The Tyranny of Small Decisions – And How It Affects Your Health

Dr Kathryn Fox is an Australian medical doctor and bestselling crime writer, best known for her forensic thrillers featuring pathologist Dr Anya Crichton. Drawing on her medical expertise, she crafts gripping, authentic crime fiction and is also a passionate advocate for forensic medicine education and public engagement. Her columns appear twice weekly.

I once had a patient in her 40s who always had a reason for not having a Pap smear when she attended.

She’d always come after work and wanted to come back another day when she’d showered first. On other visits, she didn’t have time, was rushing somewhere or it was ‘that time of the month’ and she wasn’t comfortable. Something always seemed to get in the way.

I began to worry about her. I always made a point of reminding her how important it was to have a check-up and a Paps smear and I kept offering to do them – even when she came in for something unrelated, like a cough, a cold, or a script.

She had breast examinations and skin checks. But not a pelvic exam.

This went on for more than two years.

One day, she presented with severe lower abdominal pain. On examination, things became urgent.

A gynaecologist later confirmed advanced cervical cancer.

Initially, she was very angry with me for not performing a Pap smear during the time she had been seeing me. I wanted to know if I could have done more. Going over my notes, it became clear that at every visit, I had suggested she have one, and often strongly advised it, outlining the risks of postponing the smear and exam.

Each time, she had declined.

Later, she told me she had assumed everything was fine. Each time, she intended to come back and have it done. But time got away from her.

Those decisions didn’t feel significant at the time.

It’s rarely one big decision that affects our health. It’s the small ones:

• Putting something off because today isn’t convenient. Choosing to deal with it later.
• Telling yourself you’ll come back when you have more time.

These decisions don’t feel particularly important on their own. They’re understandable, reasonable and easy to justify. But over time, they accumulate.

There’s a concept known as the tyranny of small decisions.

It describes how a series of minor, individually insignificant choices can lead to an outcome that no one consciously intended.

In health, this often happens quietly. A test that gets delayed. Something doesn’t feel quite right, but it isn’t a priority. An appointment that can wait. And then waits again.

It’s not about a single moment where something goes wrong. It’s a gradual drift. That’s what makes it difficult. Because at every step, the decision felt insignificant.

Our thinking tends to favour the present. What’s immediate feels more pressing than what might happen later. And it’s why inconvenience often outweighs intention.

We plan to act. We just don’t act today. And then tomorrow becomes next week. Eventually, it becomes something we wish we hadn’t put off.

This doesn’t apply only to serious diagnoses.

It’s there in everyday decisions too:

• skipping a walk
• choosing convenience over nutrition
• deciding that something can wait*
• having another cigarette or drink

One decision doesn’t matter. But patterns do.

Health isn’t shaped by a single choice. It’s shaped by what we do repeatedly.

The good news is that it works both ways.

Just as small decisions can move things in the wrong direction, they can also move things in the right one.

Booking the appointment, getting the test done. Acting on something that doesn’t feel quite right. These may not feel like big decisions. But over time, they are.

Because they change the direction things are heading.

We don’t need to be perfect. We don’t need to get everything right. Recognising the pattern is what matters. Because once you see it, you can interrupt it.

If something doesn’t feel right, it’s worth acting on it. Not necessarily urgently, but deliberately.

Because the longer something is deferred, the easier it becomes to keep deferring it.

There are jokes doing the rounds online. If you miss a 15-minute walk today you add it to tomorrow’s total time. Someone is asked then how long they will have to walk for tomorrow? The answer is for six months and four days.

That’s where small decisions quietly develop larger consequences.

We can’t control everything about our health, but we can influence more than we think.

Often, it comes down to the small decisions that don’t feel important at the time.

IMPORTANT LEGAL INFO This article is of a general nature and FYI only, because it doesn’t take into account your personal health requirements or existing medical conditions. That means it’s not personalised health advice and shouldn’t be relied upon as if it is. Before making a health-related decision, you should work out if the info is appropriate for your situation and get professional medical advice.