The five most common excuses used by GPs and specialists in Germany against changes in practice management

What it's all about

Efficient and adaptable practice management is crucial for maintaining high standards of patient care and operational success. Despite this, many GPs and specialists in private practice are surprisingly resistant to change, even when there is clear evidence that their current systems are failing. Below are the five most common pretexts and excuses that practice owners use to avoid making necessary changes. Understanding the psychological motives behind these excuses is crucial to recognising the underlying resistance to change.

1 "We've always done it this way."

Psychological motive: Status quo bias

One of the most common excuses is the reference to tradition: "We've always done it this way." This mindset reflects an ingrained status quo bias where individuals favour the familiar and reject change because it means uncertainty. The comfort of routine and fear of the unknown make it easier for clinicians to stick to outdated methods rather than embrace new, potentially more effective strategies. This bias is often reinforced by the belief that previous methods have led to acceptable results, ignoring creeping declines in efficiency and satisfaction.

2. "We don't have time."

Psychological motive: Immediate vs. future bias

Another excuse often used is the perceived lack of time: "We don't have time." This excuse is based on the psychological concept of immediate vs. future bias, where immediate tasks and concerns take precedence over long-term planning and improvement. The daily pressures of patient care, administrative tasks and operational demands create a sense of urgency that eclipses the need for strategic change. Doctors feel overwhelmed by their current workload, so the prospect of investing time in practice management improvements seems daunting and impractical.

3. "It's too expensive."

Psychological motive: Loss aversion

Cost concerns are also often cited as a barrier to change: "It's too expensive." This excuse is fuelled by loss aversion, a psychological phenomenon in which people fear potential losses more than they value potential gains. Doctors focus on the immediate financial costs of external consultations, implementing new systems or hiring additional staff, while underestimating the long-term benefits and cost savings that these changes could bring. Fear of financial risk and the possibility of upfront costs create a significant mental barrier to considering change.

4. "Our patients are happy."

Psychological motive: Confirmation bias

The belief that patient satisfaction is already high acts as another common justification for not acting: "Our patients are happy." The argument reflects confirmation bias, where doctors selectively focus on positive feedback and ignore or downplay negative indicators. They rely on anecdotal evidence or a small sample of satisfied patients to validate their current way of working, while disregarding broader data or patient complaints that indicate otherwise. This bias reinforces the perception that no change is necessary, even when systemic problems are present.

5. "Change is too disruptive"

Psychological motive: Fear of disruption and uncertainty

Finally, fear of disruption is a powerful deterrent: "Change disrupts and hinders our work too much." This excuse is linked to a general fear of uncertainty, where the potential for temporary chaos or inconvenience outweighs the perceived benefits of change. Practice owners fear that changing their practice management will disrupt daily operations, lead to patient dissatisfaction or require a long adjustment period. This fear paralyses decision-making and leads to inactivity and the continuation of ineffective practices.

Conclusion

The reluctance to change practice management systems in medical settings is deeply rooted in psychological biases and fears. Understanding these motives, such as status quo bias, immediate vs. future bias, loss aversion, confirmation bias, and fear of disruption, offers insights into why physicians resist change despite clear evidence of its necessity. Recognising these biases for what they are is the first step in fostering an attitude that is open to improvement and progress in medical practice management.

Further reading

• Samuelson, W., & Zeckhauser, R. (1988). Status quo bias in decision making. Journal of Risk and Uncertainty, 1(1), 7-59.
• O'Donoghue, T., & Rabin, M. (1999). Doing it now or later. American Economic Review, 89(1), 103-124.
• Tversky, A., & Kahneman, D. (1991). Loss aversion in riskless choice: A reference-dependent model. The Quarterly Journal of Economics, 106(4), 1039-1061.
• Nickerson, R. S. (1998). Confirmation bias: A ubiquitous phenomenon in many guises. Review of General Psychology, 2(2), 175-220.
• Garfinkel, H. (1967). Studies in ethnomethodology. Prentice-Hall.
• Kahneman, D., Knetsch, J. L., & Thaler, R. H. (1991). Anomalies: The endowment effect, loss aversion, and status quo bias. Journal of Economic Perspectives, 5(1), 193-206.
• Loewenstein, G., & Prelec, D. (1992). Anomalies in intertemporal choice: Evidence and an interpretation. The Quarterly Journal of Economics, 107(2), 573-597.
• Gilovich, T., Griffin, D., & Kahneman, D. (Eds.). (2002). Heuristics and biases: The psychology of intuitive judgement. Cambridge University Press.
• Burmeister, K., & Schade, C. (2007). Are entrepreneurs' decisions more biased? An exploratory investigation of the susceptibility to status quo bias. Journal of Business Venturing, 22(3), 340-361.
• Taleb, N. N. (2007). The black swan: The impact of the highly improbable. Random House.

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