The Anatomy of a Good Decision

Make the hardest decisions of your life like a surgeon

Want to make life’s hardest decisions—about jobs, relationships, marriages, divorces, hiring, firing, moving cities, and everything else—all without losing your sanity?

Read on.

For the last three months, I’ve been writing about what makes for bad decisions. Today, let’s talk about how to make good ones.

(This is a long post. For a printable PDF version of the post, please scroll to the bottom)

In retrospect, I think my fascination with decision-making started in med school. A bit of background first:

Medical training in the US starts with university, followed by medical school, followed by 3 to 5 years of residency. You get to apply to college and med school, interview, and then, you get to decide which of the offers you’re going to choose. Residency is dealt with slightly differently.

You also apply. You also interview. But then, instead of programs offering slots to med students for them to accept, you both—you and the residency programs—send “rank lists” to a centralized computer.

You rank all the programs you interviewed at, from most preferred to least, and programs, in turn, rank all the students they interviewed in the same way.

The computer matches students to programs, and, with few exceptions, wherever it places you, you go.

Which means the rank list is supremely important. How should a med student rank? Should they truly pick their most preferred program first, even if it’s a reach? Should they rank a safer program first so that they’re not forced to settle for programs lower down on their list if the dream program doesn’t work? How much should the training itself factor in? The city you’re in?

And so on.

Late 1999, that was me. I stared at the pro-con list I’d written on a sheet of paper, taped to my apartment wall in Dallas. The page was creased from being taken down, folded, unfolded, and retaped so many times. Two columns, perfectly balanced, listing everything I could think of about which residency programs I should rank, and where.

How did the interview feel? How much were they offering in salary? Were there benefits? Did I like my potential colleagues? Was the city walkable? Was it too cold? Too hot? What was the training like…