Doctor as Designer?


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These slides are adapted from a talk that I gave this year at the 2013 Cusp Conference, which is a conference about the design of everything. It's about my personal journey from medical doctor to medical "designer" and why we as medical professionals must become design thinkers. I was honored to be presenting at the event and it literally was the most amazing conference I have ever attended in my life! Thank you to Dave Mason and the folks at Multiple.

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  • Any and all opinions that I express about any products are unfettered by any monetary influence
  • I am Associate professorof Pediatrics at the University of Michigan. In the clinical setting, I provide medical care to children and their families at mott children’s hospital.
  • I specialize in pediatric endocrinology, so that means I mostly take care of kids with type 1 diabetes.
  • I am also a researcher. I perform clinical research which means that I work with real live patients and I also conduct health child health policy research, mostly focused on measuing the burden and long term health consequences of childhood diabetes and obesity. I also c0-direct a program focused on the use of mobile technology andinteractive data visualizations for helping children manage their chronic disease. Finally, I have a strong interest in social media for connecting patients and providers and for enhancing communication among researchers.
  • I started a blog focused on the intersection between design thinking and health. I will be sharing excerpts of posts throughout this talk.
  • So what I want to share with you today is my personal evoluation as a design thinker which was heavily influenced by my kids, b and s.
  • Both of my children have severe life threatening food allergies. My son B for example is allergic to dairy, nuts and aggs, and if he is exposed to even just a small amount of allergen he can develop a generalized allergic reaction called analphylaxis, which can cause difficulty breathing, shock and can be fatal.
  •  You get something called a food allergy action plan from the allergist, which is 2 sheets of paper printed out, that you are supposed to give to the teachers, outlining allergy symptoms and when to use the epipen for serious reactions and when to use the medication called an antihistamine for the mild reaction.
  • It’s a piece of paper. It’s blak and white it’s got a lot of words. Unfortunately…this is how we print out pt instructions even using our sophisticated emrs.
  • So we had just arrived in silicon valley, the epicentre of social media (google youtube. khan academy,) Make a videoAll of his teachers have smartphones. And with an iphone and some screencasting software,  . my son had just learned to read and write the previous year. I sat down and drafted a script for the video, He then helped create the illustrations for the video, and narrated the entire script himself.
  • Design thinking can help you solve health problems. This was my first exercise in design thinking: Identified the problem, ideate solutions, created and tested prototypes, and we found a prototype that worked! I didn’t set out to make a prototype, I just had a problem that needed to be fixed, so I came up with a design solution.
  • New medicine is peer to peer patient to patient. Sharing online on social media, on online communities. You must follow…..SO as much as I am disturbed by Howard Tullman’s talk yesterday about social media and the dark side, THERE IS A POSITIVE SIDE TO SOCIAL MEDIA IN MEDICINE.
  • Finally this was an example of Participatory Design (in which patient and family helped to create and design the solution). I can say for myself that it was a therapeutic and empowering experience for our family. I had peace of mind that I could make an accessible place online that his teachers could refer to anytime as a reference, but more importantly it was a great opportunity for him to practice his writing and illustration skills, and learn more about his own health condition, especially the second video which focused on “tricky allergic ingredients. Finally, there is no doubt in my mind that the video really resonated because it was done with B’s drawings and his voice as the narrator instead of his mother’s., making for more effective learning (I made sure to add the Thanks for taking care of me slide to that they understood how cute he was , so that they would be extra careful).
  • I MADE SOMe prototypes with my first design experiments but the other thing I learned to do this year is learn to see like a designer. And again, this transformation, was again mediated by
  • In medicine, we are used to pretty dismal design, whether its our web browsers, out pagers that we use in the hospital or our medical Devices. So you just learn to accept the status quo. And you don’t have high expectations. Design suckiness….there’s a lot of that in healthcare.
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  • Tools providers, clinics health systems
  • Joyce Lee, MD, MPHAssociate ProfessorCo-Director, Program on Mobile Technology in Child HealthPediatric Endocrinology and Health Services ResearchChild Health Evaluation and Research UnitUniversity of Michigan300 NIB, Room 6E18, Campus Box 5456Ann Arbor, MI 48109-5456Tel: 734-615-3139 Fax: 734-936-0941Email: joyclee@umich.edu @joyclee
  • Doctor as Designer?

    1. 1. Doctor as Designer? Joyce Lee, MD, MPH Twitter: @joyclee
    2. 2. I have no ties to any pharmaceutical companies
    3. 3. I am Pediatrician
    4. 4. Diabetes specialist
    5. 5. and Pediatric Researcher who studies Obesity and Diabetes
    6. 6. I have no formal training as a designer, but these were my notes from when I was studying for my medical board exams. Does this count as design?
    7. 7. This is design, right? “A priesthood of folk in black turtlenecks and designer glasses working on small things.” So how does this have anything to do with me, a physician?
    8. 8. I had the great privilege of learning about design thinking while I was on sabbatical last year at Stanford
    9. 9. And I started blogging about design thinking and its intersection with health
    10. 10. But this journey started for me as a Personal Design Experiment
    11. 11. My son “B” has life-threatening food allergies so he has to carry an epi-pen with him at all times
    12. 12. The doctor gave us a paper allergy action plan to show the teachers how and when to use the pens
    13. 13. But this wasn’t really effective. Could there be something better?
    14. 14. Pull him out of school. Design Idea Not an option.
    15. 15. Design Idea Not feasible, I sometimes don’t know when to give the medication and I am an MD! Teach 6 yo signs of anaphylaxis & when to give meds
    16. 16. I was in Silicon Valley, so I made a youtube video! Design Idea
    17. 17. No actually I had B make the movie, just as any good tiger mom would
    18. 18. (see 1st video) He illustrated and narrated this 1st prototype
    19. 19. I blogged about it
    20. 20. And it went viral!!
    21. 21. DESIGN SUCCESS!! (see 1st video)
    22. 22. And please check out video #2 about handling food and ingredients!
    23. 23. We also needed a Low Fi Version
    24. 24. Design Inspiration: My Medicine X nametag
    25. 25. So I made these nametags
    26. 26. Which contain vital information
    27. 27. Extra resources, and pictures of the “bad allergens”
    28. 28. How to give the meds using B’s illustrations
    29. 29. Noun Project Icons from Rodrigo Bruno, James Keuning, Sergi Delgado & Jong Hyuk Kwon. And more detailed information about allergens
    30. 30. Design thinking can solve health problems My First Design Insight
    31. 31. Design which leverages mobile technology & social media changes the paradigm of who, what, and how health information is communicated My Second Design Insight
    32. 32. The old medicine: Paternalistic Doctor to patient Off-line and in the office
    33. 33. The new medicine: Participatory Patient to Patient Online and at all hours
    34. 34. Participatory design is therapeutic, and empowers patients and caregivers My Third Design Insight
    35. 35. Anyone can “design” a health solution, even a 6 year old boy! I felt safer, and B learned a lot of fancy words! “lactalbumin, lactoglobulin, whey…”
    36. 36. The next part of the journey: “Learning to design is learning to see” -Oliver Reichenstein
    37. 37. I am used to bad design in healthcare So I never even questioned the design of the Epi-Pen
    38. 38. The thing is, you don’t know what bad design is, until…
    39. 39. You see good design
    40. 40. I didn’t realize the bad design of the Epi-Pen
    41. 41. Until I encountered the Auvi-Q
    42. 42. Check out this video:
    43. 43. The Auvi-Q made me realize there are some major design flaws with the Epi-Pen
    44. 44. The needle is opposite to the cap, which is counter- intuitive The Most Important Design Flaw
    45. 45. Life or death is stressful! Don’t make me think! That causes problems in emergency situations
    46. 46. >15,000 Unintentional injections from Epi-Pens in the US between 1994-2007 There were
    47. 47. 0 500 1000 1500 2000 2500 3000 < 6 yrs 6-12 yrs18-64 yrs Total 13-17 yrs >64 yrs Unintentional Injections with Epinephrine auto-injectors Simons, 2010 “Wow it’s getting worse with time!”
    48. 48. Greenberg, 2010 “Despite instructions rendered on the package insert, a large number of health care professionals including nurses, paramedics, and physicians inadvertently self-inject while attempting to administer the EpiPen to patients. One recent report chronicles a 6- year experience at a single US poison center that fielded 365 epinephrine injections to the hand.” Trained health care providers can’t even use the pen properly!
    49. 49. Whoa the cap & needle are at the same end! But Auvi-Q found a design solution
    50. 50. It tells you what to do! And it even guides the user with it’s own version of “Siri”
    51. 51. “Bad Design Causes Injury” “Good Design Saves Lives!” Design Insight
    52. 52. Another Epi Pen Design Flaw It’s an awkward size, & doesn’t fit in your pockets So people don’t carry the pens with them
    53. 53. It’s thinner and shorter & fits in your pocket! But Auvi-Q fixed this problem too
    54. 54. And it reminds me when to refill
    55. 55. “Aesthetics Do Matter for Health” Design Insight
    56. 56. Revelation: It was designed by two brothers with food allergies!
    57. 57. When I started pulling this blog post together, I went back to the scientific literature to see what it had to say about the design of the epi pen
    58. 58. I found this article, and I began to see the world through the eyes of a designer
    59. 59. “patients frequently do not understand how and when to use [the epi-pen].” Sicherer, 2011 In medicine, we often blame the patient
    60. 60. “patients frequently do not understand how and when to use [the epi-pen].” Sicherer, 2011 But is it a patient problem or is it a design problem? Design flaw: The needle is opposite to the cap
    61. 61. “Children had only used their EpiPen device in 29% of recurrent anaphylaxis reactions. This is perhaps unsurprising because a fear of needles/injections is common” Sicherer, 2011 In medicine, we often blame the patient
    62. 62. “Children had only used their EpiPen device in 29% of recurrent anaphylaxis reactions. This is perhaps unsurprising because a fear of needles/injections is common” Sicherer, 2011 But is it a patient problem or is it a design problem? Design Flaw: It’s confusing to use in a scary emergency
    63. 63. “patients often forget [the device], allow it to expire” Sicherer, 2011 In medicine, we often blame the patient
    64. 64. But is it a patient problem or is it a design problem? “patients often forget [the device], allow it to expire” Sicherer, 2011 Design Flaw:It’s too long & wide & where’s the app to go w/ it?
    65. 65.
    66. 66. A designer would never say, “It’s the user’s fault”
    67. 67. “Fix the Design and then its no longer the “Patient’s” problem” -Joyce Lee, MD, MPH Medical Designer?
    68. 68. “Patient” problems are really “Design” problems -Joyce Lee, MD, MPH DEO* (Design Executive Officer?) *Check out @mgiudice for the def’n of a DEO; she’s the one who told me that I could call myself a DEO :)
    69. 69. Could Doctors have something to learn from Designers?
    70. 70. As a medical designer (MD), instead of seeing the world like this:
    71. 71. 75% Wood, 2012 of children fail to meet recommended blood sugar goals in Type 1 Diabetes
    72. 72. I now see the world like this:
    73. 73. 75%of health care providers/systems fail to help children achieve recommended blood sugar goals in Type 1 Diabetes
    74. 74. Clinic is a Design Thinking Problem every 15 minutes
    75. 75. Book knowledge is still important, but is probably not as critical as…
    76. 76. Empathy for our Patients
    77. 77. If we as health care providers do not think like designers, we will fail in our mission to serve our patients
    78. 78. B you are a true “design thiker”; thanks for teaching me so much
    79. 79. Joyce Lee, Medical Designer, DEO Twitter @joyclee Thanks to: B, S, and E Hyoung O. Lee, MD, Heeja Lee Friends, Colleagues, Twitter connections, & @CuspConference for inspiring this talk!