Design for Your Future, Design for Yourself

Recently faced with making a series of major life changes, a friend of mind decided to apply design thinking principles to his personal situation. He had accepted a fabulous new job that would require leaving the town he loved and long called home for our nation's capitol and doing so in a relatively short timeframe. Familiar enough with D.C., he started his relocation process with the information closest at hand — the dog and the cat were coming with him. And then he interviewed himself.

"I asked myself questions like: self, what kind of place do you want? What should it be near? What do you dislike about your current place? I made Post-Its with my must haves, wants and dislikes," he wrote.

Post-Its are a key component to the process at IDEO—the Silicon Valley design firm where my friend and I have been lucky enough to explore questions that begin "How might we..." and focus on patient-centered solutions within health care. Post-Its allow one to jot down an idea or make a meaningful doodle that is then both tactile and disposable, preserved but not permanent. From the multicolored confetti came a series of hotel stays in various D.C. neighborhoods to practice the commute to work and sample local restaurants. "In other words, prototypes," he wrote. 

I'd like to say that when I decided to approach my problem of achieving better work-life balance concerning my job as a magazine editor, my consulting and advocacy and my relationships with my family, friends and self that I too reached for my Post-Its and Sharpie. Rather I took a very literal approach to form following function. I made a flow chart, or perhaps more accurately, a decision tree. 

The goal was to determine what personal parameters I would apply in deciding whether or not to accept an opportunity. Some opportunities offer an abstract pay off while others come with cold, hard cash. Some clearly are worthwhile while others offer nothing by way of joy or enlightenment. For all there is a price to be paid, as saying yes to one thing limits one's ability to say yes to another—doing two things half-heartedly is no greater accomplishment than doing one thing well.

I spent a week on my own posing questions, redirecting arrows and contemplating additional possibilities before I sent my draft decision tree out to a group of personal advisors for review. Advocates praised it. Company managers played devil's advocates. And my friend who was designing his new life first suggested, "Seems like you are really wrestling with getting paid for doing the work you want to do," and then asserted, "Follow your damn dreams."

Following dreams inherently is easier when others believe one's dreams are worth following and thus will help make those dreams come true. I am fortunate in that this is the case for me and my dreams. It is enormously satisfying to know that those in the industry I have come to respect and admire seem to feel the same way about me. Their encouragement, partnered with my own stubbornness, has kept me moving along this path. 

Shortly after completing my decision tree, I had cause to implement its process, and accept a year-long contract to serve as administrator of an ePatient scholarship program that enables advocates to attend one of the foremost health care conferences. I also will be leading a workshop on making clinical trials more patient-focused and speaking at this conference as well as speaking at the world's premier nephrology conference. I have applied for a two-week design thinking internship with the intent of researching generosity in relation to financial giving so as to further develop strategic plans for my nonprofit and to a mindfulness in health care symposium focused on patients and caregivers within palliative medicine. If I am selected, I will consult my decision tree to determine these opportunities' return on investment. If I am lucky, this fall will be busy, financially feasible and personally and professionally rewarding. 

Too often I hear complaints from people who are so overwhelmed by what they have to do that they have no time for what they want to do. I say—put in the time and effort to determine one's priorities, to establish standards such that saying no allows one to say yes to something better. Design not for your current self but the self you want to be. 

She's Not Here Right Now

Priorities. It's time for me to get mine straight. And right now, my first priority is saying "yes" to the things that matter and "no" to the things that don't.

The problem is that I'm not entirely sure what those things are. The second problem is that I resent having to choose.

Being an advocate is not my primary job. Since becoming an advocate with a very public persona in 2011, I've kept my professional employment and my advocacy work separate. My decision was two-fold. I did not want to accomplish anything as an advocate as a result of my position. (No, I'm the head of The Economist or the like, but my name is unique enough and the magazine widely distributed enough that there are certain circles in which I am known, and it's amazing how many people think they can favor their way into some ink). Secondly, the magazine, which has zip to do with health, is not an appropriate outlet for my advocacy voice. Do I push for historical preservation and cultural conservation? Yes. Do I call for hospital-acquired infection reduction and patient engagement in clinical trials? No.

Fortunately, my primary job also is a part-time job. An argument could be made that a publication having only a part-time managing editor is less than optimal. I would agree with that argument. However, I also have greatly enjoyed my freedom to come and go as I please and never be shackled to an office or office hours — so long as deadlines were met and I could be found via email or a phone call. Whenever I travelled for advocacy purposes, I took my real work with me. The magazine tagged along from Paris for Doctors 2.0 & You to the Metro in Washington, DC for Rare Disease Day, from Vancouver, Canada for B.C. Renal Days to Cleveland, OH for the First International FMD Research Network Symposium, from Palo Alto, CA for Medicine X at Stanford to Kansas City, MO for Partnership With Patients. Sometimes I even carried on the latest print edition to strategically leave in some airport in the hopes that its presence and the boredom of a long layover would lead to a new subscriber. In that regard my part-time job has been an all-the-time or any-time job. There is not a day or a time at which I could not be working on it.

I'd imagine that most people have such jobs — jobs that occupy the mind even when they do not occupy the hands. I hear rumor of people who go to an office, put in a solid 8 to 5 and leave it all behind when they walk out the door. I am not those people. However, t was one job I had — a test proctor for state licensing exams — that was so grinding, so regimented, so much a matter of process over product that proctors vehemently were discouraged from expressing a modicum of joy or sympathy for a test taker when he or she passed or failed. Test takers were not allowed to use their own writing utensils, wear hats, wear bulky clothing, eat or drink or take breaks longer than five minutes, during which time they were allowed to stretch, so long as they remained within my direct line of sight, and use the restroom (quickly). The test we administered most frequently lasted five hours. Work days were unpredictable, their length determined in part by the type of tests given but more so by the test takers themselves. Some days it was a push to clock an hour and half. Others stretched on for 10. I lasted nine months before the $9 an hour just wasn't worth it any longer and I walked out the door.

I've found myself in the position of determining a job's worth once again. Worth is about more than money, but when there's not much money to spare, money takes a dominate role in the equation. Certainly I want to be happy. I also want to continue to have a house. Having a house makes me happier than not having a house. Having groceries makes me happier than not having groceries. Thus having a job that pays makes me happier than not having a job that pays. And the job that pays is the job I have — not the mythological advocacy job upon which, I confess, I have been hoping to stumble. Advocacy is a word that I am using broadly to characterize this work for which I did not go to school, this proclivity for all things health care related, for fostering the patient voice in medicine. This isn't about waving around a colored flag and issuing a list of complaints. This is about getting elbow-deep in the quagmire of policies and prejudices to search for answers that can help change the system. This is about listening, analyzing and doing. This is about the Kingdom of the Unwell and the Kingdom of Healers laying down arms to unite as the Kingdom of People.

For me, to be able to help someone, to be able to make change for the better, to be able to collaborate with people who are passionate about making a difference too is worth so much more than money. I've found more meaning in my life in health care (and teaching) than I ever have in publishing.

For some, this greater personal depth and purpose in life clearly would indicate a need to leave the publishing world behind and transition to being an advocate full-time. But the power company doesn't accept payment in warm and fuzzies. The resolution then is to flip the predicament — rather than lament that doing what I love does not pay, how can I make what pays into something I love? Can I implement changes such that I see as much value in my job as I do my advocacy? Can I make it worth it?

In order to give more of myself to my job, I must give less of myself to my advocacy. To have less of myself to give necessitates that I make more strident choices about how I spend my time and energy. Effective Monday, June 9, and until further notice, I am suspending all advocacy work and related social media that is not specifically related to Medicine X or my own organization, FMD Chat.

It is my hope that this self-limitation will allow me the mental and emotional capacity to return to writing, which I love, and thus my individual voice will not altogether be silenced. So please look for me here.

Should you wish to contact me, please do so by blog comment or email. 

Or... make me an offer I can't refuse.