Are your decisions really your decisions?

We make gazillions of decisions every day – pretty much one a second sometimes more. Can you imagine having to consciously think every one of those decision? It would be so time consuming that we would never get anything done.

Our body has designed a way to save our energy through the creation of internal scripts that run automatically. This allows us to freely to do other things, which on the whole generally works well for us. However, in certain situations they can really limit us in our decision making capacity.

Nobel Awards winner Daniel Kahneman, author of the book “Thinking Fast and Thinking Slow, and co-founder of Prospect Theory  showed that people tend to default to certain cognitive biases, when presented with emotionally charged information.  He suggests that people are more likely to make a decision, not on the final outcome but rather on the potential value of perceived losses and gains.


So, in other words depending on how information is framed people will respond to the information given by becoming either more Risk Averse or Risk Seeking.


I am not going to go into this theory in great detail but it does have bearing on understanding how we might influence our clients, whether that be directly or indirectly. Or indeed how anyone in a position of responsibility might also do that, to the detriment of our client?

Recently,this very nearly happened for my client. Very briefly my client, who origionally came for chemotherapy optimisation support therapy, was asked towards the end of her chemotherapy course to take the BRCA1 gene test. This was because her type of cancer was linked to the BRCA1 gene. It was suggested if she tested positive to have prophylactic chemotherapy medication .

The BRCA1 is a human tumour suppressor gene (to be specific, a caretaker gene), found in all humans; its protein, also called by the synonym breast cancer type 1 susceptibility protein, is responsible for repairing DNA.

The first question that I ask her was “What she was going to do if the result was positive?” I have found that often when people are faced with their mortality they generally go into a tail-spin. All they want to do is to survive and their brain jolts into one gear only. Sadly, this can seriously compromise their cognitive abilities and sometimes causing them to make some very seriously hasty decisions. Decisions that have the potential to result in long term consequence which that they may not be properly prepared for and which they then might regret.

I also asked her about the drug that was suggested she take, immediately looking it up for myself, and told her that the drug was another chemotherapy drug. I was surprised at how little information she had been given but what was even more concerning was, that she was going to be doing another year of chemotherapy and the doctor wasn’t sure when she would be able to stop administering the drug to her. There were no concrete test available for that.

Of course, I accept that she was quite stressed, at the time, but she seemed a little clueless here. Nevertheless, she did compile a list of questions to ask the doctor and did decide to have the prophylactic chemotherapy drug for a year. She then took a break and at her last check-up her doctor again suggested that she go back again onto the same prophylactic chemotherapy drug. This was despite all her results parameters being normal.

However, this time she questioned the validity of his decisions telling him that didn’t want any more of the prophylactic treatment.  He immediately told her that she needed to “do this for her children”. He even had the audacity to impress on her to think about “how her children might feel if she died” – implying that it would be her fault.

Talk about pressure!!

I, congratulated my client because she immediately sought another doctor who after some investigations told her that her risk of getting breast cancer  was a little higher than the average post menopausal woman, but was really quite small when looked at theough the age specific window. This was because she was now fully though the menopause, eating well, actively taking charge of her life and was dealing purposefully with all factors known to potentiate disease.

However, the specialist did ask my client to think about whether she would regret her decision if the disease came back? This was not to scare her but to help her have clarity on the choices that she was making.

Research shows us that people generally go for risk minimising effects – the safe option rather than the risker option for fear of future consequences. So, we would put ourselves in danger for the bigger goal of being safe in the future. And in my client’s case that her children would not feel pain or blame her in the future.

My client immediately recognised that this was one of the questions I had asked at our first session and was glad to see that she had gone leaps and bounds ahead, pretty much ensuring that she kept herself healthy. She believed that she was doing the best that she can and that she is making the right choice for her. Also, that she was not being careless wth her decision and that was taking responsibility for her choices. She reckoned that she could be hit by a car tomorrow and the same senario would apply for her children.

For the moment my client is content with that decision. She knows that she is still being monitored and that if things change she can always reverse her decision.

If you are ever in this position here are a couple of tips that you can do that might help you:

  1. Get as much information that you can and also talk to people that may have been in your situation. Do not hide this from people, tell them – keeping things in is not good for you.
  2. Speak to people that have made different decisions on what the doctors have prescribed. Find out what helped them make a decision and importantly how did they know when the decision was made. This will give you a more balanced view. They have been through it and they can give you the benefit of their learning and any regrets that they may have had.
  3. Go on the assumption that unless something is life threatening right now i.e. you are bleeding out, there is probably a couple of days to make a decision. Take the time!!!
  4. Check your level of anxiety – if you have feelings of foreboding then it is very likely you will be persuaded by family dynamics, your doctor or any other person. You decisions will be based on their fears and might not be on your own decisions!
  5. You best decision comes when you feel a sense of calm – this doesn’t mean that you still don’t have some concerns but that you are at peace with the decision that you make – you take ownership of it.

For more information about dealing with these sorts of situation you can message or email me.


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