Achieving Your Goals: Lessons From Medicine

In the old days (or at least until now), doctors would give their orders (i.e. lose 50 lbs; exercise aerobically for 60 minutes, 5 days a week; eat a low-fat, low-salt diet; and take each of your medications as directed).

When you returned a year later – for a refill of your 3-month supply of medications, having lost no weight, not yet started on that exercise program and following the same snack food-supplemented fast food diet, doctors would label you as “noncompliant.”

That is now considered an old (med) school term. To be noncompliant literally meant that the patient didn’t bend to the will of the doctor.

Through my province’s Practice Support Program, I’ve taught my colleagues the new approach to helping our patients achieve their goals in health. We recognize that only a fraction of a patient’s health care is provided by doctors, nurses and other allied health care providers.

The majority of health care is self-care. Patients themselves are responsible for their own health between clinic visits. Our role as physicians is to support them in the self-management of their health.

To facilitate positive change, we have to change the old way doctors set goals with their patients. Recognizing that though physicians may be the experts on medical conditions, it is patients who are the experts on their own lives.

If a patient is “noncompliant” with the goal set by the doctor, it is quite likely that the goal was the doctor’s and not the patient’s.

In our new approach, we recognize that goal setting must be collaborative. Those goals must be those of the individual who must feel that they are both personally important and possible for them to accomplish.

Next: How the new principals of facilitating self-management can help you achieve your own goals.

Turning Mega-Goals into Goals You Can Achieve Today

We all procrastinate something in our lives.

I recognize this when patients follow-up not having started their exercise program or not having done the blood tests I requested last year. At the same time, I realize that I have procrastinated calling up an old friend to catch up. Every weekend, I feel vaguely guilty having not cleaned up the clutter in my study.

As I wrote in my earlier blogs on procrastination, we put off what we mean to do for many reasons.

Sometimes, it is because the task at hand is so huge and overwhelming we don’t know where to begin. Afraid of feeling buried in work with no end in sight, we don’t even start.

That’s why you may never get around to starting that novel you’ve been aching to write most of your life, why you don’t even take the first steps towards applying for the job of your dreams, or why don’t give up your reliable day job and start studying the subject that you love.

Do you have a mega-goal – a life dream you’ve never really started because you lack the confidence that you can really bring it to completion?

A student I know is working full-time while she completes her undergraduate degree and her prerequisites for dental school. She originally planned to study to be a dental hygienist but when she thought about it, she realized that she was taking a lot of the same prerequisite courses and what she would really love to do was dentistry.

Though the road to acceptance into dental school is daunting, she asked herself, “Why not give it my best? If I don’t make it in at least I would have tried and I’d still be where I am now.”

So if you’re afraid of trying and failing, why don’t you turn it around like this. If you try, persevere and succeed, you may live your dreams. If you give it your best, you won’t be looking back on your life with regret and wondering, “What if . . . ?”

Coming up: Gaining Confidence by Achieving Small Victories

Your Do-it-yourself Needs Assessment

In crafting your own grown-up curriculum, begin with a mainstay of adult education, the needs assessment. I define health as the dynamic balance of the important areas of your life with the goal of achieving your potential in each of them.

I’ve previously posted on this blog a series on balance. https://davidicuswong.wordpress.com/2011/05/19/the-endless-art-of-balancing-your-life/

Achieving perfect balance is a stretch goal. We aspire to it, but recognize that the one unchanging aspect of life is change! But like a compass pointing north, though few of us will make it to the magnetic north pole, it keeps us on track and reminds us of our goals.

So start with the important areas of your life: social, psychological, family, physical, intellectual, emotional, financial, creative, recreational and spiritual. Take a pulse check, and assess how you’re doing in each of those areas.

How do you judge success for yourself in these areas? What are the special challenges? What are your goals?

By the time you work your way through each sphere of your life, you may have a list of pretty daunting goals. Don’t be overwhelmed. We are given a lifetime to master our lives.

Coming up: Turning the Mega-Goals into Goals You Can Achieve Today.

The Learning Never Stops: What’s On Your Agenda?

During our school years, we dream about life after graduation: the end of lectures, assignments and exams and the beginning of paid work and independence.

But now that we’re grown up and finished school, the learning never stops. In spite of years of formal education, I don’t feel I’ve mastered life. The learning never stops.

If you could go back to school right now, what would you study?

Would it be a subject you’ve always been interested in?

Would it be some skill you’d like to develop? Playing a musical instrument, songwriting, storytelling, writing, singing, dancing, painting or drawing?

Would you want to learn more about your emotions, where they come from and how to manage them better?

Would you like to work on your relationships?

Would you want to learn more about nutrition, exercise physiology or other aspects of healthy living?

If you’re not going to school now, why not begin your own independent course of study? 

Choose your area of interest or need.

Coming up: Where to start.

Homework for Grown-ups: A Healthy Mind Needs a Healthy Body

The most important homework for my kids is the daily care of their own bodies.

I can keep an eye and give greater direction to my daughter in grade 8 and my son in grade 12. I can only hope that my son in university is getting enough sleep in his dorm and not skipping breakfast.

We encourage our kids to prepare for each day well in advance. This means a routine of making a healthy sandwich for lunch the night before and packing fluids and fruit in their schoolbags.

Though studying and completing their assignments is important, adequate rest is essential. Without guidance, teens can easily stay up past midnight and cheat on the 8 to 10 hours of sleep their brains and bodies need.

We grown-ups still need on average 7 1/2 to 8 hours of sleep each night and too often we let other matters take priority. It’s okay to let a minor family crisis steal a few nights’ sleep, but late night TV is a poor substitute for a proper rest.

With kids in school, the whole family can be rushed in the morning, and all of us could find ourselves eating – or not eating – breakfast on the run. If we don’t plan our lunch, we may end up skipping it or eating fast food.

I make it a point of eating healthy breakfast every day. This is particularly important on the busiest days. It doesn’t take much effort to eat a bowl of high-fibre cereal with skim milk with fresh blueberries, blackberries or a banana.

I pack my own lunch, usually a salad with fresh fruit and chicken breast or a sandwich on whole wheat bread. I also pack plenty of fruit and protein bars for my morning and afternoon breaks.

I also schedule physical activity into each day. This is crucial with high-stress and sedentary jobs. I swim 2000 metres at the pool each morning before the rest of the family wakes up. After a short workout in the weight room, I’m back home to have breakfast with the kids.

On most days, I can sneak out during my lunch hour to swim another 800 to 1000 metres at our community pool. Just 20 minutes of intense aerobic activity refreshes me more than a few cups of coffee.

Your homework assignment: Plan for the day ahead. Where will you schedule physical activity? What will you have for breakfast and lunch? And don’t forget: get to bed on time!

 

 

The Learning Never Stops. Have You Done Your Homework?

Each of my kids in school has an agenda book in which they’ve been taught to write their list of homework assignments. It’s a system to keep them organized . . . and for parents to check up on them. In elementary school, we had to initial their entries every school night.

Any one who has been to college or university remembers the freedom and bliss of the first month of classes. There is so much free time . . . and no homework! Most classes don’t have daily assignments. Exams and papers are on the horizon.

Of course, the homework-free state is an illusion. You have plenty of work to do but no one tells you when to do it. Like the motto of U.B.C., Tuum est, it’s up to you. You’re supposed to be an adult now.

As a physician, in spite of the countless hours of labs, lectures, hospital rounds and late night study in medical school, I have learned much more in the intervening years of clinical practice and continuing medical education since I earned my M.D.

But for all of us adults, the real learning in life takes place outside of the classroom and beyond the covers of our books. We continue to grow in the living of our real lives. We learn more about ourselves, our relationships and our world . . . but only if we remain open to that growth and our potential in life.

Though it’s great to relax, kick up your feet and watch another episode of Criminal Minds or Grey’s Anatomy, let’s not fool ourselves into thinking that there’s no homework tonight.

Coming up: What’s on your learning agenda?

Prescription for Health

Yesterday, I wrote how grownups can get into that Back to School spirit by re-examining their routines, choosing fresh new goals and taking the first steps towards an even healthier, happier future.

Since June 1, 2011, the Ministry of Health in partnership with the GPSC (General Practice Services Committee) launched the Healthy Lifestyle Prescription for Health program. Family physicians have been given new tools to help their patients adopt healthier lifestyles. You can book a special Personal Health Risk Assessment with your family physician if you have at least one of the following risk factors: (1) smoking, (2) unhealthy eating (excess calories, fat or sodium), (3) physical inactivity (less than 30 minutes of activity several times a week) or (4) obesity.

At these visits, British Columbians will be able to set a health goal with their family doctors who can refer them to free-of-charge telephone-based lifestyle support services. These include the physical activity line, dietician services, smoking cessation programs (quitnow.ca), patient voices network peer coaching program, self-management programs and Bounce Back (for mental health). For more information, check the program website at healthyfamiliesbc.ca/healthy-lifestyles-prescription-for-health.php.

If you’re not a BC resident, you can still find great resources on healthy lifestyle changes at healthyfamiliesbc.ca.

 

Back to School

At the start of a new school year, our kids experience a mixture of anxiety and excitement. My daughter is just starting high school: a new school, new routines, new friends. My son experienced his last first day of school. He’ll be graduating in June.

Many adults still feel a touch of that September anxiety long after finishing school. In the spring, the recently graduated can still get some exam anxiety – without the exams.

But most of us aren’t reentering that annual cycle of revising our schedules, choosing our courses and beginning new extra-curricular activities. Maybe we should.

At her new school, my daughter is making new friends. Over time, she will get to know them much better. A few may become lifelong friends. Getting to know one another and growing in the depth and breadth of our relationships is a big part of the learning at school . . . and in life. As adults, we can take this for granted and as with much the rest of our lives, fall into the unexamined routine.

As our children, sign up for new clubs and try out for teams, I take the time to reflect on how I’ve chosen to occupy my “extracurricular” hours. What should I do more? What should I do less? Which activities reflect my priorities and values? Which are wastes of precious family time?

With their return to school, our children continue building upon a growing foundation of knowledge and life skills. They recognize that they are travelling along the long road towards mastery.

The journey of course doesn’t end with graduation. Yet for us adults without the external prompts of daily classes, exams, papers and projects, we can get stuck in unproductive, unstimulating and often unhealthy routine.

So as you slow down in driving and watch out for kids in school zones, reflect on your daily routine, your own curriculum, your relationships and your health. What big or small changes might you need?

Though self-change does not come overnight, you can begin a change at any time.

Why I Write

From time to time, we should all question what we are doing with our time and with our lives. This is especially true when we simply fall into routine living and find ourselves doing what we do simply just because we’ve being doing it day after day, year after year.

In my own method of meditation (7 questions, 7 mantras), I ask myself each day, “What am I doing?”

That question is designed to address my current course of action and routines into which I have fallen. Are my actions aligned with my greatest values? Alternatively, have I somehow lost my way and fallen off the path? Have I responded to circumstances reactively rather than mindfully?

Next month will mark the 20^th anniversary of my newspaper column. My first column in the Burnaby Now and the Royal City Record appeared in September 1991. Over time, I moved from writing twice a month to every week, and my column has been carried by other papers in the Now network.

At first, I was paid $20 for each article, but after a few years, I chose to make my writing part of my volunteer work for my community. It’s been a forum through which I could contribute to the health and wellbeing of more people than I could personally meet in my medical practice.

Writing a regular column can be challenging. However, I can never run out topics on which to write as I am ever learning from my patients and my children. I can keep writing as long as I keep learning.

Finding time to write is difficult. I’m as busy as most family physicians with practices that can consume as much of our lives as we allow. I have tried not to steal precious time from my family.

I regret that I’ve been unable to personally answer letters from my readers, but I do appreciate their words of support and encouragement. Without their feedback, writing is a solitary activity. I write with the intent that what I share will make a positive difference.

I’ve appreciated cards from long-time readers who took the time to say thank you and those who’ve told me that I gave them the words they needed to get through the hardest times in their lives. I’ve kept the letter from a mother who wrote that an article on hope helped her understand her son and find peace when he died from cancer.

One young man wrote how my series on finding our calling gave him the courage to leave his job, go back to school and do what he was really meant to do. He became an inspiration to those around him who noticed how much happier he had become

When I’ve given public education talks for nonprofit groups, I’ve been moved by faithful readers who tell me that they’ve saved every column I wrote and sent their favourites to loved ones.

This summer, I came to question my own writing routine but not because I was about to start my third decade. One of the papers published three very negative letters to the editor. They read as personal attacks from people I had never met. They conveyed a meanness of spirit that negated the spirit of my own writing.

It made me question why I wrote for the paper. With reflection over the past month, I realized that I don’t write for any newspaper. I write for my readers.

I write to share practical perspectives that can help others negotiate challenges to their wellbeing, improve their relationships, negotiate the health care system and inspire them to achieve their positive potential for health and happiness.

Mastering Procrastination 6: 5 Reasons Why We Procrastinate – and the Solutions

 

Why do you procrastinate?

1. You’re too disorganized. You have so much to do, you don’t know where to begin . . . so you don’t.

The solution: Make a to-do list (a.k.a. your procrastination list). Prioritize it, and estimate the time required to do each item. If you discover – as I have – that the time to complete every item on your list exceeds the number of hours in a normal human lifetime, you have to accept the facts that you are mortal, you have to make some hard choices about what is most important to you, and sleeping 7 to 8 hours each night is not a waste of your precious time.

2. You feel overwhelmed. The thing you procrastinate the most is like a dreaded monster that you can never defeat. The more you avoid it the greater its power over you.

The solution: Break down the monster task into smaller, doable steps. When you’ve accomplished the first bite-sized task, you’ll gain both confidence and momentum to move on to the next. Over time, you will complete the monster task that once intimidated you. Imagine it as a trophy on your shelf (rather than a shadow over your shoulder).

3. It’s something so important – a speech, a job application, a resume, an important letter, or a novel – that you have to do a great job. 

The solution: Take the pressure off. Jot down your ideas, speed write your first draft, and give yourself the luxury of rewriting that draft. Don’t wait for the pressure of a looming deadline to motivate you to start that important project. The lack of time may make it an inadequate effort. If you put off starting it indefinitely, you’ll miss out on the potential opportunities and personal satisfaction that would come with your completed task.

By starting earlier – with a quick draft, you’ll have a foundation on which to build and refine your best effort. You’ll be less likely to make careless omissions, and you’ll have extra time to add icing to the cake.

4. It’s something you really don’t want to do.

The solution: Decide if it’s important or necessary. If it’s neither, scratch it off your list. Don’t waste your lifetime completing someone else’s to-do list.

5. You keep getting sidelined by other more enjoyable activities.

The solution: Be a grownup and defer immediate gratification. Think about the benefits of getting the job done. Visualize yourself having completed your goal, and imagine the sense of accomplishment you will feel. Reward yourself after you get it done (not before).

Updating your Facebook status, chatting with friends and having a Starbucks can be your rewards after you get things done – not distractions, excuses or time-burners before you’ve completed your important task.