Clinical decision fatigue as a reversible state in the continuum of professional exhaustion

Concerns about clinician fatigue typically focus on burnout and workload, yet less attention has been paid to how the process of making repeated, emotionally and ethically challenging decisions may transiently affect decision quality. The concept of clinical decision fatigue (CDF) remains debated, partly because empirical findings differ across clinical contexts. We propose that CDF is best understood as a short-term, reversible state arising from sustained self-regulatory demands during emotionally and morally salient clinical decision-making. Drawing on contemporary process models of self-regulation, we argue that repeated exposure to empathic strain, moral conflict, and responsibility for consequential outcomes can shift clinicians' motivational and attentional priorities away from effortful, reflective decision-making toward simplified or defensive strategies. This state is distinct from compassion fatigue and burnout in its timescale, mechanisms, and phenomenology, but may interact with these conditions when episodes recur without recovery. We argue that clinical decision fatigue is a reversible state of regulatory strain that can be situated within a broader continuum of professional exhaustion. Clinical environments that intensify emotional and moral load may accelerate the onset of CDF, whereas structures that support emotion regulation, ethical clarity, and shared decision-making may mitigate it. Recognizing CDF as a modifiable systems risk highlights opportunities to protect decisional integrity, patient safety, and clinician mental health.