Why You’re Unknowingly Making Bad Decisions

Podcast Transcript

I’ve often thought about why some decisions feel automatic while others require immense mental effort as a business owner. Why do some good or bad choices seem obvious in hindsight but not at the time?

If you’ve ever felt overwhelmed by the many decisions you make as a clinic owner or maybe you’re thinking of taking the dive into starting your own clinic but want to know more about what it’s really like to make decisions as a clinic owner, this episode is for you.

This is Behind The Osteopath. I’m Alan Zaia. I’m an osteopath and Founder & CEO of Osteohustle, where we bring osteopaths together to plan, build and grow your dream career.

If you find value in what I’m doing, please rate it, share it with your osteo mates, your principal, associates, Facebook forums, social media—all that good stuff. Thank you.

Alright, as you know, this podcast is centred around the idea that you should never open a clinic without fully understanding what it takes, and a part of that means me covering 10 books I believe every osteopath should read.

Thinking, Fast and Slow by Daniel Kahneman is book 19 in this series. I first read it in 2019 and re-read it for this podcast.

Let’s dive in. As always, read the book for yourself because I won’t cover everything in a 30-minute podcast. You might even find a copy at your local library.

So, Kahneman kickstarts the book by explaining that: “Our thoughts are influenced by two systems—System 1 and System 2.” System 1 is your fast, automatic, intuitive mind. It’s like when you’re doing a standing exam and immediately spot a potential issue. System 2 is slower, deliberate and effortful—think of when you’re sitting down to review your clinic’s finances or writing newsletters.

Kahneman describes these systems as: “System 1 runs automatically and effortlessly, while System 2 requires effort and is often lazy.”

As osteopaths, when it comes to running a clinic, System 2 is crucial because you’re being deliberate and purposeful. If you rely solely on your gut, you may overlook and miss valuable insights and information that can improve your practice.

With that being said, let’s dive into the first lesson.

Lesson 1: Avoiding Cognitive Ease

Cognitive ease is when something feels true simply because it’s familiar. The more familiar a phrase or idea, the more likely you are to believe it.

Imagine a new associate who hears from another practitioner, “Patients always cancel in winter.” Without any supporting data, that statement sticks because it’s been repeated.

Kahneman writes: “A reliable way to make people believe in falsehoods is frequent repetition, because familiarity is not easily distinguished from truth.”

In your clinic, this might mean that you or your team believe assumptions simply because they’ve been repeated.

At Osteohustle, we often find cognitive ease showing up in our client’s marketing or decision-making. For example, you might stick with the same practice management system or website design despite frustrations, simply because your current practice management system feels familiar and the idea of switching feels overwhelming.

I’ve experienced many clinic owners hesitate beyond sense to introduce new tools or ways of doing things, thinking, “We have something that does a job, so why change?” But sticking with an outdated system could mean missing out on features that save time and improve the patient experience.

The least you should be doing is keeping your ear to the ground so that if you hear of something that’s worth changing despite it being uncomfortable, you’re at least aware of it and able to make an informed decision. It’s easy to stick with what’s familiar, but in my experience, that’s how you can get left behind when external things happen like recessions, pandemics and just how things change inside of our profession.

Lesson 2: The Anchoring Effect

Anchoring is when we rely too much on the first piece of information we hear, even if it’s not relevant.

Kahneman gives an example of how anchoring works by asking people to estimate how many countries are in Africa. Before giving their answers, participants spun a wheel of fortune marked with random numbers. The wheel was rigged to stop at either 10 or 65. Even though the number on the wheel had no relevance to the question, it strongly influenced their guesses: those who saw 10 gave much lower estimates, while those who saw 65 gave much higher estimates. This experiment shows how irrelevant numbers can act as anchors, shaping our judgments in ways we might not realise.

In clinic life, anchoring can show up in many ways:

1. Setting expectations for associates: It’s natural to compare new associates to past team members, but this comparison can anchor you to outdated assumptions. For example, if a previous associate was highly independent and needed minimal support, you might expect the same from a new hire, even if they are at a different experience level or have different strengths. This could lead to frustration on both sides if the new associate needs more onboarding or guidance. Instead, try to assess each team member as a blank slate—review their goals, learning style and areas where they excel. Providing structured progress reviews and feedback will ensure that you’re not falling into this comparison trap.

2. Patient wait times: Anchoring can make you hold onto the belief that your waiting list is always long simply because it used to be. This assumption can create a false sense of security and lead to sudden anxiety when things inevitably slow down. If you assume that demand remains high without checking recent data, a sudden drop in bookings may feel like an emergency, prompting drastic decisions such as cutting staff hours or rushing into expensive marketing campaigns. Kahneman explains that: “We can be blind to the obvious, and we are also blind to our blindness.” In other words, we often overlook the reality that trends change and our past perceptions can mislead us.

By routinely reviewing your appointment data, you can avoid outdated assumptions and create a more adaptive scheduling system.

3. Daily workload: A more simple one is anchoring your daily workload to a historical number—such as seeing 15 patients per day because it’s what you’ve always done—what worked five years ago might not fit your current stage of practice or life. Therefore, it’s important to review how long each type of appointment takes, consider your energy levels throughout the last 30 days and evaluate how many appointments per day leave you feeling productive and fresh rather than exhausted.

Lesson 3: The Availability Heuristic (HERE-RIS-TIC)

The availability heuristic is when we judge the frequency or importance of something based on how easily examples come to mind.

Kahneman explains: “We often overestimate the importance of memorable events.”

For example, if you’ve had three late cancellations this week, you might feel like cancellations are spiralling out of control. But is that really true or are those events simply vivid because they happened recently?

The reverse is also true, when things are busy — does that mean you should slow things down? This depends on your own goals and whether or not you’re responsible for getting your associates busy etc, but generally, you shouldn’t slow down your marketing.

This can also apply when hiring. If you’ve had a difficult experience with one associate, you might assume all future hires will present the same challenges, which could make you overly cautious when looking to bring on other associates.

I find this particular idea fascinating because it forces you to challenge yourself when presented with both good and bad events. I would love to hear your thoughts about this one, but to summarise: data beats anecdotes. Take time to step back and think about what’s happening in context rather than reacting to isolated incidents.

Lesson 4: The Illusion of Understanding

The illusion of understanding happens when we believe we know the reason behind an event, but in reality, we’re filling in the gaps.

Think about when an associate leaves your clinic. It’s easy to assume it was due to workload. But is that the full story? Did you ask why they left or are you relying on assumptions?

Kahneman says: “Our comforting conviction that the world makes sense rests on a secure foundation: our almost unlimited ability to ignore our ignorance.”

When financial performance dips, it’s tempting to link it to a single factor like a marketing issue or external economic conditions. However, without digging into detailed reports which you can get using any practice management system, you could miss key answers, such as missed follow-ups or seasonal appointment trends like the occasional recession or certainly during and on the lead up to Christmas when everyone seemingly tightens their belts for certain purchases.

Don’t rely on assumptions. Ask for feedback to find out the real reasons why the associate decided to leave. Work with your accountant or business coach to look at your finances to see if there are some other causes. Use the information to make meaningful decisions as well as develop your understanding in case something similar happens in the future.

Lesson 5: The Remembering vs. Experiencing Self

Kahneman distinguishes between the experiencing self (which lives in the moment) and the remembering self (which reflects on experiences afterward). These two selves often have very different views of the same event, which can strongly affect decision-making and perception.

The experiencing self is what the patient feels during their appointment—every movement, every explanation and every stage of the appointment. But the remembering self only captures key moments, particularly how things end. Kahneman explains that “memories are dominated by how experiences end rather than how they are sustained.” This means that while the overall session may be smooth, the final moments are what the patient recalls most vividly.

This how-things-end principle can even influence patient retention and referrals. If the last part of the appointment feels rushed or unclear, the patient might remember the session as stressful, even if everything else went well. On the other hand, ending with a brief, friendly summary of their progress and the next steps can leave them feeling confident and cared for.

The same idea applies to impact on clinic culture. If an associate ends their workday with a hectic, last-minute task or a stressful situation, they may remember the entire day as difficult, regardless of how productive or positive the rest of the day was. Over time, this can affect their motivation and overall job satisfaction.

Summary

Kahneman’s work reminds us that understanding how we think is crucial for better decision-making as osteopathic clinic owners.

If you feel stuck or unsure why certain strategies aren’t working, reflect on how often you’ve relied on System 1 versus System 2.

Both systems have their place, but for critical decisions about running your clinic, System 2 must lead.

Thank you for listening to Behind The Osteopath. If you found this valuable, please share it with your colleagues, principals or anyone building their dream career.

See you next week. Cheers.