31. The Decision-Making Skill They Don’t Teach in Med School

In medicine, you get used to making decisions with a framework. There’s a protocol, a gold standard, someone to sanity-check your plan. And then you start a business and… it’s just you. All day. Making hundreds of decisions you can’t outsource, and trying not to second-guess yourself into paralysis.

This post is about how to make decisions when there’s no “right” answer: start by getting clear on your North Star (what you’re actually building, and why), then use a simple warmer/colder test to check whether a choice moves you towards freedom… or towards feeling boxed in.

Business decisions are not clinical decisions

In clinic, you're trained to make decisions in a very specific way: gather evidence, apply a method, follow what's been proven and documented. You're not guessing. You're working inside a system that's designed to reduce uncertainty.

Business is basically the opposite.

There's no consistent "right way" because the rules keep changing, and what works for one kind of business might be completely wrong for another. Even "best practice" can turn out to be someone else's preference dressed up as a rule.

So when you find yourself thinking:

"What's the standard?"

"What is everyone else doing?"

"What's the gold standard approach here?"

…that makes sense. It's just not a question business reliably answers.

What needs to be true if you want to succeed

There are two things that need to be true if you want to make it as a business owner:

1. You have to be willing to let other people think you're wrong… or stupid… or incompetent.

If you're coming from academic/corporate medicine, where perception and credibility are everything, this can feel especially painful. But business comes with public decisions, and not everyone is going to agree with yours.

Here's what this looks like in practice: 

• You might choose to raise your prices when everyone else is offering discounts. 
• You might decide not to be on Instagram when "everyone knows" you need to be visible on social media. 
• You might structure your services in a way that makes zero sense to your colleagues, and some of them will think you're making a mistake. That's the price of building something that's actually yours.

The stakes feel different too. In medicine, being wrong can harm a patient. In business, being "wrong" according to someone else's standards might just mean you're building something they wouldn't build. And that's okay.

2. You need to build your own internal compass (your "North Star").

Without it, you end up outsourcing your decisions to:

• the loudest voice online
• the most confident person in the room
• whatever looks "standard"
• whatever you can justify on paper

And then you wonder why you feel stuck or drained. (It's because those decisions aren't actually yours.)

Your North Star is not a strategy

When I say "North Star," I'm talking about the bundle of things that are true for you:

• what you value
• what your mission is
• what success means to you (not what it means on LinkedIn)
• how you want to live day to day
• what kind of business you actually want to run

It's not a marketing plan, it's the internal "this is the direction" feeling.

A real North Star might sound like: "I want to work four days a week, have Fridays completely off, and build a business that helps burned-out doctors transition out of clinical work without going broke." Or: "I want to generate passive income through online courses while keeping my clinical skills sharp with part-time locum work."

Notice these aren't strategies. They're not the how. They're the what and the why—the destination you're actually trying to reach.

Most people already have it. They just haven't practiced trusting it. And that's the real work: not finding your North Star, but learning to believe it when it's telling you something that doesn't make logical sense on paper.

Martha Beck, a beaver, and a stained-glass window

This is where things might sound a bit unusual, but stick with me… because this story illustrates something important about decision-making that doesn't fit neatly into a business framework.

Sometimes the decisions that make the least logical sense turn out to be exactly right. And if you're someone who's been trained to rely only on evidence and logic, that can be deeply uncomfortable. But it's worth paying attention to.

Martha Beck, a life coach and author, shared this story on her podcast about moving houses even though there was no logical reason. Nothing was wrong with the old house… no external push. Just a strong pull towards a particular place.

And after the move, she describes these synchronicities, including discovering a hidden colored-glass window that came from a chapel, and spotting a beaver in the woods that matched a childhood dream she'd had for years.

If you're allergic to anything remotely “woo”, that's fine. You don't have to turn this into a belief system. The useful part is simple: Sometimes the decision that makes no rational sense is still the right one.

And in business, you'll face plenty of those moments. The client project that pays well but makes you feel hollow. The opportunity that looks perfect on paper but makes your stomach clench. The pivot that seems risky but feels like relief.

The warmer/colder test

Martha Beck describes decision-making like the warmer/colder game. You know the one when you're trying to find something and someone says "warmer" when you're getting closer, "colder" when you're moving away?

She says life can work like that too. You can feel when you're moving in the right direction.

And this is the line I want printed on a mug: Warmer feels like freedom.

Colder feels like constraint. Containment, de-energizing… that boxed-in feeling.

Say you're choosing between two marketing approaches: one is a polished webinar funnel that all the experts recommend, and the other is writing a weekly email to a small list of people you actually want to work with. The webinar might look more "professional" and scalable. But if thinking about it makes you feel obligated, anxious, like you're performing for an invisible audience—that's colder.

Yes, the email might seem less impressive. But if it feels like you're having a real conversation, like you're creating space for the work you actually want to do, that's warmer. Warmer isn't always loud. It's not always "I'm so excited!!!" Sometimes it's quieter than that, like a subtle pull, or a sense of space opening up. It might feel like relief, possibility, or just like you can breathe a little deeper.

Colder can show up differently depending on the person. For some people, it's resentment or irritation. For others, it's going quiet, withdrawing, feeling stuck. Some people feel it as physical tension, where their shoulders go up and their jaw tightens. Others just notice they keep procrastinating or finding reasons not to start.

Different signals, same message.

A quick challenge

Next time you're stuck on a decision, try this. Don't start with "What's the right move?" Start with:

Does this feel warmer or colder?

Do I feel more freedom… or more constraint?

Do I feel pulled towards it… or drained by it?

That's the practice. It doesn't replace logic, it just adds back the part most high-achievers learned to ignore.

And if you've spent years training yourself to override your body and emotions (hi, medicine), this can take time. But it's worth it. Because the goal isn't perfect decision-making, the goal is building a business (and a life) that actually aligns with your values.

Listen to the full episode to hear more about trusting your inner compass over external standards. And if you're a physician entrepreneur trying to figure out what your North Star is and want support making decisions that are actually yours, reach out at [email protected].