Intended for healthcare professionals

Career Focus

How do you make decisions? Thinking and feeling

BMJ 2004; 329 doi: (Published 20 November 2004) Cite this as: BMJ 2004;329:s213
  1. Anita Houghton, careers counsellor and coach
  1. Londonanita.houghton{at}


In the fourth article in our series on understanding personality type, Anita Houghton explains how people prefer to make decisions

There is a group exercise that's great for demonstrating differences in people's decision making processes. Divided into the two preferences, the groups are asked to imagine they are a research team that has recently completed a project. So interesting is the project that they have been invited to present its findings at a conference... in Barbados. All expenses paid. The trouble is, only one person can go, and the task is for each group to decide who it will be.

The first time I tried out this exercise was in a research department, and six people were in the “thinking” group and three in the “feeling” group. The thinking group had their decision in about five minutes. “No problem,” they said. “We simply chose the person who is best at presentations.” The feeling group took much longer. They agonised and agonised, and when eventually I called time, I saw them drawing straws.

This pair of preferences relate to the basis on which people like to make their decisions. We can all use both preferences, and do, but some people prefer to stand outside a situation in order to make a decision. They use logical analysis to work out the advantages and disadvantages of different options; they may be seen as hardheaded but fair, firm but reasonable, and they are said to prefer “thinking.”

Others prefer to make their decisions on the basis of their values, and the effect that a decision will have on the people concerned. They are less concerned, one might say, with what is logically correct than with what is important to them and others. Said to prefer “feeling,” they may be seen as compassionate and tenderhearted. If asked for a preference between the words “justice” and “mercy,” a feeling type is more likely to prefer mercy, and a thinking type justice. Box 1 shows some main characteristics of either types.

Box 1: Characteristics of preferences

Thinking deciders

  • Logical and analytical

  • Objective

  • Seen as tough minded

  • Interested in cause and effect

Feeling deciders

  • Interested in effect on people

  • Seen as compassionate/tender

  • Subjective

  • Value driven

Box 2: Medicine related activities requiring thinking and feeling


  • Treating according to evidence

  • Explaining cause and effect

  • Analysis and technical work

  • Creating logical order in a department

  • Critical problem solving


  • Treating according to individual

  • Dealing with personal problems

  • Looking after people in a department

  • Talking to patients and relatives

  • Explaining personal consequences

In the case of the conference exercise, the thinking group had no problem in making a decision, and they did so in double quick time. The right person to go was obviously the one most competent for the job, and they were totally bemused by, and somewhat derisive about, the feeling group. What on earth could be the problem, and why couldn't these half brains make a decision? The feeling group had had a terrible time. They just couldn't bear the thought of putting one person forward for this wonderful trip while others wanted to go. They tried looking at who wanted to go, who deserved to go, who went last time, and so on. Presentation skills didn't come into it. Failing to find a suitably compelling reason for one to be chosen over another, in the end they drew straws.

The results? Well the feeling team were all happy about their choice, but they didn't know how good the presentation was going to be. The thinking group had made a logical decision, but they hadn't asked anyone about how they felt about it, and it turned out that the person selected had a small baby at home whom they didn't want to leave. Arguably the best decision would have been made if the two groups had put their heads together.

Seeing differences through the lens of type

Types who prefer thinking:

  • May be seen as hardhearted, insensitive, cold

  • Could be seen as logical, clear headed, and willing to make difficult decisions

Types who prefer feeling:

  • May be seen as soppy, illogical, weak

  • Could be seen as kind, sensitive, and good with people

It's important to understand that both these ways of making decisions are rational, they are just based on different priorities and different sets of information, and everybody uses both. Thinking deciders will tend to look objectively at a situation, then consider the people aspects, and then return to the objective information for a final decision. Feeling deciders will tend to consider the effect on people first, then look at the logic, and then return to the feeling information for the final decision. Of all the preferences, this is the only one where there is a gender bias, with around 60% of men preferring thinking, and around 60% of women preferring feeling. The jury is still out as to whether this is an inherent or cultural effect.

Thinking and Feeling at work

Both preferences are important in medicine (see box 2), and all doctors will use both in their decision making. However, the scientific basis of medicine and the fact that that it has traditionally been a male profession, mean that medical culture tends to favour thinking over feeling. In a study of surgical senior house officers, 85% were found to prefer thinking,1 and in a cohort of medical students 64% preferred thinking.2 This will vary with specialty, of course, there being relatively more feeling deciders in general practice, for example, but even where there are more feelers, medical training and practice is such that feelers have to learn to put their feeling preferences to one side for much of the time, and develop their thinking skills. It's hard to say if it is because of this, or because feelers are more likely to be upset if they can't help someone, or if medical realities clash with their values, but Clack found that feelers were more likely than any of the other preferences to report low job satisfaction.3

It is not plain sailing for thinkers either, now that there is much greater public demand and expectation for empathy and patient centred approaches to care. Also the tendency of thinking types to focus on what needs fixing in a situation, rather than what is good about it, may leave them open to accusations of insensitive management or feedback to juniors. Once again, both preferences are essential, both for the competent and sensitive delivery of health services, and the management of staff.

Where differences cause problems

Thinking types can be exasperated by what they see as the wishy washy, touchy feely approach to problems that feelers seem to have. Why can't they be rational for once? Feelers can be appalled by what they see as the thinker's apparent complete disregard for people's perspectives and feelings. Because of the association of thinking with being male and feeling with being female, these are the battlefields of many a relationship.

As with all the preferences, the trick is understanding difference and using it to your advantage. A surgical trainee came to see me once. A feeling type, he was anxious and depressed about his choice of specialty and was feeling undervalued and incompetent. Once he understood that he was working in a highly thinking culture, and realised that his strength in talking empathetically with patients and relatives was not only valuable but rare in his department, he was able to return to work with a new spring in his step.

Tips on how to cope with the bits you find hard...

  • Develop your non-preferred skills. Knowing what you find hard, and why, is an essential first step to doing something about it. If you are a feeling type, try consciously standing back from situations in order to consider your options. If you are a thinking type, try putting yourself in someone else's shoes when making decisions about them

  • Get help from someone who finds them easy. If you are a feeler and you are having problems with making a tough decision, then you may benefit from asking a thinking type for help. If you are a thinking type, and have difficulty dealing with, say, social problems in your clinical work, or even in your personal life, why not ask a feeling type for help or advice? Good quality problem solving includes attention to all the preferences, so when you are about to make an important or difficult decision, try getting a perspective from other preferences first

  • Do your toughest jobs when you're at your best. If you are a thinking type and have need to get into someone else's shoes to make a good decision, try to do it when you are fresh. Similarly, for feeling types who have some tough objective analysis to do

  • Think carefully about applying for jobs ill suited to your preference. Knowledge of your type will help you identify these in advance, so if you're a feeling type, think carefully about applying for jobs that require a lot of logical decision making, or where the culture is predominantly thinking. If you are a thinker, you may want to think carefully before applying for a job where the emphasis is more on dealing with patients' personal perspectives than objective problem solving

If you're having thinking-feeling related problems at work, look in the tips box for how to cope.


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