Stewart McCure

Writer, performer, management consultant

An Australian living in London.  A self-employed training consultant to the global health care industry.  A producer, director and performer of improv comedy.  A trustee of an adult education charity in West London.  A writer and occaisional blogger

 

 

Filtering by Tag: Health

Protection against my dumber future self

I'm at the end of an absolutely brutal week of travel.  In the office all day Monday.  Night flight to the US to make a pitch presentation on Tuesday.  It went well enough. Night flight back for a full day of work on Wednesday.  Day trip to Switzerland yesterday.  Be careful what you wish for and all that.

No complaints.  As I've said in these pages many times, 'If I'm not on planes I'm probably not getting paid'.  The real challenge is how to keep functioning in amongst these waves of fatigue.  A partial answer may be this: -

Be aware that sometimes you are smarter than usual and sometimes you are dumber.  The job of your smarter self is to protect you against your dumber self for the foreseeable future.

My dumber self forgets things.  He fires off emails with spelling and grammatical errors or worse.  He packs badly and eats poorly. He mis-prioritises and has overly emotional reactions to simple setbacks.  Whether because he's tired, jetlagged or just hungover he is an idiot.

He is an idiot and my smarter, I'd like to say 'normal', self has to mitigate against him.  We all know this.  We've all stood in the middle of a supermarket feeling like an idiot for not writing up a shopping list.  We curse our would-be smarter selves for not thinking this one through.

My smarter self writes lists and sets alarms.  He allocates tasks commensurate with my fluctuating IQ to various times of the day and week.  Aren't we all that much are smarter on Monday morning than on Friday afternoon?  My smarter self is mindful of my tendency to react emotionally when fatigued and plans accordingly.  My smarter self works hard so that the dumber me can lean against a wall in the sunshine with a pint of beer in hand.

It is Friday and the UK Met Office is predicting 26C and sunny.

Running to stand still

Predictable as ever I've fallen for one of the classic blogging blunders; I decided to live an unjournaled life for a time and fell out of the habit of writing.  Not that I've had much of a choice as a proliferation of projects has had me working at a barely sustainable level for over six months now.  My passport has new stamps from all the usual places plus Lebanon, Hungary, Egypt and next week Japan.

I have to monitor my mental energy levels and devote the hours where my concentration is highest to the least forgiving tasks (and clients).  I live in a near-constant state of paranoia that some day soon I'll turn up in Madrid for a meeting with Client A but my slides will be for a German-speaking subsidiary of Client B.

Diet and exercise are more important than ever but not as important as sleep.  I find myself daydreaming about a holiday where all I do is sleep during the day.  In the mean time I do my best to exercise every day I'm at home and every other day when I'm traveling.  In the fortnight when a head cold kept me away from the gym my weight drifted up a disturbing three or four kilos.  When that happens I move slower and fatigue more easily and lose concentration right when I need it most.

I need my accountant, my lawyer and my travel agent to ask all the smart questions the first time we discuss the job.  I'm on the lookout for a new graphic designer and one guy failed the audition the moment he told me that he wasn't a mindreader.

Over Christmas in Australia I ploughed through the last draft of the book I've writing on and off for years.  At best it'll need more time than I can give it but at least it's off the 2013 'To Do list'.  At worst it was a flawed idea badly executed but, hey, at least it's done.  This year I'll be hard pressed to read a complete book, let alone write or edit one.

I have a new business idea.  Something really cool that might just be a scalable add-on to my (decidedly unscalable) consultancy.  The only problem is that Phase 1 of a six or seven step project requires 30-40 quality hours of my time.  The earliest I reckon I can offer that up is July.  So of course I worry that opportunity's window might be closed by then.  I tell myself that this isn't a case of the urgent crowding out the important but I worry that I'll look back in five years and think that taking on that one extra client in February 2013 was a dumb play, regardless of the cash it put in the bank.  And let's be thankful that at least there's cash in the bank.

So much as I'd like to write on these pages more (and more often) I'm not going to make that promise to myself. I'll check in from time to time, especially as my world seems to be changing faster than ever but I doubt that there'll be a discernable pattern.

Until next time...

Advice for the self-employed (January edition)

Sometimes your ambitions move faster than the world.  Sometimes the world moves faster than you.

I finished my last job of last year the week of Christmas.  I never have paid consulting work that late in the year.  The preceding months are a blurred pastiche of meetings, telecons, airports and familiar hotel rooms in cities I'd never visited before.  Back in August my business accelerated and by December I was tumbling down the chute that opens with exhilaration then descends through fatigue, helplessness and exhaustion before bottoming out in tangible, physical illness.  Be careful what you wish for.
 
Sixteen days later I'm in a more familiar state of mind: my ambitions moving faster than my world.  I'm back to wanting more than what's on offer.  I'm impatient and paranoid.  Am I being deliberately excluded?  Are potential clients buying my old book instead of hiring the new me? The glass between me and a shining future is smudged with my greasy noseprints.  I read the Euro crisis stories and fret that last year was my financial high water mark. Then I worry that a smarter, savvier me would look at the state of the world and see where there's a quid to be made from all this chaos.  A fortnight is a long time in self-employment.
 
I've been at this Headcount:1 game a long time now (viz. my previous post.) so here’s my advice to those underemployed self-employed folks out there who spent the Christmas-New Year interregnum drinking too much and ignoring the gnawing knowledge that you don't have guaranteed work lined up for January already.  Reinhold Niebuhr’s ‘Serenity Prayer’ is always a good place to start: -
God grant me the serenity to accept the things I cannot change,
Courage to change the things I can,
And wisdom to know the difference.
Self-employment means that is that there's no boss to impress, no underling to browbeat and no rivalrous colleague to outmanoeuvre.  The brutal truth is that only thing you get to change is you.
 
January 6 is just too soon to start badgering clients so you're tempted to run headlong at all those clichéd resolutions: diet & exercise,better sleep patterns and commendable reading habits.  This impulse is prophylactic at best; racking up cosmic credits for the next time the spiralling chute opens beneath you.  Except that there is no godly ledger balancing a January spent at the gym against a May-time diet of airport pizza and beer.  At worst these resolutions are symptomatic of the very mismatch between ambition and action that you're looking to escape.  Even as you sweat over The Economist some part of you knows that you're just waiting for the phone call that will fill your days.  Diet and exercise might be change but not the sort you can really believe in. 
 
Devoting all this excess time to your actual business can be more damaging still. Parkinson’s Law assumes at least some sort of deadline.
 
My advice to my time-rich client-poor comrades is as follows: -
Find some small, new, discrete thing and do it well.
Not some rambling yearlong project.  You have one of those already: building your business.  Rather that small thing that is affordable in terms of both your time and money but that doesn't require you waiting on anyone else.  A one-off class.  A lecture. A walk to a place you've never been before.  An afternoon taking photos.  A blog post. Don't reorganise your life but somehow extend it.  A measure might be this to complete some thing that allows you to greet your life partner at the door with, “Guess what I did today?” Achievement, no matter how minor, is not risible.
 
Create small ambitions that are under your control and sit them alongside those larger ones that are not. But do this small thing for its own sake, not with one eye fastened on the far side of the smudgy glass.
And don't worry too much about 2012.  My reading of the news is that we all, those with bosses and offices and those without, are going to hell in a handbasket of soon-to-be resurrected European currencies anyway.
 
Happy New Year.

The callous disinterestedness of the NHS

In the last month I've been out ‘on the road’ for three days observing sales representatives selling into the NHS.  As with any sales job the days are long and usually frustrating.  Busy doctors are always cancelling appointments.  The rest of the time gets filled with the strange burden of minor expectations that health care professionals, from the most senior doctor to the student nurse, have of the pharmaceutical industry.  Branded pens and Post-It notes have been banned but the ‘drug rep’ is still the conduit for funding for educational meetings here and abroad and for sandwiches (“We prefer a selection of wraps from M&S”) at least once a week.

What struck me hardest was the visible level of stress being carried by every NHS employee.  It had been a couple of years since I’d been out in the UK system and I was surprised by the universal interest in the price of the drug being sold.  Once upon a time only pharmacists and payers bothered to discuss cost; doctors and nurses didn’t sully their minds with such mundane financial matters.  But last week I watched a junior nurse, who is years away from prescriber status, quiz the rep about the comparative cost of rival treatments.  The nurse didn’t seem to be aggressive or point-scoring nor was he being clever for the sake of it; he just saw it as part of his job to understand the treatment options from a financial as well as a scientific-clinical standpoint.

I can’t think of another government department anywhere in the world where cost-consciousness pervades so thoroughly through the hierarchy as in the NHS.  Of course everywhere there are low-ranking teachers, police and perhaps even soldiers who are aware of their departmental budgets but not so consistently across an entire system.  By some counts the NHS is the second largest employer on the planet and every one of those employees has been trained to count the pennies. 

The taxpayer in me supposes that this is a good thing but I'm also sure that this cost-consciousness contributes significantly to the stress levels I saw in English hospitals.  No one ever went into the caring professions because they enjoyed the budgeting process yet this is now a substantial part of the job.

The reps I shadowed were selling expensive drugs.  This is true by definition: the only cheap drugs are ‘off-patent’ and so with insufficient margins to justify the formidable expense of a sales team.  With the NHS set up the way it is, any conversation with a drug rep is going to end with him asking for something that is difficult financially.  The medicine in question may amount to a revolution in the fight against a given disease but the health care professional is still left with the same old zero-sum game: - 

I cannot treat any patient as well as I would like to treat every patient

This has seeped into the organisation’s DNA.  Last year when the new Coalition government announced its Cancer Drugs Fund (CDF) the idea was for doctors to stop acting as financial comptrollers and get back to practicing medicine.  Yet the initial budget of £50,000,000 for the first twelve months will be underspent by a considerable margin.  This is not because Britain doesn’t have enough cancer sufferers to justify the money but because doctors across the country are genuinely suspicious about the long-term consequences of adopting newer, more advanced treatments in case the funding is later withdrawn

I've sat in on those sales calls.  I've seen doctors agree that there are patients under their care who would benefit from the drug in question.  But when the CDF is mentioned I've watched them narrow their eyes and ask for assurance that they weren't being tricked into changing their practice in an ultimately unsustainable way.  The logic being that it would be better to deny all current patients a better treatment if future patients would be denied it also.

 At the heart of the global financial crisis is the dawning realisation that for the first time in centuries we have to accept that future generations may lead less happy lives than us.  We are faced with the fact that the constant improvement in general wellbeing that the West has enjoyed since the mid-18th Century is not inexorable.  If you work in the NHS then every day you're learning this unpalatable truth first hand: Britain cannot afford to keep offering every citizen continually improving health care.

By God that’s a stressful way to work.

A paradox of identity

Think about all those times you've left a meeting with that carefully drafted background document still in your bag or all those old business cards you paid for but never handed out. Certainly it's waste, but is it overcapitalisation?

Probably. The challenge of spending not-too-much on a given project is one of the fundamental challenges of business. The only difference in a Headcount:1 world is that we just call it 'waste'.

The challenge faced by the self-employed is that we constantly undervalue our time. I suspect that this is because of our extremely high levels of self-identification: what we do is who we are.  Ergo, if we're not working how do we know we even exist? I'm being more serious here than I may seem: -

Q: What's the difference between self-employment and unemployment?
A: The self-employed get up every morning and do something.
Farmers patrol their fields. Stand-up comics take unpaid gigs. Consultants like me trawl the Internet accumulating a level of detail about my clients that runs needlessly deep. Others dutifully attend 'networking' events and try and sell their services to suppliers with identical offerings to our own. We work because that's what we do.

How do I know this time is wasted? Because if a more valuable activity presented itself we'd shift our time, energy and attention to it in a heartbeat. We waste time, energy and attention on our egos as manifested in our businesses. The alternative is to 'waste' those scarce resources on our families and a healthier version of ourselves.

No self-employed person can lead a truly happy and balanced life without resolving this paradox of identity

The job of not working

Just back from ten lovely days in Greece.  After about twenty years of self-employment I may just have mastered the art of taking a holiday.  I've long been plagued by freelancer’s paranoia: that horrible suspicion that you only get the work because you're the first supplier the client calls so if you don’t answer the phone then she'll just go to whomever is next on the list.  Never give your understudy a break and all that.

Absurd of course: the only like-for-like substitute I have is my business partner and he’s busy with clients in Asia-Pac.  So why has my mindset has always been to behave as if I have dozens of direct competitors across Europe?

Partly, I suspect, it’s my attitude to work itself.  One of the books I read on the beach* described two conflicting attitudes to work and leisure: the ‘income’ effect and the ‘substitution’ effect: -

Income effect: the old school economists’ assumption that once a man has earned sufficient for his needs then devote the remaining time to leisure 
Substitution effect: the phenomenon that as a man’s time becomes more valuable he is less and less likely to substitute high-paid work for another activity that pays less (i.e. any other activity, including leisure)
Supposedly we're all looking for a life informed by the income effect but of course it’s the substitution effect that describes most modern lives. This is especially so for anyone working in corporate services and especially for anyone self-employed in that sector. We work every hour that God, or the client, gives us.

Contrast this with a farmer or other seasonal worker: when the time is right you work as hard as you can as efficiently as you can then you rest.  Only a fool harvests an unripe crop.  Still, it's rare for a truly successful freelancer to be continually snowed under.  If you are then you're probably either on the way to taking on staff (good) or becoming an employee of your biggest client in all but name (bad).

So I persist with comedy, blogging and sundry other projects out of a need to create a substitution effect: there’s only so much time and attention I can pour onto a consulting project before it becomes counterproductive.

I work hard for good money when the opportunity demands it.  My real problem is that I actually like working hard all the time.  Idleness has never become me.  So for the last week I've been hanging out in the Greek islands forcing myself to not work.  I had to convince myself that proper relaxation was a right and proper substitute for thinking about something I’ll be working on in a month’s time. 

Only I could create a job out of not working.



* Yep, that’s me on holiday – reading economic theory for shits’n’giggles…

To win going slowly

My life is pretty frantic right now and over the weekend I was reminded of a line from an old Clive James essay*: -

The secret of applying energy is to economise on effort — to win going as slowly as possible.
James has been a prolific and interesting broadcaster, critic and essayist for almost fifty years and there are few living people in the creative arts that I admire more. I am in awe of the breadth of his work. He has a bewildering range of passions (including the poetry of Shelley, F1 motor racing, all forms of television and the samba) and he writes with the same tremendous intelligence and sympathy on them all.

His prolificacy should be an inspiration for anyone trying to create a multidimensional life, surely one of the attractions of self-employment.

* The complete essay is on the Austrian F1 driver Niki Lauda. The quote I've lifted is from the final paragraph

How free is free?

Of late I've had a few dealings with UK's much-vaunted National Health Service (the 'NHS').

It is an amazing institution, set up in 1948 by the Attlee Labour Government to ensure that health care was available to every Briton 'free at the point of delivery'. Millions upon millions of words have been written for and against the NHS. It is rightly seen as a sort of national glue that protects against the health-driven inequities of the US. Equally it is described as a bloated and wasteful bureaucracy, said to be the second largest employer on the planet after the Chinese Red Army.

What I'd like to focus on is the word 'free'.

As a system, the NHS is only free in a monetary sense. And what the customer saves in pennies is extracted from him in time and frustration. It's in the system's interest to keep me waiting. It's also in the system's interest to have me wait in as uninviting an environment as possible, but that's perhaps a lesser point. It is not in the system's interest to treat me as a 'professional'; as someone whose time has a monetary value.

This is why we like dealing professionals, be they individuals or organisations. If there seems to be an unspoken awareness that your time has a value then you're probably in good hands.

Off to Sydney

Today my wife and I leave for three weeks in Australia.  We're girding our loins for a flight that's near enough to 24 hours but at the other end is family and friends, sunshine and laughter.


2008 was a great year for my business, both consulting and comedy and I have huge plans for 2009 so the break is both warranted and needed.

But what sort of break?

My clients have been warned to expect as much as a 12-hour response time to emails and to avoid unscheduled phone calls wherever possible.  This is as much as I can offer myself without stressing that my business will suffer.

Headcount = 1 means I actually relax more when I can check emails than when I leave the BlackBerry at home.

Pneumonia

Looking over my journal I see that two years ago I was diagnosed with an atypical pneumonia with secondary reactive arthritis.  I'd been having dreadful coughing fits and becoming increasingly lethargic for a while so my doctor sent me for chest a X-Ray.  This led to one of the all-time great interactions with Britain's National Health Service: -

Nurse: "You've obviously got some sort of pneumonia.  Before we go any further, have you traveled anywhere unusual of late?"

Me: "Well, I was wandering around respiratory care hospitals in Beijing a few weeks ago."

Nurse: "Excuse me whilst I put on this mask."
This was 2006 and for a while there I was 'Patient Zero' in the upcoming European Bird Flu pandemic.  In the end it was diagnosed as 'atypical', meaning that no one had any idea except that I'd probably been on too many planes.

The arthritis hit a month later.  I was running a two-day workshop in Newmarket in Suffolk when just before lunch on the second day I felt a twinge in my left ankle that I couldn't explain.  By mid-afternoon I was limping badly and by the time I got off the train at Liverpool Street station at 7pm I couldn't walk at all.  I was on crutches for about seven weeks including a few excruciatingly painful days on the cobblestoned streets of Lisbon.

Again, the NHS had no definitive diagnosis; the arthritis was probably my body's reaction to the earlier pneumonia and both conditions would totally resolve with no long-term after-effects.  Two years on this prognosis seems happily correct.

My journal from the time is unsurprisingly depressing, the consistent theme being if I don't work I don't get paid.  And much of my work involves plane flights.

This is the reality of self-employment.  You have to look after your health because you will go broke if you don't.  This is not to say that your clients aren't nice people who wish you well.  I consider quite a few of my clients as friends but as much as they'd like to help me out, I have to do the work first.

Over the next few months I have a lot of flying to do and there is no excuse for getting ill.

A long walk

Today was hard.  I slept poorly and unusually for me, late.  It was one of those days where I overcomplicated even the simplest tasks.  Around midday it occurred to me that anything attempted today would take longer and be done worse than if I put it off until tomorrow or next week.


Instead I wrote a list of the simplest things I could think of doing for the afternoon: office filing, doing some laundry, preparing something nice for dinner, finishing the book I'm reading and so on.  At the top of the page was 'go for a long walk'.  So I walked through London to a coffee shop on a busy high street, I bought a coffee, sat in the window and watched the Friday world go by, then I walked home again.

Sure the week ended with a whimper not a bang but at least I ended it with a sense of agency.

Jet lag

I flew to the US last Tuesday evening and home again on Friday night.


Whilst in the US I was fine, functioning at an extremely high level and converting a trip that I was ambivalent about into a real winner.  But since getting back to London I've struggled against fatigue.  I had a comedy gig on Saturday night (preparation for my Edinburgh Fringe Festival show) that went well enough but since then I've been unable to think straight.  I'd planned a relatively short To Do List for today but I'm not sure how I would've coped if I'd been genuinely busy.

I know its no more than a cost of doing business and I feel guilty about complaining even here (see previous posts) but sometimes I worry that my fortysomething body is feeling its age.  I read somewhere that typical 'active' McKinsey's consultant is in his or her early 30's; on days like this I understand why.

Work out when you work best

Working alone gives you the luxury of working when you work best, especially if you work from home like me.


Personally I do my best thinking alone and between the hours of 530am and 10am.  I get up at 5am, make coffee and then spend about 30 minutes checking emails from other parts of the world, reviewing my To Do List and so on.  So around 530am I can get a clear run at my most important tasks; ie. the ones requiring the clearest thinking.  By my calculations, by lunchtime I've achieved more than most of my office-bound competitors will in the entire day.

Whenever I can I also schedule any meetings (phone or face-to-face) after lunch.  Personally, I've never had a problem with getting focused for client interactions so I'd rather not 'expend' my best thinking time in that way which is why I have them later in the day.  Not that I could convince many clients to meet me at 530am anyway...

I'm not suggesting that early rising is the only successful work pattern, its just the one that works for me.  However, understanding when your brain works best and making every effort to protect that time for your most important tasks is vital.

In the consultancy game what you're actually being paid for is the thinking you do before you get in front of the client.