In this election year, with so many choices to be made between so many totally insane and completely unqualified applicants, I think it would be helpful to remember how totally insane and completely unqualified any of us are when it comes to making decisions, political, occupational, medical, or otherwise.
Most people don’t know what they want.
We have to see things in context and comparison. What we see tends to change depending on what things are next to each other and how we judge each. My car looks great next to that old jalopy but it looks like a bucket of bolts compared to the Jaguar on the other side. Nursing looks great next to my high school friend working at Starbucks, but maybe doesn’t look so great next to your other friend who is transplanting hearts.
What other people think also has a great impact on what we think we want. When somebody says “You’re so smart. You should go to med school”, they are imposing their judgements, values, and stereotypes on the decision. But you’ll care about what they think, and as I said above, it will influence how you decide.
Another problem with knowing What You Want is the relationships we have with past present, and future. Knowing What You Want means that you have to be able to anticipate how you will feel if you choose different options, which in the case of health care is very difficult to do. And the ability to accurately predict how you will feel is even more important when the thing being chosen, as in medicine, is years away from actually happening.
Here is how Kent Greenfield, in his book The Myth of Choice, puts this:
“Our ability to make anything close to a good decision in the present depends not only on our judgements about what we want, think, and feel right now but on our memories of what we wanted, thought, and felt in the past and our predictions about what we will want, think, and feel in the future.”
A classic example of this is in food shopping. When we go to the store we are buying in the present things we think we will eat in the future, because we liked them in the past. If we buy something that is new, we are predicting that we will like it in the future and that when the future becomes the present we will eat it, because we liked similar things in the past. When it comes time to actually choose something to eat, we might or might not like the things we bought.
Most people know what they want.
This is why a simple list of pros and cons doesn’t work when it comes to these kinds of decisions. Gut feeling is a powerful indicator of what we really want. Most of the time our gut is drowned out by social structures and expectations, but it is a very important piece to pay attention to. For example, if you are making a decision about whether or not to buy a new car you might make a list of all the good things and bad things about buying a new car vs. keeping the old one. What you might not factor in is the gut feeling that says “I want a new car. Now.” So you end up buying one even if your list concluded it wasn’t a good idea. We are not completely rational creatures.
You have to get this step right. No amount of information will help if you don’t know yourself and what you want. Not just what you think you want, or what you think you should want, or what someone else tells you is the right thing to want.