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not goals

Sometimes, when you get sleepy early, it isn't because you're really tired, but because your brain needs the bandwidth to figure something out. 

Last night was one of those nights.

Yesterday, I was contemplating the difference between modern achievement theory and modern medicine. It wasn't an odd thing, because in my day job, I am in medicine, work for a medical services company, and maintain an internal wiki to educate people who support caregivers.

This morning at 2:30 AM, I woke up with a couple of epiphanies; thought I might share them here.

Goals are Broken
When trying to achieve things, we set goals; then we measure deficiencies and set deadlines for changing those deficiencies into adequacies. If I make it sound dull and unexciting, that's because it is. It's a lot of work, and 100% of the time, when we're working toward goals, we are inadequate by our own measures.

One modern not-a-guru describes it this way: "A plane is off course 100% of the time! But they have instruments on board, so they adjust, and they land in Hawaii on a dime! That's what life is like!" 


Remembering how we do medicine, I realized that whole goal-setting process is just broken. Who wants to feel like they are always deficient? Never good enough? Never quite there? Nobody, of course. 

Either New Year's resolutions and goals tend to fall by the way, or we become these driving, obsessive, crazy people who can't enjoy life because we're so busy trying to climb the next mountain. We are pushed to make everything conform to our unachievable vision of a perfect world for usThere's not really an in-between, and to me, this explains a lot of the turmoil we're seeing currently.

Medical Progress
Yesterday, in an exam room, the heading on a form I was holding caught my eye in a new way: Progress Notes. As I drove home last night, I felt like I had encountered something new, but hadn't figured it out. That's probably why I felt like going to bed early.

This morning when I woke up, it hit me: we don't use actions, outcomes, and purposes that much in medicine. It sounds funny, but it's true, and it's actually correct.

People are organic systems. They are always functioning at some level. There is no perfect person, and there is no average person. As soon as you start looking for the ideal, you get caught up in sports medicine and you lose your sanity.

What do doctors do instead? Well, it isn't quite laid out as clearly as all that, but last night I figured how to substitute the correct headings in a goal chart or a project management table. Here's what I got.

Change Labels, Change Your Life?
Instead of actions, we have activities. Instead of outcomes, we have indications. And instead of goals, we have trends. And this entire collection of attributes is dedicated to one thing: making progress. Hence the title, "Progress Notes."

I know, I know. Strange stuff for a sewing blog, but oddly enough, I think it works. Not just for sewing, but for a lot of things.

Let me use myself as an example. My goal might be to weigh 185, but the trend I want is better health. My outcome might be a healthier diet, but my indication -- given that I already know a lot about nutrition and biochemistry, that is, I know better -- my indication is that I feel at peace about what I'm eating. My action might be to create a diet that matches the right numbers in each nutrition category, but my activity is to eat more fruits and vegetables, and less processed food.

It's still a work in progress, but I think you can see where it's going.

Life Charting
For most providers, a significant part of the day is charting, which basically means keeping track of patient progress, in a standard way that will be understood by other providers. It's probably overkill for what I want here, but the idea is good.

I opened up my appointment book, which is two pages per day, and on the daily notes page, I made a table that has the following headings:

Dur  Pri   Activity    Indicator   Trend

I substituted "Duration" for frequency and "Priority" for dose, because those terms make a little more sense in everyday life. I haven't really tried the chart yet, so I'm going to stop here, and report back on it later. But in case you get a little crazy, you might want to try this yourself, and report back what you get in the comments. 

It's entirely up to you, but remember the number one rule is, "first, do no harm." Don't mess up something important because you're trying to change systems or use something some wacky guy put on a blog. Take it slow, and phase it in.

I'll let you know in a few days how it goes for me.

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