March 29, 2023
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Living with a chronic condition means making tons of decisions every day. How should I time my meals with my medications? Is this treatment covered by insurance? Learn what decision fatigue is, how it affects those living with chronic conditions, and simple tips to manage it.
The average adult makes more than 200 decisions every single day about food alone, according to a 2007 study. We make tens of thousands of other big, small, conscious, and unconscious decisions all day long, too.
For anyone who lives in a body that requires a higher level of care than the average able body, I’m willing to bet this already staggering number is even higher.
For example, if you have dietary restrictions or intolerances, need to time your meals with medication, or experience symptoms like nausea, you have to devote even more brain space to your food intake.
It’s exhausting to make a million little decisions every day, trying my hardest to mitigate the consequences that my body will give me after each one — and still failing much of the time. Add in calculating how many spoons every outing will use up, navigating the healthcare system, and more, and the extra decisions really pile on.
This decision fatigue often goes hand-in-hand with living with a chronic condition. Here’s why, plus some tips to feel more confident in your choices.
Decision fatigue is mental exhaustion and the decreased capacity to make additional decisions caused by making a lot of decisions. Decision fatigue might cause you to make bad decisions or to feel paralyzed and unable to choose.
As a person who lives with one or more chronic conditions, you might have to make regular decisions related to any or all of the following:
These constant decisions can burden you with mental fatigue. Signs and effects of decision fatigue include:
For Clare Edge (@clarewonders on social media), an author living with type 1 diabetes, decision fatigue is a very real part of her daily life. Edge was diagnosed at the age of 16 and is coming up on the 19th anniversary of her diagnosis. She currently relies on a continuous glucose monitor and an insulin pump to manage her condition.
“Diabetes has 10,000 variables at any given time,” Edge says. “It goes so far beyond dosage and food decisions and includes whether I choose to participate in an activity, what to bring with me on a walk to get the mail, what eventualities to prepare for, and what to just leave to chance.”
She also points out that when you live with a chronic condition, you’re often dealing with intense physical symptoms at the moment you need to make an important decision the most. For her, this looks like either high or low blood sugar and the additional symptoms that come with that. For me, this might be dizziness or intense fatigue, and brain fog.
Decision fatigue isn’t just inconvenient or annoying. For those of us who are chronically ill and/or disabled, making the wrong decision can get dangerous fast. I am often placed in situations when I wonder if I can safely drive myself somewhere, what I should do when I feel a seizure coming on, or whether it’s necessary or worth it to go to the ER for issues with my implanted medical devices.
I probably push through more than I should. But just one wrong decision could, quite feasibly, cost me my life.
“I think abled people profoundly underestimate not only the number of decisions those of us who are chronically ill deal with but the stakes of those decisions,” says Edge. “As a diabetic, I’m dosing a hormone that is both lifesaving and lethal. If I intend to dose 2 units and instead dose 20, I could die. The margins are extremely small.”
She shares the story of a time she was out to dinner with a friend, got distracted, and shot significantly more insulin than she’d intended. The effects caught up with her hours later. After eating every carbohydrate in her tiny New York apartment, she still wasn’t at a safe blood sugar level and walked to CVS at 2 a.m. to buy more food.
“There are often so many if/thens I’m considering at any given time, and there is often no ‘right’ answer, only being better [or] worse prepared,” Edge adds. “It’s a strange balance of all of the myriad decisions I need to make becoming nearly mundane while understanding that a very simple slip-up could cause major damage or even death.”
Decision fatigue doesn’t stop with medical decisions. It permeates every aspect of our lives.
“If I have to make a bunch of diabetes-related decisions, it becomes harder to make super simple decisions in other areas of my life,” says Edge, giving the example decisions of what to have for dinner, whether to start the laundry, or whether to answer a text.
This trend works the other way, too.
“If I’ve already made a bunch of decisions for work, diabetes decisions become harder,” she says.
Decision fatigue has also worsened for many, if not all of us, since the start of the COVID-19 pandemic. We stress about whether we should attend a group event, wear a mask, or see someone who may have been exposed.
And ironically, I feel that making decisions is actually more difficult during times when my health is better. If I’m in a flare-up or recovering from surgery, I have fewer choices. I simply know that I can’t do much. Give me one decent day, however, and my mind runs wild with all of the possibilities as I try to narrow down everything I’d like to do.
Research shows that healthcare providers experience decision fatigue because they spend their days making continuous decisions about patient care. This can negatively impact the quality of care they’re able to provide. But people don’t often recognize that those of us receiving care are at risk of this phenomenon, too.
Unfortunately, there’s no magic cure for decision fatigue. For the most part, it’s something we have to live with — just like the rest of our chronic symptoms. But there are small steps you can take to help your daily decisions feel a little easier.
One idea is to cut down on the number of choices you have to make. You can’t eliminate all medical decisions, but simplify habits where you can, like wearing the same outfit or eating the same lunch every day. (This is why President Obama wore the same clothes every day. He had more important things to think about than what to wear.)
If you have a partner, caregiver, or close friend, see if you can delegate any decisions (whether medical or otherwise) to them. Other choices might be able to be automated or pushed off until a later time. If at all possible, try making important decisions in the morning, when you’re likely more mentally fresh.
Edge also recommends making mundane things fun or, at the very least, somewhat enjoyable.
“I have a lot of things I call ‘cute-tilitarian.’ My silly mashup of cute and utilitarian. If something is adorable or makes me happy to use, I’ll be more likely to use it,” she says. “A cat that is also a container that holds pills or vitamins. A tea steep cover with a cactus on it.”
Decision fatigue is very real for people with chronic conditions and disabilities. It frustrates me, and I wish there was an easier fix.
Over time, however, you can implement small changes to your decision-making process that will make those thousands of daily choices a little easier to manage.
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