Most health plans count outcomes. Weight. Sleep duration. Glucose. Steps. Symptoms. Medication adherence.
This practice counts the work.
Take one sheet of paper. Write down everything your health currently asks you to do during an ordinary week. Include appointments, refills, meal preparation, food rules, exercise, supplements, devices, symptom tracking, insurance calls, reading, and the private work of worrying about whether you are doing any of it correctly.
Do not organize the list yet.
Read it once as though it belonged to someone you cared about. Notice the total demand before deciding whether any single item is useful.
Beside each task, write one word: helps, unclear, or costs.
“Helps” means you can identify what the task changes. “Unclear” means it entered the plan but no one defined how success would be measured. “Costs” does not mean the task is medically wrong. It means the physical, financial, cognitive, or emotional burden is now substantial.
Then circle one item marked “unclear.”
Do not stop medication or prescribed treatment on your own. Bring that item to the clinician responsible for it and ask three questions.
What specific problem is this addressing?
How will we know whether it is working?
What would allow us to reduce or stop it?
The purpose is not to build a smaller plan for appearance’s sake. The purpose is to make every demand earn its place.
A plan should use your capacity carefully. It should not require you to disappear in order to complete it.
Return to the page one week later. Add what the plan has displaced. Sleep. Meals with other people. Money. Unstructured time. Exercise you enjoy. Work with your hands. A morning that belongs to nobody else.
That second list is clinical information.
Your physician may never see it on a laboratory report. Bring it anyway.
This practice is for reviewing treatment burden with your clinician. It is not a recommendation to stop prescribed medication or treatment.
It goes with last week’s essay, The Patient Who Was Excellent at Being Unwell.
Practices here are small, specific, and meant to be done, not admired. Subscribing is free, and it's how the next one finds you.
If someone you love has a health plan that has become a second job, send this to them.
Which word showed up most on your list: helps, unclear, or costs? Tell me in the comments. I read them.
Dr Shiv Kumar Goel is an internal medicine and functional medicine physician and founder of Prime Vitality Care in San Antonio. Across 25 years in hospitals, intensive care, and functional medicine, he has studied the gap between what medicine can measure and what patients actually live through. He writes Healing the Split and is the author of the forthcoming book Healing the Split: When Your Biology Is Fighting Your Biography.