It depends on what kind of design I'm doing. If it's an all over random pattern, then yes I start in the middle.
But if it's based on echoing a foundation line, then I "draw" the line across the area first, then do the echo lines.
For all kinds of ideas, check out Leah Day's blog at
www.freemotionquilting.blogspot.com
It's a great site for FMQ ideas and techniques.