How Fear Holds Osteopaths Back

I talk about core lessons inside Derek Sivers' "Hell Yeah Or Hell No" and translate them into how you can apply them as an osteopath.

Podcast Episode Transcript

This episode will be challenging for a lot of you. We’re going to talk about fear, what makes a practice a great place to work and the pressure we put on ourselves on trying to get new patients and what to do about it.

Hell Yeah Or Hell No: What’s Worth Doing by Derek Sivers, which I first read in early 2023 is a short book that packs unbelievably valuable lessons on entrepreneurship which you can read in about an hour.

This is one of my favourite episodes already, so I hope you enjoy it.

Welcome back to Behind The Osteopath. My name is Alan Zaia, I’m an osteopath, Founder of Osteohustle where we plan, build and grow dream careers for osteopaths.

At Osteohustle, you can find your identity with branding, attract patients from Google and grow your business with coaching.

First, a huge thank you to everyone who’s got involved in the Q&A section, emailed me, shared on episodes on social platforms – thank you so much.

With that being said, if you enjoy the episodes, if you can, please leave a 5 star review. If you want to connect with me, my email is in the description or if you’re on your phone, click on the episode, scroll down and you’ll find a Q&A section.

I’ve got a great question for all you clinic owners listening, so listen out for that.

Alright so, as you know, Behind The Osteopath is based on my belief that you should never open a clinic without fully understanding what it takes. So, I’m translating a bunch of business, marketing, entrepreneurship and self-help books into the context of being an osteopath.

This is the second of Derek’s books we’ve covered, so if you like this one, go check out episode 13 Ten Years Of Business Experience In One Hour after this one.

Alright, let’s dive into Hell Yeah Or Hell No.

Actions, Not Words, Reveal Our Values

Alright, starting off with a hard-hitting one here. Derek explains a conversation he had with his business coach at the time, saying that he really wanted to start his new company.

Derek was shocked when his coach’s reply was “You don’t want to really start this business. Otherwise you’d have started by now. Derek’s reaction was ‘well, hang on a minute, I’m telling you what I want and what’s important to me, so you can’t just dismiss what I’m telling you’. Coach’s reply was: “Yeah I can. Our actions always reveal our real values. If you really wanted to do it, you would have started by now”.

The takeaway here is that our actions show us what we actually want and there are two hard-hitting, but smart reactions:

  1. Stop lying to yourself and admit your real priorities.
  2. Start doing what you say you want to do and see if it’s really true.

I’d like to share something with you at this point. I’d say that 80 plus percent of conversations I have with osteopaths, whether that be on a free discovery call or during our business coaching process, include me asking the question: “What’s stopping you from getting started?”

Now, sometimes it’s about logistical things like not having enough money to get started, and even then the majority of scenarios centred around money are boiled down to not actually needing as much as they thought because it’s filled with non-essentials. But the majority of the time, not getting started is based around two things: marketing and asking for what you need at work.

So, I’ll expand on these two.

First up, marketing.

Marketing always asks you to put yourself out there in some way.

For example, connecting with a local business, getting signage put up, creating videos for social media, getting photos done for your website. With all these asks, we end up fabricating so many mental blocks that we get ourselves in a spin then end up scaring ourselves out of doing it, even though we know it needs to be done, then getting frustrated at ourselves when we can’t seem to make the jump.

The reality is that you need to get over your version of fear.

Because, and this is the real truth that’s hard to remind yourself of, you need to always remind yourself when you do have days of doubting yourself that if you are not going to be the person who backs yourself by saying, hey, I’m here and this is how I can help.

Who are you expecting to do it?

No one else is going to care as much about your business as much as you do, so it’s up to you to get over that fear.

Bearing in mind that all these excuses we tell ourselves causes our fear and frustration to compound again and again when our finances don’t look so good.

The bottom line is that in order for you to get new patients and for you to grow your patient list, no matter whether you’re an associate or clinic owner, you need to just get over it and understand that the buck stops with you.

The way you get over the thoughts in your head is by doing.

You’ll quickly realise that everything’s safe on the other side.

Moving onto the second point which is asking for what we need at work.

I cannot tell you the amount of problems that have been solved by pushing for a bit of communication and transparency by all people involved. Again, start doing what you say you want to do. Before I go on, of course there are many nuances and of course there are complexities to each scenario, but as I’ve always asked you to do which is to try to take the general principal and mould it to your situation.

So, with that being said, there are dozens of principals who aren’t totally happy with certain things in their practice when actually, the same goes for the associate too.

I’ll give you a common example.

Let’s say we have an associate isn’t happy with the amount of money they’re earning at the practice to a point where they’re tempted to go and rent a room elsewhere and venture out on their own and at the same time, they’re annoyed that the mentorship promised during the job interview never happened and it’s been over six months since joining the practice.

On the opposite side of the table, we have a principal who isn’t happy that random blocks of time are being blocked off, some important details about the patient experience are being ignored or forgotten and a couple of patients have even requested for another practitioner because they’re not happy with how the associate’s treatment approach.

I think you’d agree that on each end of the table, we have legitimate issues with the other person.

Here’s the thing both the associate and principal have in common: they both claim to want it to work out and are both willing to do what it takes to make things work.

This is where communication comes in by simply asking what you want from each other comes into play. With a simple 1 hour sit-down airing these grievances without any judgement from either person, everyone came away getting what they wanted. Now they just have to start doing what they said they want and see if it’s really true.

Imagine if this conversation never happened – things would have probably ended in fireworks, both thinking what the hell just happened and both probably not learning anything because they think it’s the other’s fault or thinking that they just had an unlucky draw.

I promise you that if you bit the bullet, have those hard conversations, be vulnerable, be transparent, be honest, you will get what you want because between two people who want to make things work, you’ll find a way that’s great for everyone.

So, those two things again:

  1. Stop lying to yourself and admit your real priorities.
  2. Start doing what you say you want to do and see if it’s really true.

Fish Don’t Know They’re In Water

Stick with me for this silly analogy because at the end of it is a really important lesson.

Derek says: “Fish don’t know they’re in water. If you tried to explain it, they’d say, “water? what water?” They’re so surrounded by it that it’s impossible to see. They can’t see it until they jump outside of it. This is how I feel about culture.

So, because the idea of clinic culture is still a fairly new term in osteopathy and the healthcare world in general, what do we mean by culture?

We’re talking about shared values, beliefs, behaviours and actions.

It’s quite simple when we boil it down- if everyone shares the same values and beliefs and everyone does what they say their going to do, it works. If values and beliefs are not aligned and people start going in different directions, things typically don’t work out.

We all know people who say, I love working at this clinic, it’s such a difference compared to where I used to practice. I’m so glad I left, things are so much better.

And when that person is asked why it’s so much better, they typically say logical and tangible things like ‘things just seem to get done’, ‘the mentorship sessions are fantastic’, ‘they listen to my ideas’ or ‘things are just easy going and I get on with everyone’.

But all those tangible things are actions based on values. And the values come from the principal. You know, the manager of the football club ingrains the style of play, standards and the culture of the club.

So, if you’re looking to keep your team together, clinic culture is what you’re looking for.

If you want help, complete the clinic quiz in the description of this episode.

Now for today’s question, so if you’re on your phone, click on the episode, scroll down and you’ll find a Q&A section.

Here’s the question: If you had 2 people interviewing as an associate, they’re exactly the same skillset, experience and it just boils down to a culture fit, what would the reason be for hiring one over the other?

This is a great starting point to make you think: “Alright, beyond clinical skills, what actually matters in a person I’m looking to bring into my clinic?

Come connect with me! I’d love to hear your thoughts.


For this, I’m going to read directly from what I’ve underlined inside this chapter.

Derek says: “Life can be improved by adding or by subtracting. The world pushes us to add, because that benefits them. But the secret is the focus of subtracting. The adding mindset is deeply ingrained within us all. It’s easy to think I need something else. It’s hard to look instead at want to remove. The least successful people I know running conflicting directions, and I’ve drawn to distractions, say yes to almost everything and are chained to emotional obstacles. The most successful people I know have a narrow focus, protecting themselves against time wasters, say no to almost everything and have to let go of old limiting beliefs. Subtracting reminds me that what I need to change is something already here, not out there.

Alright. So, I cannot tell you how much I resonate with this notion. There is so much temptation to add on to what you have thinking that it’s the answer. Trust me when I tell you, that feeling doesn’t end. Here’s two questions you can ask yourself to break this adding mentality:

  1. What do I already have that will help me solve this issue?
  2. What can I stop focusing on or remove that will make my life simpler?

I’ll give you a couple examples here.

I’ve worked with many multi-disciplinary who offer a dozen services thinking that by offering more will attract more patients then as soon as they simplify, they’re able to focus much more on pushing their core services. It’s well known across the business and marketing world that if you give people too many options, they’ll get confused. The phrase is ‘a confused person never buys’. So stripping things back, simplifying the website, online booking, educating patients about other services makes all the difference.

Another example, which is a classic one, too much focus on trying to get new patients. Another well-known fact in the business and marketing world is that it’s easier to get a current customer to come back than it is to attract a new customer. And it’s no different for us as osteopaths.

So, going back to “Subtracting reminds me that what I need to change is something already here, not out there.” When was the last time you looked at your retention?

We have several ethical retention methods which when put in place lead to, obviously, increased patient return numbers, better patient-centred outcomes because we’re no longer under-treating and because of that patients are happier, want to come back and that level of satisfaction leads to them talking to people about you and the practice – then new patient referrals go up.

There’s another layer here which is that a new patient that comes because their friend who’s a patient of yours has recommended you is much easier to ‘get’ so to speak than someone who doesn’t have that friend referral. Why do you think every osteopath on the planet loves word of mouth referrals?!

Don’t get me wrong, there are many things you can do to improve patient retention beyond the actual treatment itself, but can can you see how by focusing on what you already have, you’re able to find the answer you’re looking for, which is more new patients, without the stress of finding new patients who don’t have that friend referring them?

The bottom line is, stop adding and start subtracting.


I hope you found these lessons as valuable as I did. The biggest thing you can do is share it with your principal, associates, your osteo mates, share it across Facebook forums – all that good stuff.

Get involved in the Q&A section. Here’s the question again: If you had 2 people interviewing as an associate, they’re exactly the same skillset, experience and it just boils down to a culture fit, what would the reason be for hiring one over the other?

Subscribe to the podcast so you don’t miss an episode. Your career will thank you for it.

See you for the next episode. Cheers.

Written by Alan Zaia M.Ost

Founder & CEO of Osteohustle. You’ll find Alan coaching osteopaths, travelling in a van or writing our weekly newsletter, The Hustle.

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