succeeds or fails. If the success or failure of the Fifth, some decisions harm current operations in the long run
decision impacts someone, but they had no role in the decision, more than they benefit the team in the short term. Why do we make
then they learn helplessness, and stop trying. No matter what the decisions where the true opportunity costs were both knowable and
decision is, it will fail because the wrong person made the decision. too high? We do this because we fall in love with certain decisions
There is a famous story about stakeholders – A pig and a chicken and fail to count all the true costs. We all would agree that we cannot
decide to open a bacon and eggs breakfast diner. The chicken is in- lose more than we would gain, yet if we love a decision, we sub-
volved, but the pig is committed. Thus, the pig should have the most consciously start shaving off its true costs. We need to count all
say in any decisions involving that diner. but we often let the loudest true costs of any decision - lights, heat, personnel, computers and
or most passionate person have the most say. Passion is not neces- offices in analyzing any true decision.
sarily equivalent to truth. Why do we fall in love with a decision where the opportunity
Related to this, the third mistake is that the costs are too high? Most often, we fall in love with a given decision
wrong person benefits, and this harms the because we personally benefit from it. It might not be that we ben-
very people the decision was supposed to efit financially, rather it may just be that we benefit by gaining self-
help. In fact, we cannot get around esteem or increased esteem in the eyes of others. We ignore such
the huge bias towards self-bene- secondary individual gain even though it is just as real as money.
fit, and the person who bene- The best way to avoid this is to ask what the costs are if we do the
fits from a decision I make opposite, and then compare those to the preferred decision. If the
is usually me. No matter opposite decision results in less true costs than the proposed direc-
how hard we try to be tion, then you have fallen in love with a bad decision.
objective, we make de- Sixth, we make a decision based on a painful or delightful past
cisions that benefit us event. The more recent a loss or a gain in a related event, the more
personally, and they it influences our decision. I can be trying to rescue a previous poor
can inadvertently decision that I made, because I cannot accept that I made a bad de-
harm other mem- cision. Sunk costs must be counted as already lost. A renowned ex-
bers of the team. ample of this is the European Union central bank, where the loan
One way to pre- officer who made an original loan is far more likely to extend further
vent this is to credit than a neutral, new, loan officer. like flipping the coin, the
switch sides in the current decision must be independent of all past related decisions,
discussion and but this is especially hard if those decisions were our own. These
argue for the reverse mistakes can ruin a decision, and unless I am ruthless in my self-as-
of the decision. This sessment, I will not understand why.
helps you to see the de- Many of these decision-making errors are described in my book,
cision through the eyes Einstein’s Boss-Ten Rules for Leading Genius. The bexar County Medical
of others on the team. Society has a physician leadership course that also discusses deci-
The fourth mistake is to sion-making process. If you are really dedicated to mastering this
make a decision where a lot of area, many local universities offer MbA’s and MHA’s. Many physi-
assumptions have to come true for cian leaders are well versed in medical science but understand less
our decision to be correct. The more as- well the science of how we make decisions, yet the power these
sumptions we make for any decision, the principles can lend to leadership is significant.
more chance that the decision will be in error. The
famed statistician Carlo bonferroni showed that we need to Robert Hromas, MD, FACP, is the Dean of the Long School of Medicine
divide our chance of success by the number of assumptions that and Vice President for Medical Affairs of UT Health San Antonio. Dr.
must come true for success. We should apply this correction to all Hromas is a member of the Bexar County Medical Society.

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