If you can’t measure it …

I don’t know if it still happens today, but back in the 1980’s and 90’s you couldn’t go on any management training course without at some point hearing the mantra “If you can’t measure it, you can’t manage it”.

Useful advice as part of helping people become more effective managers, but does this apply in other areas of life as well?  In particular, what about our health, particularly for those of us with long-term conditions like ME, where symptoms come and go, and periods of gradual recovery may still be followed by a relapse?

Over the years I’ve tried several ways of recording and measuring levels of health, for example the severity of different symptoms (pain, sleep problems, dizziness, etc.), and sometimes tried to spot patterns related to levels of activity – without a great deal of success in most cases.  I still record these, at least descriptively (e.g. “legs aching today”) so at least I can look back.

But there is one simple measure that I use and analyse, and have done soconsistently since December 2006.  Each day I give myself an overall score from 1 to 10.  This is based on a scale described in the book “Better Recovery from Viral Illnesses” by Dr. Darrell Ho-Yen (which also contains lots of good advice I ought to follow more closely).  On this scale, 10 represents complete health and fitness, and there are gudelines for the other values.  In practice, I have only used 2 to 7 since my records began, and 2’s and 7’s are very rare.

I tend to use scores of 5 and above to represent “good” days – “good” being a relative terms in cases of chronic illness, of course.  A 5 means no major symptoms on a day with fairly low levels of activity, or some symptoms with some activity.  6 would mean being able to do more with few symptoms, etc.

Dr. Ho-Yen suggests taking an average score for the week as an indication of general health, with the recovery process geared to patterns of rest and activity that gradually  increase this.  I found that this average fluctuates quite a bit, without giving a helpful picture of my health: for example, a week made up of 4’s and 6’s would have a similar average as one with all 5’s, without reflecting the experience of several “bad” days.

It occurred to me that when someone asks me how I am, or if I’m better, or how I’ve been, one of my stock answers is “I have good days and bad days”.  So the question is, how many of each?  I then started to analyse the number of “good” days (scores of 5 or more) over different periodsof  time.  I use percentages to help comparison: for example,  60% of days being good over the past 4 weeks compared with 70% over the past 3 months shows I’m having a relatively bad time.  Fortunately, I am able to use spreadsheets quite a bit, including drawing the results in a graph; and because I had kept records I was able to apply ths analysis back to the start of these.

I was still working at the time, though under regular review because of the amount of sick leave I was taking.  When I did this analysis, the resulting graphs still went up and down, but matched quite closely a similar graph showing the percentage time I had been able to work over a similar period – so 60% of good days over 4 weeks would match an average of 60% of working time.  Sometimes the graphs coincided; sometimes the work graph was a week or so behind the health one.

It seemed to me, then, that analysing the number of good days is a useful indicator of my overall health, especially my ability to do any activity.  It’s also quite simple (something important for spoonies!).  Now that the spreadsheet is set up, all I have to do is record the score each day (in a notebook I also use for jotting down major symptoms), then once a week add up the number of good days and enter this in the spreadsheet, which does the rest.

The resulting graph still goes up and down, and sadly I’ve found that overall health seems to have gone down since taking early retirement from work on ill health grounds.  I think there are two reasons for this.  One is that I had generally found that doing some activity often kept me going, and that it was only when I stopped that I started to feel the effects; this may be the same in regard to work, on a larger scale.  The other is that after retirement I went back to doing a lot in our church (which I had given up in an attempt to keep enough energy for work), and even taking on a leadership role, which in hindsight was probably a mistake (although no-one else had offered).  Could I give it up?  It’s complicated.

The moral of this story is that “if you can’t measure it you can’t manage it” is true; but then so is “if you measure it and take no action, you’re still not managing it”.

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One Response to If you can’t measure it …

  1. Pingback: Another door closes | Allan Dickinson

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