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Decision making

“Decision making is not easy”. I can remember very well the scene when this statement has once first knocked in my ears. She was a young lady anesthesiologist  wearing the surgical theatre suit. In that time, I was just a freshly graduated medical doctor who dared to enter the most horrible medical situations, namely the cardiothoracic surgical room, seeking for nobility, self and glory. Once the soft and serious voice touched my ears and my whole being, I felt again the difficulty of the duty that hangs on a word and a meaning I am apparently deficient in, decision. I was not really raised up to know what a decision could be. And now it might be the time to have it, inevitably, face to face. Was it really the time? – Maybe.

As a physician one has to train on decision making as precise and as time-fitting as possible. One time you decide to start a medical treatment, another time if to discharge a recovering patient, again whether to refer the case to another colleague, and so on. Simply, I would ask myself very curiously how many decisions I had to make this finished work day and how my score in terms of right and false ones was. Do medical decision making differ from that in the general life themes?

The process of decision making comprises 4 elements: 1) ‘resolved’ person, 2) ‘adequate and reliable’ information, 3) ‘proper’ scaling and interpretation and 4) ‘titratable’ stepping. An appreciable cost of time is needed for each of these elements. There could be an order for the functionality of decision making which includes: instinct → cognition → insight → intuition → inspiration → revelation → destiny and divine providence. The person is, thus, quite obviously the most important player in the right decision making. To be a ‘resolved one’ I would need to have: 1- things in a reasonable order and to 2- critically and objectively assess my own self-perception. A systematic way in decision making would help the person to sustain an ambitious and promising performance and to cope with the thus restrained and unlikely embarrassing incidents.

Inclination, decision and obligation are three words that would contrast the meaning of one another. Inclination might be a kind of default that could be good or bad. Obligation is a kind of constraint that would bear benefit as it is the case with medical recommendations. These two seem like simplest form of behavior. Decision, on the other hand, would imply a much longer and elaborate problem solving starting from ‘order’ passing through ‘information’ and ‘interpretation’ and effected in incremental or ‘titratable steps’.

Being person-dependent, decision making may vary considerably in form and utter. However, a preservation of consensus of ethics would greatly neaten such personal variations.


A considerable challenge in the medical profession is to come up with a large number of standard and non-standard abbreviations. NPO in the medical practice stands for “Nil per os” which means nothing by mouth.

Physicians should not only point to medicines in their different forms but also to life acitivities, including food consumption, as for their relevance to the current illness of their patients. Indeed, in many cases of health problems proper shaping of life style and nutrition rules would save doctors and patients as well much unnecessary and dispensable medical prescriptions (see also: Emotional whirl).

Logically, none of the body systems is functioning in separation of the others. Indeed, body systems have to work in a harmony to best enable a certain performance or function at a given time. A dozen of autonomic reflexes (involuntarily) are set up to ensure this functional harmony. Although the extent and intesity of these involuntary reflexes may vary from one person to another and even in the same person depending on the health state for example, it seems that they present inherent physiological rules.

Generally speaking, it is the personal and professional view of the physician whether to consider NPO for a patient where the decision maybe absolutely needed for one case but too superfluous for the other.

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