Extreme Decisions

GW Assistant Professor of Organizational Sciences Nils Olsen researches how people deal with complex choices.

May 8, 2010

Nils Olsen

By Julia Parmley

In the summer of 1990, GW Assistant Professor of Organizational Sciences Nils Olsen was a 22-year-old tennis instructor at a country club in Washington, D.C., while working as a waiter in a small family-run restaurant. One night while waiting tables, he was approached by the father of two of his tennis students with the incredible offer of being the summer tennis instructor for the family at its villa in Italy. Dr. Olsen would be fully compensated, and his travel expenses and food completely would paid for—but he had two days to make a decision. Dr. Olsen ultimately decided to decline the offer but says it was a decision he still questions today.

“I basically had a head-versus-heart decision,” he says. “In my head, I took the rational approach and weighed the pros and cons. Then there was the heart side of it, the irrational, emotional gut-level approach where I ultimately made the decision. Still to this day I wonder if I should have taken the offer. I think there are a lot of cases in life where there are decisions that can really affect where you end up professionally and personally.”

How people make these kinds of major decisions—and often under the most extreme of conditions—is the focus of Dr. Olsen’s research and teaching at GW.

In GW’s Department of Organizational Sciences and Communication, where he serves as interim program director of organizational sciences, Dr. Olsen teaches a wide range of undergraduate and graduate classes, including the Psychology of Individual and Group Decision Making; Statistics; and Extreme Decisions, a course that he introduced at GW. His research, which is widely published, spans a variety of areas, including patient flow and utilization of hospital space and stress management. Dr. Olsen also has been invited to lecture on extreme decision-making, and he delivered a talk on “Hot Decisions” at GW’s Last Lecture Series on March 2.

His current research involves an in-depth look at how emergency room physicians make decisions in intense, high stress situations and how trust develops between physicians and lawyers with their respective clients.

To collect data on how physicians make decisions in extreme situations, Dr. Olsen and GW Assistant Professor of Emergency Medicine Ray Lucas have created a computer-based simulation titled “Blink-Think: Intuitive vs. Systematic Decision-Making Among Emergency Department Physicians.” The simulation presents realistic medical situations with symptoms ranging from moderate to severe to test the decision-making of highly stressed physicians. Drs. Olsen and Lucas plan to present the data in a paper this fall.

“What we want to test is whether even the most expert of physicians in emergency department medicine are challenged under cognitive stress,” says Dr. Olsen. “We’ve found that the more stress you’re under and the more information you have to process – both of these factors affect your processing capacity and efficacy to make decisions. You might overlook really crucial details in these situations.”

Dr. Olsen’s collaborative work with Duke University professor Dan Ariely on the same subject is featured in Dr. Ariely’s New York Times best-selling book “Predictably Irrational,” which examines how decision-making can easily break down, even among intelligent, highly skilled individuals. Along these lines, Dr. Olsen worked with GW’s Luther Rice Society to deliver a series of decision-making presentations to Wall Street executives in March of 2009. He also invited Dr. Ariely to speak about financial decision-making on the trading floor of the New York Stock Exchange.

“If the contextual constraints are such that ‘experts’ are experiencing high stress, time constraints or anything that can affect their ability to process information and to think clearly, it will influence the choices they make,” says Dr. Olsen.

Dr. Olsen says the availability of medical alternatives can also impact a physician’s decisions. For example, a 1995 study by Redelmeier and Shafir, cited in Dan Ariely’s “Predictably Irrational,” shows that if asked to choose between doing hip replacement surgery and providing basic pain management on a patient, physicians most often choose to provide pain management.

“But when you give them more than one option, like using different medications for pain management, Redelmeier and Shafir’s study shows that physicians actually overwhelmingly choose to do the hip replacement, which can be a life-changing procedure,” he says. “This shows that when a decision becomes more complex, it clouds your judgment, and you’re less likely to make an optimal decision even if you’re an established expert. This is what we’re interested in exploring—how this can happen to everyday people.”

Dr. Olsen is also collaborating with E. Allan Lind, the James L. Vincent Professor of Leadership at Duke University, to study the interactions between physicians and lawyers and their clients. “We compared these two groups, because we thought there might be differences in how trust develops and whether clients retain that professional,” he says.

A nationwide study they recently conducted from a sample of 10,000 individuals reveals that for physicians, the medical outcome and the extent to which the physician prioritizes the patient’s case gain the patient’s trust. For lawyers, it was the respect they gave to their clients which mattered most to clients, even above and beyond the legal outcome of the case.

“Trust matters--it’s a huge indicator of whether a client will retain a professional or not,” says Dr. Olsen. “These results suggest that perhaps the adversarial nature of the legal profession makes procedural justice phenomena – such as treating the client’s case as important and treating the client with respect – that much more salient when it comes to clients’ assessment of their own trust in lawyers.”

“When it comes to physicians, on the other hand, it is presumably the case that health care providers are ideally working towards the same goal of optimal health for a given patient, so the medical outcome itself would understandably be the single best predictor of a patient’s trust in a physician,” he adds.

What interests Dr. Olsen most about decisions is that they affect everyone—regardless of class, gender or age. “There are a lot of ways in which we make less than optimal decisions,” he says. “But the beauty of going through life is that while you don’t have control over the events that occur or other people’s behaviors, you can always control your reaction to it.”

Through his research and own personal experiences, Dr. Olsen says being both humble about what you know and being vigilant about the details of a decision can help steer you in the right direction, even under the most extreme of circumstances.

“For a lot of us, as time goes on and life becomes more complex, we look less carefully at the information in front of us,” he says. “Be aware of your weakness and where you could fall prey to cognitive shortcuts. And try to actively process information, as it will help you make the most advantageous decision.”

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