I rarely stick to the actual pattern, changing up borders, size, etc. I will also design quilts in EQ8 which makes it easy for me to play with color and size or if I can't quite get it figured out there I pull out the graph paper. I've recently started doing more modern Quilts and most of those are either major modifications of a pattern (in which case i sketch it out) or completely mine usually with the help of EQ8. I'm working on a modern medallion quilt now that I'm loving--all solids, asymmetrical, some very precise piecing, some improv blocks. I'm loving it (but realize modern is not everyone's cup of tea). I have found helpful quilt books that are not just patterns, but teach design--color (Jinny Beyer and Joen Wolfram are my favs); actual design layout (several do a great job of this); ways to change things in any quilt (Border Bling is great for this). I will add that I wrote a very simple baby quilt pattern for a friend's shop and will never write a pattern again! That took longer than making and quilting the sample!