The night my judgment hit a wall

Do you remember a time you hit a wall and suddenly couldn’t make one more decision?I do.It was towards the end of a 15-hour overnight shift. The ER physician referred me a patient to rule out a heart attack. A question I’d answered hundreds of times before: start anticoagulation or not. I struggled to come up with an answer.I called a cardiology colleague who knew me well for help. He was surprised; it was a relatively straightforward case. After giving me advice, he paused, then said: “You better get some sleep soon.”That moment reminds me of our finite decision-making capacity.Over the past decade, the cognitive load of our inpatient medicine has quietly exploded:The average medication list on admission has grown from about nine drugs to about 12Patient complexity continues to riseAdmissions per long overnight shift have increased from about 15 to about 21That means an internist working in the ER today is making 18 more home medication decisions per shift than a decade ago—on top of dozens of other high-stakes calls about starting new medications and stabilizing patients.We often talk about burnout as emotional exhaustion.Less often do we name decision fatigue—the erosion of judgment that comes from sustained, high-consequence choices with no margin for error. Ignoring that reality doesn’t make our patients safer. Listening to physicians does.That’s why we made the change at Juravinski Hospital to cap internal medicine shifts at 12 hours—not just as a wellness gesture, but as a safety decision. To protect patients from the risks of fatigued judgment, and to respect the limits of the physicians carrying that responsibility. AI may be able to help with these decisions, but it will not take responsibility for them.When frontline physicians tell us the system is pushing past safe cognitive limits, leadership has a choice: explain it away—or respond.We chose to respond.Dr. Haroon Yousuf is an internist in Hamilton and was recently voted in as OMA president-elect. This item originally appeared on LinkedIn.

The night my judgment hit a wall

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