The phrase "a few choice words" reflects prioritization because it implies that a limited number of words have been carefully selected by a speaker or writer.  With an entire science of choice being developed today, we would be wise to be aware of how to use choice to enrich our lives. 

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Choice presents itself with surprising frequency.  Often we don''t recognize choice when a decision appears obvious, especially when the choice lies between a clear positive and a clear negative. Will you choose the cool, high-paying job or the tedious position with low salary and no opportunity for advancement?  So what’s to choose!  

But "true choice" requires selecting between two positive outcomes (for example, as in epic movies of days gone by, love versus honor) or two negative outcomes (some might say, as in American presidential elections).  Because true choice options are relatively equal, when we reach our decision, our chosen option may still appear only slightly better than the alternatives.  The unresolvable uncertainty can drive us crazy.

For example, it was maddening several months ago, when my dermatologist asked me to choose between divergent medical strategies for determining whether I had a melanoma.  Despite the fact that I''ve been an oncologist for three decades, I didn''t want to hear about the pluses and minuses.  I wanted an expert to offer a firm recommendation, by which I mean, I wanted an expert to make a decision for me.  

In fact, multiple studies demonstrate that at least two-thirds of cancer-free individuals envision that, if they were to be diagnosed with cancer, then they would want to choose their own care plan. When the same investigators survey people already struggling with cancer, less than 15% want to make their own care-related decisions. When I discuss these data with interns and resident physicians whom I train, they find it more startling to flip the latter statistic: 85% of cancer patients are reaching out to their physicians to announce, "I don''t want to choose!" 

Although ranked well below The Bible and The Boys of Summer, The Paradox of Choice by Barry Schwartz resides somewhere on my top-ten-books list.  A professor of Social Theory at Swarthmore College, Schwartz warns that, as numbers of choices increase in our consumer culture, our logic tells us that we are enjoying increasing autonomy and control.  But paradoxically, we are, in reality, not liberated by choice but hampered by it. (Schwartz uses the more dramatic term, "tyrannized by choice.")

You may have observed the phenomenon in your own experience, whether trying to pick out a product in the supermarket aisles or, more significantly, a life partner. Often, the panoply of choice and the process of choosing can lead to confusion, dissatisfaction, and anxiety. 

For me, the great irony of choice is that, often, choice doesn''t revolve around an axis of options as much as an axis of limitations.  Some years ago, at the bat mitzvah of our daughter Elisheva, I gave a speech that dissected the phrase, "life is a series of choices."  I subscribe to that world view for three primary reasons.  First, when we look back, most of us can see the array of choices in our lives. Second, the "serial" nature of choice underscores the weight of decision. While driving, when I reach an intersection, I must select a particular road.  That road then leads me to another intersection that no longer gives me access to the path I initially rejected. Third – and this is why I brought it up at a coming of age ritual like a bat mitzvah, when I make a choice, it''s usually with the understanding that I cannot have the thing I rejected.  Choosing, therefore, requires intellectual honesty as well as maturity.

On a 1970s TV show, I saw an interviewer ask the economist Milton Friedman why America could not solve the hunger problem among impoverished cities when it could put a man on the moon.  Friedman answered that America cannot solve its hunger problem because it allocated so much money to the space program. In other words, a choice had been made that involved limits and consequences.

Once we realize that the rules of the choice game are actually steeped in limits, we can try to play the game more effectively.  When I feel I’m drowning in options, I usually do best by imposing constraints or telling myself that there is no option.  For example, because medical school was grueling and burdensome, like many of my classmates, at times, I contemplated an exit strategy. Many of the people in my supportive network had sincerely assured me that they would stick with me no matter what. They would have understood had I chosen to leave medical school, but at some point, I decided that dropping out was simply not an option. It was counterintuitive then, but by constricting my choice, I found it easier to persevere with my studies. By doing so, I resolved my dissonance. 

Of course, it doesn''t always work out that way.  But at the end of his book, Schwartz suggests that most good decisions entail figuring out your goals, evaluating options, and then restricting your choices to optimize your chances of achieving those goals.  If you accept the premise that limiting options plays a critical role in the process of choosing, then it can make sense to proactively impose limits from the outset rather than in retrospect. 

Choice is a robust force in our lives. I could continue to argue in favor of that reality, but I choose not to.

Until next Monday, Shalom.
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