Work out what you actually need – not what the title-and-mortgage version of success says you need – and the threat surface shrinks; decisions stop auditioning for an imagined disciplinary panel. There is real freedom in holding little that must be defended: no incumbent position to protect; no sunk empire; nothing an adverse outcome can take that you haven’t already priced.
Colding’s own measures of freedom translate directly into a clinical career – choose the projects you work on; choose work by how much it teaches you; and be able to step away without a permission slip.
Where I part company with the personal-finance version of this idea is that it treats fear as an individual problem with an individual solution – save harder, need less, back yourself. In a health system that answer is incomplete, in my considered view, because most clinicians’ fear is manufactured upstream of them.
The junior doctor who over-orders is not timid, but is responding rationally to a system in which the personal cost of one missed finding is catastrophic; and the system cost of a thousand unnecessary scans is invisible. You do not audit that out with a policy reminding people to be brave. You remove it structurally, and that is what clinical governance is actually for – open disclosure that’s genuinely safe to use; incident review that separates the learning question from the blame question; and value-based measures that make the right decision and the defensible decision the same decision.
Dr Karolina Brook and colleagues have shown what this looks like in practice, rebuilding the morbidity and mortality conference around ‘just-culture’ principles – cases selected for their system lessons rather than to prosecute individual error, discussed in psychological safety and peer-review protection, closing with concrete assigned follow-up (Brook, Agarwala & Tewfik, J Patient Saf, 2024). Her work on transparency after adverse events lands on the same mechanism – reporting and disclosure are products of freedom from fear, not substitutes for it (Wilde et al, Curr Opin Anaesthesiol, 2025).
This is where a ‘just-safety’ culture comes from, and how it is bred – one person at a time, not by decree. A system is well-governed precisely to the degree that the people inside it can make choices that are not fear-based.
