On Alignment

What do you think of when you hear the word alignment? The wheels on your car? Your body position in a yoga pose? I bet it’s not online education. . . but hear me out.

Because I believe breakthroughs come from cross-pollination among disciplines, I’m going to borrow this concept from Quality Matters— which is a system for evaluating the quality of online courses. In this context, alignment refers to the relationships among course objectives, unit or module objectives, instructional materials, learning activities, and assessments. Are the outcomes measurable and appropriate, at both levels? Are the course components aligned with those outcomes? This sounds basic, but it can be surprisingly challenging to achieve. Mapping out these connections can be difficult– and enlightening. I’ve done it as both a course instructor and a peer reviewer for other courses, and found it enormously valuable.

So let’s distill this idea down to the basic components: set high-level goals, set smaller goals to support the big goals, and choose actions and assessments that align with those goals.

Where else can we use this simple structure to improve things?

  • Clinical management. The patient’s “big-picture” goals are surprisingly frequently absent from the conversation. But patient-centered care demands identifying goals for health and for life. A care plan that doesn’t include an assessment of goals is in peril before it even gets off the ground. And I don’t mean goals like “get A1C less than 7%”. I mean goals like “extend my healthy lifespan so that I can travel in retirement”. That might be a radical shift and it might alter management. Or it might mean the same basic management plan is perceived very differently by the patient. I’ve written about the concept of concordance in healthcare before– it’s similar. Aligning our plans to treat, follow-up, and assess our patients with our shared goals, both long-term and more immediate, is crucial to effective care.
  • Career trajectories. I recently wrote about the challenges of focus in an academic/clinical career.  What if, instead of a single-minded focus on a narrow area, each opportunity is considered in terms of alignment with “big-picture” goals? This approach allows for more bricolage (which, BTW, can make work relevant and grounded), more cross-pollination, more serendipity, more diversity– without falling into a scattered mess. I have a couple of broad interest areas and goals, and I find that rather than continue to narrow into extreme sub-specialization, I prefer to exist as a practicing member of the communities I’m a part of, and participate in projects that align with those areas.
  • Self development. This is what tools like the Passion Planner promote– making big goals, identifying smaller pieces of those goals, and taking steps to move towards them. The act of identifying goals, and identifying small steps, is enormously powerful in making progress. It takes deliberate thought and reflection, but the outcomes of small actions over time that are all aligned with a goal can be mind-blowing.

So there you go. Take a simple principle, and see how powerful it can be in different contexts. Think about how Atul Gawande used a checklist strategy from aviation to improve surgery, and think about what big ideas might disrupt your regular practices.

What’s on your keychain? What’s in your heart?

I listened to an interview the other day on the Outside Magazine podcast. It was Tim Ferris, of all people, talking with Cheryl Strayed.  And boy is she something! I knew this, of course, having read Wild and cried over Tiny Beautiful Things. But Tim Ferris? Not really my thing. But he was, and so was she. They talked about writing, among other things, and she mentioned a favorite writing prompt to be about an object, a talisman— beginning with something simple like your keychain.

My keychain has a long, shiny, neon-pink rod with a tapered end attatched. It’s ridged all the way down, with a flat bottom. It looks like something that might belong to Christain Grey . . but it’s acutally a self-defense keychain, or kubotan. A tool– or a weapon, depending on how you think about it. I have mixed feelings about it.  I’m not interested in weapons. I don’t like guns. I wish we could all just get along, hold hands, et cetera.
I’d never, ever initiate violence against someone— but I would defend myself or my loved one if it became necessary. That’s a powerful thing to learn about yourself— or decide about yourself. I decided that about myself in my first year of becoming UNFUCKWITHABLE (2017). Listen,  2016 felt disasterous to me in a lot of ways, and I felt so sad and defeated at the end of it. 2017 was the year I decided to get up and handle my shit. I started learning self-defense (krav maga), got stronger, focused on yoga and meditation, planned my priorities carefully. I met some amazing friends and teachers. I cried for a while, and then I started working to close the cracks in my life.
And now, I have this keychain. Sometimes, I hold this object in my hand, my thumb over its flat base, my fingers slotted into its grooves, as if ready— and it changes my fear and sadness into power.

Fragility and Resilience

Ever injure yourself in a really dumb way? Come on, yes you have. Recent stories I’ve heard from other early-30’s women at my gym: 1. I stepped on a lime and sprained my ankle. 2. I sprained my toe putting on underwear. I mean, this is kind of funny, we joke about getting old and hurting ourselves by like, getting out of bed. But are we really fragile enough that something like that can put us down for the count?

 

Relatedly: Ever had your day completely ruined by something completely stupid? The restaurant was out of the thing you wanted. Someone forgot your meeting. Someone said something mean. And then suddenly you’re a mess, and you can’t get your mojo back (guilty!).  How can we cope with this? How can we be come resilient, to the physical and the emotional?

Resilience: from Merriam-Webster online:

  • 1: the capability of a strained body to recover its size and shape after deformation caused especially by compressive stress.
  • 2: an ability to recover from or adjust easily to misfortune or change.

Ok, yeah. This sounds awesome. Sign me up! Advice for cultivating psychological resilience is generally broad— really broad. Keep a positive attitude! Maintian perspective! Practice self-care! Great, Ok, but how to I put this into practice?

Continue reading

Running, Thrills, and Awesome

It’s THRILLING to accomplish something you weren’t certain you could do. For all the babble out there and instagram quotes about comfort zones and breakthroughs and whatnot, that central truth remains. And to accomplish something you aren’t certain you can do, you have to, well, do something you aren’t sure you can do. For people who are risk-averse creatures of habit, this can be a huge leap— but so, so worth it. There are roller-coaster thrills, and then there are life-changing thrills. On the roller coaster, you know you’re on there for five minutes and everything’s been safety-checked. For the other kind, there’s no net— you don’t know what will happen.

Last weekend, I ran a Ragnar Relay with my sister and a bunch of other lawyers.

the van

what could go wrong?

Continue reading

On Choosing

I recently read Marie Kondo’s now-classic The Life Changing Magic of Tyding Up. Underlying the advice about how to fold your clothes and the batty-seeming suggestion to talk to your stuff was a solid truth: we can choose our lives, but unless we decide to do so deliberately, we will not— and we will often not even be aware that this is happening. Kondo demonstrates this easily in reference to possessions: we keep unused gifts and promotional throw-aways and things that came in the mail even when we don’t like them, want them, or have any use for them. They become part of our stuff without our ever having chosen them. They show up, we let them in, and then bam! They’re ours. This happens with stuff, with people, with habits, with jobs, with whole careers, with whole lives. When zoomed out to these macro things, asking “does it spark joy?” somehow seems more important.

If we do not make deliberate choices about the elements of our lives, they will be decided for us by circumstance, chance, and others’ interests.

Woah.
Of course, sponteneity can bring joy, serendipity, the unexpected, the delightful, the life-changing, in its own right. I don’t mean to suggest we can’t open ourselves to things that come along– but when they do, ask ourselves why we are letting them be part of our lives. There are two benefits to this approach: first, we aren’t cluttered with things that don’t serve us, and second, we can truly value the things that do.
Identifying our values through sorting our stuff? OK, I’m sold. As a healthcare provider, I’m keenly interested in identifying what people value.

Happiness: When Thinking Fast Steers Us Wrong

I read a lot of books last year— among them The Undoing Project, by Michael Lewis, which led me to Thinking Fast and Slow, by the behavioral psychologist Daniel Kahneman. In Thinking Fast and Slow, Kahneman proposes that the “fast” system of thinking, or system 1, is the efficient and rapid way of processing information and taking action— it’s a heuristic-reliant process and always looks for the shortest path to an answer. It’s helpful, unless it isn’t. System 1 makes mistakes— and one of them is answering the wrong question. Politicians are aces at this one— answer the question you have the ready answer for, and hope the questioner doesn’t notice. And in the brain, often, it doesn’t.
What does this have to do with happiness or goal-setting?

We might ask ourselves “what do I want?”. There are lots of ways to answer that question, and the answer we’re after is sometimes complicated. It might be scary to admit, it might freak us out that there’s no clear way to achieve it, it might look like an insurmountable amount of work to get there, we might think it’s silly. We might be subconsiously blocking the real question for these reasons. Or we might not have really figured out how to listen to ourselves. So when we ask ourselves what we want, sometimes we get a system-one sleight-of-hand. What would make me comfortable right now? What do others expect of me? What would be easiest? What do I already know how to do? What would impress people? And system 1 will answer that question for us before we realize that it’s not really what we wanted to know.

Where does that leave us? I believe that self-reflection is a necessarily slow process. That’s not to say that we can’t have bursts of insight that hit like lightnening and change everything, but those aren’t enough on their own. We hear a lot about goal setting this time of year, and there’s a booming business for planners, self-help books, journals, programs, and “goal getter” t-shirts. All of this is fine, but none of it is going to help us unless we can take dedicated time thinking slow about what we want.