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What Do You Want?

July 24, 2014

Here’s an excerpt from a project I’m working on about the choice between nursing and medicine.  I’d love to know what you think.

Barry Schwartz, in his book The Paradox of Choice, asserts that most good decisions involve the following steps:

Figure out what your goals are
Evaluate how important each goal is
Gather all your options
Evaluate how likely each option is to fulfill each goal
Pick a winning option

Reference here: Schwarz, Barry.  The Paradox of Choice: why more is less.  HarperCollins, NY, 2004.

These steps sound simple enough.  You know these steps.  You run these steps a thousand times a day in small ways.  Here’s the problem.  Step number 1 involves figuring out What You Want.  Step number 1 can take your whole life to complete.  Figuring out What You Want involves all your prior experiences with good and bad choices, how you expect future experiences to feel, and the experiences you’re having now.

Let’s take a simple example.  You go to the library to choose a book to read.  The decision to go to the library for your book is based on prior experience with the library and a glance at your overburdened bookshelves.  In the library, you can choose to go to the “new book” section or upstairs to older fiction.  But wait, maybe your prior experience with fiction was unpleasant.  Or maybe you like fiction but the work of fiction you’re currently reading is unpleasant.  So you decide to go to the biography section, for something different.  You don’t know if you will like biography, having had no experience with it.  You anticipate you will like it because you liked History 101 in college.  Once you’ve chosen biography, you still have no idea what you want because you have no experience with the different authors.  So you choose a book about Abraham Lincoln because you just saw the movie.  You leave the library, hoping you made a good choice, but not knowing for sure.  Your chances of having made a good decision for yourself are fifty-fifty at best.
Schwartz says that knowing What You Want means that you have to be able to anticipate how you will feel if you choose different options, which in the case of health care is very difficult to do.  And the ability to accurately predict how you will feel is even more important when the thing being chosen, as in medicine, is years away from actually happening.  Here are two seemingly contradictory conclusions drawn by people who do research into decision-making:

Most people don’t know what they want.
We have to see things in context and comparison.  What we see tends to change depending on what things are next to each other and how we judge each.  My car looks great next to that old jalopy but it looks like a bucket of bolts compared to the Jaguar on the other side.  Nursing looks great next to my high school friend working at Starbucks, but maybe doesn’t look so great next to your other friend who is transplanting hearts.
What other people think also has a great impact on what we think we want.  When somebody says “You’re so smart.  You should go to med school”, they are imposing their judgements, values, and stereotypes on the decision.  But you’ll care about what they think, and as I said above, it will influence how you decide.

Most people know what they want
This is why a simple list of pros and cons doesn’t work when it comes to these kinds of decisions.  Gut feeling is a powerful indicator of what we really want.  Most of the time our gut is drowned out by social structures and expectations, but it is a very important piece to pay attention to.  For example, if you are making a decision about whether or not to buy a new car you might make a list of all the good things and bad things about buying a new car vs. keeping the old one.  What you might not factor in is the gut feeling that says “I want a new car.  Now.”  So you end up buying one even if your list concluded it wasn’t a good idea.  We are not completely rational creatures.

It is clear that, using Barry Schwartz’s steps to good decision-making, you have to get step number one right.  No amount of information will help if you don’t know yourself and what you want.  Not just what you think you want, or what you think you should want, or what someone else tells you is the right thing to want.


From → Healthcare

  1. thetinfoilhatsociety permalink

    And to make it even more complicated, sometimes you find that you have to specifically make a choice for something you don’t want, as an intermediary step, to get to what you do want. Not necessarily as in nursing versus medicine, but in life generally.

    Ah, the complicated life we bipedal apes create for ourselves…

    • Indeed. For both medicine and advanced practice nursing there are a lot of tedious steps along the way. That’s why knowing what we want is important. It sustains us through the boring and irritating parts.

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