Breaking free from decision paralysis

I have found myself feeling the weight behind my professional decisions on numerous occasions. These included determining which services to provide during the pandemic, transitioning my place and scope of practice, and setting boundaries with difficult prescribers. I have come to realize that these decisions weren’t challenging due to a lack of information, but rather because I was standing too closely to the situations to see clearly.The pharmaceutical care crisis of 1990In 1990, the pharmacy profession faced an identity crisis. While not the existential threat some describe, the profession was clearly at a turning point. Traditional dispensing roles were becoming commoditized, and forward-thinking leaders recognized the need for a fundamental shift in professional identity.Pharmacists and educators Charles Hepler and Linda Strand used what we now recognize as a powerful self-distancing technique. Instead of asking "How do we save our profession?" they asked: "If someone new took over our profession tomorrow, free from our attachment to traditional dispensing roles, what would they do?"The key insight wasn't their specific solution, but their approach. They used what we now recognize as self-distancing to overcome limiting assumptions about the future of pharmacy.The decision and its aftermathWe know what happened from there. The professional organizations endorsed it. I lived through this transition as I graduated in 2003. Now, many may argue that we haven’t come as far along as we should have due to competing struggles and the influence of money, but we should respect Hepler and Strand’s revolutionary thinking and their contributions to the profession.Why self-distancing worksSelf-distancing isn't mental trickery; it is a scientifically validated technique that fundamentally changes how your brain processes decisions. When you use distancing strategies, several significant things happen.Reduced emotional reactivity: Research using fMRI brain imaging shows that self-distancing decreases activity in the medial prefrontal cortex, the region associated with self-referential processing and emotional overwhelm. At the same time, it doesn't increase activity in areas related to cognitive control, meaning it provides emotional regulation without requiring additional mental effort.1Enhanced Rational Thinking: When you distance yourself psychologically, you shift from intuitive, emotionally-driven thinking to more deliberative, rational analysis. This is particularly crucial for pharmacists, as we make high-stakes decisions while managing decision fatigue.2Improved Perspective-Taking: Self-distancing activates the same neural pathways used when thinking about others rather than yourself. This creates psychological distance, helping you see situations more objectively, as though you were advising a trusted colleague or friend.3When you step back, clarity steps in.-Daniel Pink, authorFour practical self-distancing techniques1. Third-person self-talkInstead of asking "What should I do?," use your own name or "you:" "What should [your name] do?" This simple linguistic shift creates psychological distance.4The first time I was exposed to this was while watching an episode of Seinfeld, where George and Jerry continually referred to themselves in the third person. Research backs up the effectiveness of this technique beyond sitcoms. Studies show that third-person self-talk reduces emotional reactivity within the first second of encountering stressful stimuli, and it does so without taxing your already-depleted cognitive resources.When facing a decision about whether to implement a new provincial clinical service, ask: "What would [your name] advise another pharmacist in this situation?" This removes the emotional weight of your specific circumstances and lets you evaluate the opportunity more objectively.2. The successor questionFollowing Hepler and Strand’s approach, ask yourself this question: “If I were replaced tomorrow, what would my successor do?”This is especially powerful for pharmacy owners considering whether to sell, pharmacists debating a move from community to hospital practice, or those weighing expanded prescribing authorities. Your hypothetical successor has no emotional attachment to your current situation. This can cut through years of conditioning and obligation. It frees you from feeling fear of what others will think.3. The best friend frameworkAsk yourself: "What would I tell my best friend to do in this situation?" Or better yet, picture a younger version of yourself coming to your present self with this dilemma. When we advise someone other than ourselves, we are more direct and compassionate. You're less influenced by fear, ego, or attachment.If a colleague asked whether they should pursue additional prescribing authorities in their province, you'd likely give balanced advice weighing training time, patient benefit, and revenue potential. Apply that same objectivity to your own decisions.4. Living your life againViktor Frankl, the psychiatrist and Holocaust survivor, shares a technique whereby you imagine you are living your life a second time in this present moment. Each moment up until now is identical to your first life, but now you are making this critical decision again. Using the wisdom of hindsight, would you choose differently? The question to ask yourself is, "Knowing what I now know about the cost of this choice, do I still want to choose this?"Why pharmacists need this mostAs pharmacists, we face unique decision-making challenges that make self-distancing particularly valuable. We make daily clinical decisions, including evaluating symptoms, interpreting results, building care plans and managing side effects and drug interactions for patients. Each patient we encounter has many input variables to assess, and heavy workloads require us to make these decisions for many people simultaneously. Furthermore, our decisions impact the quality of health of our patients. This creates intense pressure and ethical weight that depletes mental resources.5Research confirms that job burnout significantly affects clinical decision-making, consciousness, and coping ability. When burned out, healthcare professionals experience decreased empathy, impaired judgment, and an increased likelihood of making errors.6Self-distancing is ultimately about perspective. It gives you back self-agency, where you regain the power to see a situation, not as an overwhelming burden, but as a challenge someone capable can navigate.Building this skill in practiceThe research is clear: people who practice self-distancing when reflecting on difficult experiences show lower emotional reactivity, less intrusive thoughts over time, and better problem-solving behaviour.7 This isn't a one-time technique but a skill that strengthens with practice.Your patients need you to be at your best. Our profession needs leaders who can see beyond immediate pressures and look towards long-term possibilities. And you deserve decisions that align with both your professional values and personal well-being.Manjit Hansra is a breathwork facilitator, mental fitness trainer, CDE and consultant pharmacist focused on providing tools to help pharmacists prevent and manage burnout. Subscribe to his newsletter HERE.References:[1] https://pmc.ncbi.nlm.nih.gov/articles/PMC5495792/[2] https://pubmed.ncbi.nlm.nih.gov/37851354/[3] https://uwaterloo.ca/wisdom-and-culture-lab/sites/default/files/uploads/files/kross_grossmann_jepg_2012.pdf[4] https://science.howstuffworks.com/life/inside-the-mind/emotions/benefits-talking-like-egomaniac.htm[5] https://fmch.bmj.com/content/13/1/e003033[6] https://www.thelancet.com/journals/lanepe/article/PIIS2666-7762(24)00128-5/fulltext[7] https://rascl.studentorg.berkeley.edu/assets/files/kross_ayduk_2011_cd.pdf