On big, dramatic changes
Today I want to talk about how humans change.
But first, I want to talk about medical change — you’ll see why soon. Let’s talk about Atul Gawande, a surgeon and writer.
Gawande shares in “The Heroism of Incremental Care” that while he was in medical school, he watched a resident cut open the abdomen of a patient with a ruptured spleen in “two, quick moves,” cutting through the patient’s tendon “as if it were wrapping paper.”
He was amazed. A surgeon could make a huge difference in someone’s life — the difference between life and death — with just a few Big, Dramatic Actions.
Gawande wanted to be able to do those Big, Dramatic Actions, too.
And yet, as he moved through his career, he realized that there are many, many medical problems that cannot be solved with Big, Dramatic Actions. These medical issues are also extremely serious, but “two, quick moves” won’t resolve them.
One great example is chronic headaches and migraines, which can last for decades, occur daily and be so debilitating that people can’t work, maintain relationships, or even make personal commitments.
The John Graham Headache Center, in Boston, has a reputation for being successful with difficult headache cases. Gawande spent time with Elizabeth Loder, the Center’s lead physician, as she met with a new patient. He watched as Loder listened to a patient’s history and did an examination.
Then, he says:
“We came to the moment I’d been waiting for, the moment when I would see what made the clinic so effective. Would Loder diagnose a condition that had never been suspected? Would she suggest a treatment I’d never heard of? Would she have some special microvascular procedure she could perform that others couldn’t?”
Gawande was waiting for the Big, Dramatic Action.
But disappointingly, he found, “the answer was no.”
“No” to all of it.
There was no flashy diagnosis, no innovative procedure, and no fancy treatment. In fact, Loder spent most of the first meeting managing expectations — telling the patient that the process would be slow and incremental, and if their work produced anything more than a fifty percent reduction in the number and severity of headaches, “they’d call that a victory.”
And yet, Loder is one of the best doctors in the country at this. “The Heroism of Incremental Care” includes more detail on the many people whose lives she has radically changed for the better.
She is extremely skillful, but her work is gradual, iterative, and incremental.
Despite the fact that we all love the flashy, dramatic, quick, “heroic” intervention, it is often the slow, iterative interventions — done by doctors such as headache specialists, but also as primary care physicians and family doctors and geriatricians — that can be the most impactful.
…
Gawande’s writing is about the medical field, but can you see how it might apply to human change, more generally?
I see this all the time with my 1:1 life coaching clients. People come to me because they want more traction toward satisfaction, fulfillment, or well-being in their lives. They often think that they need to take dramatic action and want my help in figuring out which dramatic action to take.
Should I quit my job and try to become a TV writer?
Should I get a divorce?
And, of course, sometimes people do need to take a “bigger” action. But far more often, our work goes like this:
I get to know you as deeply as I can. We talk about how you’re doing now, what you’re yearning for, and what you’ve tried in the past. What has worked? What hasn’t?
Then, I point something out — a blind spot, a new model, a way of thinking about something you’re struggling with, a new thing to try.
You make a small shift, and we reconnect. We discuss our learnings, adjust, and try something new — another new idea, new model, new practice.
And yes, there are weeks when everything suddenly seems to change — it’s fun and exciting! But they typically follow many previous weeks in which we laid the groundwork.
The end result is often quite astonishingly deep + impactful. Just this week, a client of three months told me: Katie, I had no idea how deep life coaching was going to be.
But — there are no “two, quick moves” that resolve everything. There’s no Big, Dramatic Action. It is incremental, gradual, and iterative.
In my experience, most human changes — even the things that look big and flashy from the outside — ultimately happen like this.
With that in mind, here’s my questions for you:
In what areas of your life are you dreaming of a big, dramatic, flashy change?
What could you do to make small, incremental, undramatic progress toward that goal?
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As always, I’m rooting for you. You’ve got this.
Katie