Design in medicine (STEAM-power)

This blog reflects my own opinions and not necessarily that of my affiliations.

I’ve been a fan of STEAM (Science, Technology, Engineering, Arts, Math) education for a long time. Choosing science vs. art is like choosing between wearing your right sock or your left sock- you need both. Also, they all exist in nature as inseparable units anyway so why do we separate them?

If you look at snowflakes, honeycombs, flowering plants, even human hands there is a definitive beauty, geometry and purpose to them. If you listen to music, there is a beat, a rhythm, a certain level of engineering of notes that come together to create something spectacular. If you look at great works of art, there is often a triangular composition to them that draws our eye to key points of the work.

Medicine itself is often said to be both an art and a science. (Some people think that it is more one than the other but I think that those percentages are variable based on each individual). Medicine is an art in that it has variations to it and like painters, providers have a framework and body of skill and knowledge but they also have leeway in its presentation and sometimes even in its practice. Medicine is also heavily people-based and people are the X-factor. It doesn’t matter what the latest literature says about a study or a certain drug or a certain behavior, if the patient doesn’t want to take it or do it, then it’s just not gonna happen and honestly, they have every right to say no, as long as they are fully informed.

Medicine is a science in that there is a body of knowledge that is passed down. That we as providers collect data and analyze it -it’s all very scientific method sometimes. Or I often liken it to being a detective, where you search for clues and always ask witnesses and get a back story. Medicine is a science because we are supposed to come up with solutions and decisions based on evidence. The thing is, you are limited by the amount of evidence, the way it was gathered, and sometimes its specificity to a particular population.

Given the the recent interdisciplinary collaborations and atmosphere of innovation in digital health and medicine, I think that now is a great time to think about design in medicine on an individual, systems and environmental level. In doing so I would like to share some of my favorite quotes on design:

“Design makes what is complex feel simpler, and what is simpler feel richer.” -John Maeda

“Design is when beauty inspires, simplicity empowers, and quality grounds trust.” -John Maeda

“Design is not just visual, design is efficiency. Design is making something simple. Design is epic. Design is making it easy for a user to get from point A to point B”.-Jack Dorsey

“Design works it it’s authentic, inspired, and has a clear point of view. It can’t be a collection of input.”-Ron Johnson

“Design is not just what it looks and feels like. Design is how it works”.- Steve Jobs

Design on an individual level
I think that design comes into play when designing tools that patients and providers will use. I think that a lot of the backlash that comes from tools developed in the past is that they didn’t fit into people’s workflow and they were often lofty, complicated, uninteresting and so heavily invested in that there was no impetus for change or innovation. If you invest millions of dollars in something and it might cost you millions to take it out, you kinda have to make do unless you make the bold move of replacement.

I think that the development of mobile devices and their ubiquity will change the landscape of medicine and I think that people developing products really need to focus on that. I also think that it’s important to really talk to the people you are building products for.You really need to be able to understand the nuances of their lives and their workflow and be willing to listen. An example of this is that in the past, all we had were desktops. What I didn’t like about them is that as a doc you were tied to the desktop or a desktop on wheels. If you are seeing patients on different floors of the hospital you have to keep running back and forth to the computer to do stuff. If you were in an outpatient setting, the computer was a divide between you and the patient. The reason why the Ipad mini is so popular is because you can use it on the go or rest it comfortably on your lap as you talk to someone. Although, some of the amendments I would like to make would be some sort of skin or something that would make it easy to clean and not get damaged in case of contact with water or body fluid as well as more privacy settings or precautions. I mean if you lost it, it doesn’t necessarily need to automatically detonate the information in it or something but at least more precautionary measures are needed.

In designing physicians tools, I also think that people forget that we are consumers and regular people too and we appreciate something that is beautiful, well made and made to last. Also, it’s strange to not have the same kind of technology you do at home at work as well. And it’s definitely something that patients notice. I remember one time a patient was like “Doc, how come you guys still use pagers, isn’t that so 1980’s. You know that joke right, only two kinds of people carry pagers, drug dealers and doctors hahaha”. That was funny and it was also highlighted by the fact that the patient had the latest Iphone and was reading the NY Times on an Ipad. But, it was really a moment when I was like wow, that’s so true, why is there such a disconnect? Or well, the whole thing where I read an article recently that Dropbox was being used for resident sign-outs. You’re not supposed to do that but it highlighted how people are gonna bring their consumer electronics to work and how certain work technologies need to be integrated into our professional environments because they make things more efficient. Though at the same time this must be balanced by not having information and tech overload like too many boxes to check or screens to go to when it would’ve been easier just talk to someone or *gasp* write it down on a piece of paper. And I think that’s where design comes in, having a process of thinking, imagining and creating something that strikes the right balance.

In designing tools for patients, I think that input from the people you are designing for is really important. What you think they want, may not be what they really want or they tell you something you have never even thought about before. I also think it’s important to know that patients, like doctors, are not a homogenous group. People have different levels of hearing and sight. People have different levels of literacy and health literacy. People have different needs.

Also, I think that now is a good time to look at re-designs of the tools that we have used forever. Stethoscopes can record heart sounds that can be played back so I can teach you the patient what your murmur sounds like. The patient gown has been re-designed so that there is more privacy. We soon will have bloodless blood drawing. What about other things? What about ambulances? Or the bed pan? Or IV systems?

I also think that looking at what is happening in the developing world is really interesting. Sometimes, it just makes more sense to go sort of high tech low tech but above all low cost. For example the way SMS is used in rural areas in developing populations. It’s like melding the ideas that necessity is the mother of invention and that innovation is often the product of limitations.

Design at a systems level
Sometimes it’s just easier to do something when there aren’t too many hands in the kitchen. Healthcare is a complex system with many different players who may have different expectations, wants, needs and motivations. How do we design a simpler, more efficient system? How do we identify problems before they start, or before they multiply? How do we measure and enact real change? Honestly, I don’t have a complete and comprehensive answer for that but I’m open to suggestions.

I think that designing a system or re-designing a system starts by looking at what has worked and not worked. I also think it might be a good idea to look outside of our field or our local geography. I think that it also helps to get someone who is outside of our immediate field to take a look around and share their opinion, a third set of eyes.

The other question to ask is do we even need a system, why can’t it be independent networks? Or if we do need one, how do we mitigate inefficiency, redundancy or the system getting in the way of things -an example being going to a meeting and the only end result of that meeting is to set up the next meeting.

Another question that is food for thought is are we a healthcare system, a sick care system, or both?

Design and our physical environment
Some people say that with the advent of technology, we are even more connected. We can text, message, call, video call, hangout, etc Or some say that we are more disconnected because there are instances where you don’t have to see or talk to a person face to face anymore or well I’ve even seen people text each other from across a a dinner table.

When I think of design in our physical enviroment I look at Nature as architect. There is this profound marriage of form and function. There is also a sense of wonder and beauty that can be healing. It’s how we feel when we look and smell flowers, breathe fresh mountain air or look out at the sun setting over the open ocean. How can we incorporate design into our health spaces?

I think about Florence Nightingale and her call for cleanliness, warmth, light and air. I think about urban garden design, about solar panels and renewable sources of energy that are not only often beautiful to look at but environmentally friendly. I also think that the funds that used to be appropriated for fuel could be spent on resident and patient education or a budget for patients that have difficulty affording their medications.

I think about the incorporation of technology.What if you could Skype to see how your grandma is doing in her hospital bed at a hospital in East Asia? What if you as a patient had a personal panel deck and it told you who was seeing you today and there was a notepad that you could write questions you had down? What if we incorporated fall sensors in the bathroom and near the bed? What if you could see pics of the MRI you had last night? Or if you had a noisy neighbor, what if could put up a cocoon of darkness and soundproof walls with a do not disturb sign? What if you are far away and someone you really care about is in their final moments and they can hear your voice for the last time or they can hear yours, all enabled by technology.

I have always looked at technology as a tool and a blend of art and science, but the main drivers of it are the people who create it and the people who use it. We too as people are art and science. We are biological beings made of cells but we are also beings capable of thought, creation and design. Time is our only limitation, so I ask, if not now, then when?

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3 thoughts on “Design in medicine (STEAM-power)

  1. Awesome article and right on point. Design in medicine needs to be improved and more carefully considered. Luckily some of the things you’ve suggested have been created but have not become ubiquitous yet. Looking forward to seeing how design improves. How do you suggest we wake people up to this gap?

  2. “Medicine itself is often said to be both an art and a science.”
    __

    Well, yeah, sometimes as an out, to deflect criticism from a bad outcome. But, science itself can be said to be both “art and science” (zero degrees of freedom in that assertion, I know). The “artful” part goes to the necessary use of “heuristics” and intuition. Science is not merely algorithmic, mechanistic, deductive. It is empirical, tentative, and frequently intuitive — “inspirational.” Damasio once elegantly took down the false dichotomy between “reason” and “emotion.” See ‘Descarte’s Error,” specifically the lessons learned from the Phineas Gage case.

    Basically, you have to CARE (emotion) about reasoning. See also, on this riff, Harry Frankurter’s delightful book “On Bullshit.” (Bullshit — indifference with respect to the truth is worse than outright lying.)

    BTW, a good place to hang: “Science Based Medicine” http://www.sciencebasedmedicine.org (though, I sometimes get the “Scientism” heebie-jeebies there)

  3. Pingback: How A Small #Digitalhealth #Startup won a Statewide Contract (and the T-shirt Story ;) #NewYork #tech | Just curious...

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