Physician Procrastination as a Decision-Making Tool

April 27, 2015

I know it is April, but I finally made a New Year's resolution. I will start being proactive about my procrastination.

This year I thought that it was about time that I made some New Year's resolutions. It's something that I've always intended to do, but I kept putting it off.

Procrastination has been characterized in pejorative terms by many notable figures:

Benjamin Franklin: "You may delay, but time will not, and lost time is never found again."

Charles Dickens: ""You cannot escape the responsibility of tomorrow by evading it today."

Abraham Lincoln: "Things may come to those who wait, but only the things left by those who hustle."

If the negative view of procrastination is valid, we procrastinators must be a sorry lot - indecisive, disorganized, slothful, and indolent. I should feel terrible about putting things off, but I don't and I started to wonder why not.

Mark Twain, as you might expect, expressed a contrarian, more sardonic, view: "Never put off 'till tomorrow what may be done day after tomorrow just as well." This encouraged me to think more analytically about the pros and cons of delaying a decision.

Sometime a situation presents an immediate threat to life or limb - a real emergency. There is no time to lose. Action is required now.

There is no time to thoroughly weigh the options. One must rely on their training, experience, and instinct. One reason that physicians get (or should get) the big bucks is their willingness and ability to handle emergencies. If there is no emergency, then there is time to deliberate, gather information, and consider the various possibilities. How much time? Sometimes a lot, sometimes not much, but enough to give some thought to the situation before acting. When time runs out, either the deliberation has produced a decision or panic ensues.

"Thinking Fast and Slow" by Daniel Kahneman has led me to believe that, rather than being a character flaw, procrastination can be a powerful decision making strategy. Not being ready to decide is often a sign that the decision is one that is either really difficult or totally trivial. In both situations it can be hard to finalize a decision.

When the matter is trivial, there is really no good basis on which to make a decision; any one of a number of options would do just fine. It boils down to personal preference and no more. It's perfectly reasonable to wait until the decision is required and then just make it. Whatever the decision, it will be fine and there was no advantage gained from making it early.

On the other hand, when the matter is really complex and the decision will have significant ramifications, there are myriad factors to consider. Generally, no single one stands out as most important or critical. All the factors are significant. One must deliberately weigh the pros and cons. Books have been written about this. The field is called Multi-Attribute (or Multi-Factor) Decision Making. For example, there is "Multiple Attribute Decision Making: An Introduction (Quantitative Applications in the Social Sciences)" by K . Paul Yoon and Ching-Lai Hwang. When the decision is complex, time allows the potentially important factors to be identified, quantified and weighed. This is why I believe that procrastination is a powerful decision-making tool.

Should time run out before the deliberations are complete, or if it runs out unexpectedly, the situation is transformed from one of thoughtful deliberation to an emergency. And we know what to do in an emergency - we fall back on training, experience, and instinct. Of course, if you haven't been getting meaningful training and experience and consequently have no instincts, you not only have an emergency, you have a problem.

So ... my first New Year's resolution is to be proactive about my procrastination. I will use it as a decision-making strategy, not simply an excuse to take a nap and, if I get around to it, I'll have another resolution to report on next time.