Shandra is a very pleasant young lady in my office who each morning fills a pitcher with water that she flavors with sliced lemons. Some days she slices the lemons into wedges and some days she cuts them into little circles. She squeezes the lemons before she puts them into her pitchers some days and other days she does not.

Why do I care enough about Shandra's lemons to post about this. Because it is another excellent example of how we as humans are inconsistent in our decision making process. Why doesn't Shandra figure out the way to extract the most lemon juice and do this the same way each time? Because she is human and humans are inconsistent in the way that they make decisions.

Malcolm Gladwell in his book Blink recounts the story of the Goldman Chest Pain Decision Tree that was first used at Cook County hospital determine what level of care patients who were admitted having chest pains should receive. The Goldman chest pain decision tree combined the EKG results with three other measurements. This included:

1. Whether the patient had unstable angina
2. Whether there was fluid in the lungs
3. Whether the systolic blood pressure was below 100

According to Gladwell, these simple decision rules applied uniformly (I would call this a naked decision making strategy) resulted in fewer unnecessary hospitalizations and were better at identifying the most critical patients than the collective wisdom on the emergency room doctors.

A simple rule based method forced the doctors to make their treatment decision in a consistent way and resulted in better decisions for the patients. Decision makers frequently lack structure in their decision making with lemons and sometimes with things much more important.