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Heuristics needed not booklets

By Dave Snowden  ·  March 19, 2014  ·  Diabetes

This is continuation of my post of yesterday, but expanding on the theme of how you get people to change behaviour and self manage change.   Again I am going to illustrate this with my own experience of managing a radical change post my diagnosis as diabetic, so there is an element of personal story here as well (so if that bores you skip the next paragraph and some of the one after).

The day I got the diagnosis I flew back to Berlin to complete the week with the final two performances of the Ring Cycle.  Now for the first two I had developed the habit of picking up a kebab and chips (freedom fries for my US readers) from the corner shop next to my hotel after the opera.  It was the only place open and it was comfort food.  That by the way was the bane of my life with travel.  You land late at night, get to a hotel and all you want to do is grab something from room service and sleep.  In general that meant burger, chips and a dark beer.  

Now I knew from on line reading that had to stop but I was simply overwhelmed by the information provided, there was simply too much to absorb.   I ended up using a local supermarket to buy wholemeal rolls and salami plus fruit as a interim measure.   Not much changed when I met the Diabetes nurse.  I said that I thought I could no longer drink a quart of milk (skimmed) a day and was told that was out, I wasn’t told it was OK to have half a pint or so as part of a balanced diet, it was all don'ts with a slightly patronising tone.  I went home and threw all sorts of things into the bin, furious with myself, the advise and life in general.  That was one of the black days, and there were more.

Now after few weeks or so I had something I could cope with and it was a set of heuristics or simple rules of thumb, not some elaborate plan.  For the record they were:

  1. Buy most stuff in Waitrose where I can check the food content on the labels
  2. Don’t by anything more that 5% sugar per 100gm
  3. Only new boiled potatoes or sweet potatoes, no other variation - baked, roast, mashed or whatever
  4. Only Basmati Wild rice mix no white rice
  5. 50% of meals fish, ideally mackerel only lean meat if taken
  6. Steak a treat only if I had walked for more than half a day and only with salad
  7. Whole meal bread and pasta only
  8. Two glasses red wine no more than twice a week or a beer, no white wine ever
  9. Two Shredded Wheat plus berries and milk for breakfast, nothing else
  10. Eat three meals a day at regular times, no snacking at all
  11. Pears not apples no grapes or melon
  12. Natural Yogurt and berries once a day
  13. Nothing labeled as low fat under any circumstances
  14. 7-10 hour walk or 4 hour cycle at least once a week, ideally more
  15. Nuts are a treat, and only allowed on a long walk

Now those worked for me, matched what I found and gave me a way of living that did not involve carrying multiple books and apps around with me.  They would not work for everyone but what I could have done with is a medically approved set of heuristic options that I could choose from.  When you first get a diagnosis of something that is or could be chronic you need something really, really simply to follow to get you started, then you read the manual.  A bit like software really grin

Heuristics are an ideal control mechanism under conditions of uncertainty and their general form is easy to understand.  Compliance is easy to test, but they handle uncertainty.  The famous US marines is another example: when the battlefield plan breaks down capture the high ground, stay in touch, keep moving.  Better than rules, better than overloaded information.