We hear a lot about compassion fatigue these days, and rightly so. We are all more aware of the potential toll our work can have on us and on all aspects of our lives outside work. But we can’t use compassion fatigue as an umbrella encompassing all of our feelings. It’s a wide-reaching issue but only one of many we face.



I’d like to talk about a different type of fatigue – the invisible and often misattributed exhaustion that comes from the constant, pervasive, unrelenting decision-making we vets do. Every. Single. Day. All day. In physiological terms, if we work a muscle “to fatigue,” it means we work it until it physically cannot do the work any more, and tasks that would normally be very easy are suddenly much more difficult because of the amount we’ve just asked it to do.


The same happens when we have to make choice after choice until our choice-making apparatus is worn out. Social psychologists call this “decision fatigue.” It’s the mental equivalent of the way you couldn’t sit down on the toilet the morning after you tried Crossfit.


We all know the routine – we take a deep breath, open the hospital door, and before we can put our things down, we have someone waiting to ask us a question, Post-its or faxes on the desk, lists of calls from clients asking for the next step, for a prescription refill, for permission to skip the recheck.


Behind the first exam room door is an anxious owner with a sick pet and little money, asking us to prioritize testing and treatment to minimize cost and maximize results. A simple wellness appointment with a reluctant owner becomes a long conversation about which preventive care is most important. A client calls asking to be fit in and is approved, but then another calls, and another.


Do we see them? Send them? Tell them it can wait? A cat with advanced periodontal disease is asleep on the table and we have to decide on her behalf which teeth are compromised enough to warrant extraction. An oozing vessel mid-spay will probably stop… unless it won’t. Do we go after it? Are those liver values elevated enough to worry? Is it too soon to start steroids? Too late to stop antibiotics?


And on… and on… and on. That’s a tiny fraction of the decisions we make at work in a typical day, and they all matter. To the clients and animals involved in each one, they matter A LOT. Of course we’re tired! But that’s the job, right? That’s what we get paid to do, and doing it earnestly, honestly, openly, and with a smile is what keeps people coming back to us.


We may not be able to control the number or the nature of decisions we need to make every hour, every minute even, with regard to patient care and client satisfaction. But research has shown that ANY decisions we need to make during a given day will sap our resources until we reach a point where we just can’t make decisions reasonably, cheerfully, or rationally anymore. That’s decision fatigue, and in my opinion it’s a HUGE contributor to burnout in this profession.


The solution, according to experts, is to do everything you can to minimize decisions you need to make in situations you CAN control. Something as simple as wearing essentially the same clothes to work every day or eating the same thing for breakfast can make you less edgy, more confident, and more able to concentrate your decision-making energy on things that come up unexpectedly.


I have struggled with decision fatigue for most of my adult life, I think. It just didn’t have a name, or I didn’t know it. I still struggle. What helps one person might be different from what helps another.


These things have really worked for me:


  • Have a “work uniform.” I haven’t stressed about what to wear in the morning since I was in my 20s and worked in an art museum. People notice and judge what you wear in an art museum. Now I wear a white coat over top of the same pants and shirt in different colors every day and no one cares. Win!


  • Meal prep. You don’t have to know about “macros” or be one of those Instagram people who show photos of their 26 Tupperware containers full of quinoa with kale and perfectly cubed sweet potatoes to benefit from a little advance planning. “Meal prep lite” has changed my life. Deciding what to eat takes a huge amount of mental energy.


  • Schedule workouts and errands ahead of time. Write down a time and place. Then be there. No dithering.


  • Make as few decisions in the morning before work as possible. Set the coffee maker on a timer. Put your work clothes out the night before, and also use that time to pack lunch and a bag for whatever you need to do after work.


You can also do small things to reduce daily decision-making you have to do at work. For instance, state number of refills on approved prescription requests. Summarize complex case findings in an alert for yourself if you know you’ll forget the details by the time you get the update you asked for in a month. Take a short break at lunch, if you can, to step away from the barrage of requests for seemingly small decisions that will “just take a minute.” Delegate any decisions you can legally, ethically, and comfortably pass on.


It’s OK not to do it all yourself. Ask your fellow vets, technicians, client care specialists, and supervisors to brainstorm with you on ways to make as much of the daily routine as automatic as possible. The entire team is affected by the short tempers, indecisiveness, and second-guessing that arise from too many judgment calls with too little mental rest.


I’m guilty of letting decision fatigue get the better of me many, many times without realizing what was really going on. Knowing it exists and that we are all susceptible is a huge help. Talking with your team about it means better understanding if you feel overwhelmed, and more empathy from you if it’s one of them who’s starting to snap.


Sometimes all a person needs is to hear, “This is what I would do – what do you think?” or maybe, “I’ll tell her you’ll call back later. You don’t have to decide this now.” By knowing this is a real phenomenon and communicating openly with one another before things get out of hand, we can make everyone’s load just a little bit lighter.


The views and opinions expressed in this article are those of the author and do not necessarily reflect the position of the DrAndyRoark.com editorial team.

Dr. Katie BerlinAbout the Author

Dr. Katie Berlin is a small animal general practitioner in Mechanicsburg, PA. She is also a reader, a rider, a runner, a lifter, a teacher, and an art lover. She graduated from Williams College in 2000 with a degree in Art History and worked in art museums before going back to school and earning her DVM from Cornell in 2009. She is an avid supporter of Fear Free practice and the battle against compassion fatigue in the veterinary profession.