What’s working? What’s not?

I do two things– I help people identify what is not working, and I help people keep doing what is working. Interestingly, the former is what gets 90% of the attention, but arguably, the latter is more important.

When I see patients, oftentimes they are not doing well. This is what prompts the visit. Sometimes it’s general health not doing well, sometimes its trouble taking care of diabetes (or another health condition), sometimes its substance use, sometimes it’s something else. Sometimes I start working with people where things are going well, but more commonly, there are things that are off track.

So, we get to work– we talk about all kinds of things that will help, medications, sleep, exercise, diet– the list is long. Usually things start to go better. The length of time is variable, but hopefully we get things to a better place; life seems to be a good track.

Patients start to feel better. Happier. It is wonderful to watch. At some point though, a lot of the big problems that we were working with initially are going better. What then?

Then, the challenge is how do we keep things going well. Because if we believe that we have some agency over making things better, it follows that there are things we are doing on a regular basis that account for the fact that things are better. Yes, it’s an obvious point, but it needs to be said. Because if we can change things to make them better (and we can!), then we can also focus on continuing to do those things.

We sometimes think about making a list of things that are not working for us– we’re eating too much fast food, we’re not sleeping well, we’re isolating. We make a list of the things we want to change, or improve on. What about making a list of the things that are going well? Making a list of the things that are working?

We could also make a list of the things that we are doing every day, and affirmatively want to be doing every day. This list might include things like going to bed on time, exercising every day, eating well, and spending time with friends and family. This second list (the continue doing this list) we often do not pay much attention to, and is given short shrift. More importantly, this list is not aspirational— it’s not the things we need to change. It is the things we are already doing that are working for us, and that we want to continue.

It seems sort of strange, in a certain way, to take inventory of things we are already doing that are working for us. Why do I need to write down that exercise is important to me? I know it, and that’s why I try and make it happen every day. In a certain way, it seems strange to write down the importance of getting good sleep if that is something we have already prioritized and mastered.

As humans, we are funny creatures. We are not nearly as good at maintenance as we should be (perhaps the topic for a future post). But we know that over time, our habits, priorities, and ambitions change— how we spend our time changes. Life is constantly changing. Often, these changes are difficult to perceive, until one day we wake up and realize we are not doing as well as we used to. This is where the list becomes helpful. Recognizing, and writing down what we are doing now that is working allows us to more easily notice when we deviate from that, which in turn makes it easier for us to self-correct. When we have had a bad day or a bad week, we can compare what we are doing to the list of things we usually do and ask, “Am I doing what I need to? Which of the things on the do this list am I no longer doing or prioritizing? Usually, the course correction we need to make becomes apparent.

So, make a list of the things you are doing in your life now that are working for you now. Stick it on your mirror, or on the refrigerator. Then, when you are having a bad day, or a bad week, look at the list, and use it to course correct.


-Dr. Justin

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