Doctor as Designer?

Joyce Lee
Joyce LeeRobert Kelch Professor of Pediatrics
Doctor as
Joyce Lee, MD, MPH
Twitter: @joyclee
I have no ties to any
pharmaceutical companies
I am Pediatrician
Diabetes specialist
and Pediatric Researcher
who studies Obesity and Diabetes
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
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
I had the great privilege of
learning about design thinking
while I was on sabbatical last
year at Stanford
And I started blogging about
design thinking and its
intersection with health
But this journey started for
me as a Personal Design
My son “B” has life-threatening
food allergies so he has to carry an
epi-pen with him at all times
The doctor gave us a paper allergy
action plan to show the teachers
how and when to use the pens
But this wasn’t really effective.
Could there be something
Pull him out of
Design Idea
Not an option.
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
I was in
Silicon Valley,
so I made a
Design Idea
No actually I had B make the movie,
just as any good tiger mom would
(see 1st video)
He illustrated and narrated
this 1st prototype
I blogged about it
And it went viral!!
(see 1st video)
And please check out video #2 about
handling food and ingredients!
We also
needed a Low
Medicine X
So I made these nametags
Which contain vital information
Extra resources, and pictures of the
“bad allergens”
How to give the meds using B’s
Noun Project Icons from Rodrigo Bruno, James Keuning, Sergi Delgado & Jong Hyuk Kwon.
And more detailed information about
Design thinking can solve
health problems
My First Design Insight
Design which leverages
mobile technology & social media
changes the paradigm of
who, what, and how health
information is communicated
My Second Design Insight
The old medicine:
Doctor to patient
Off-line and in the office
The new medicine:
Patient to Patient
Online and at all hours
Participatory design is
therapeutic, and
empowers patients and
My Third Design Insight
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…”
The next part of the journey:
“Learning to design
is learning to see”
-Oliver Reichenstein
I am used to bad design
in healthcare
So I never even questioned
the design of the Epi-Pen
The thing is,
you don’t
know what
bad design
is, until…
You see
I didn’t realize
the bad design
of the Epi-Pen
Until I encountered
the Auvi-Q
Check out this video:
The Auvi-Q made me realize
there are some major design
flaws with the Epi-Pen
The needle is
opposite to
the cap, which
is counter-
The Most Important Design Flaw
Life or death
is stressful!
Don’t make
me think!
That causes problems in
emergency situations
Unintentional injections
from Epi-Pens in the US
between 1994-2007
There were
< 6 yrs
6-12 yrs18-64 yrs
13-17 yrs
>64 yrs
Unintentional Injections with
Epinephrine auto-injectors
Simons, 2010
“Wow it’s getting worse with time!”
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
Trained health care providers can’t
even use the pen properly!
Whoa the cap
& needle are
at the same
But Auvi-Q found a design solution
tells you
what to
And it even guides the user with
it’s own version of “Siri”
“Bad Design Causes Injury”
“Good Design Saves Lives!”
Design Insight
Another Epi Pen Design Flaw
It’s an
awkward size,
& doesn’t fit in
your pockets
So people
don’t carry the
pens with
It’s thinner
shorter & fits
in your
But Auvi-Q fixed this problem too
And it
reminds me
when to refill
“Aesthetics Do Matter
for Health”
Design Insight
Revelation: It was designed by
two brothers with food allergies!
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
I found this article, and I began to
see the world through the eyes
of a designer
“patients frequently do not understand
how and when to use [the epi-pen].”
Sicherer, 2011 
In medicine, we often blame the
“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
“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
“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
“patients often forget [the device], 
allow it to expire” 
Sicherer, 2011 
In medicine, we often blame the
But is it a patient problem or is it
a design problem?
“patients often forget [the device], 
allow it to expire” 
Sicherer, 2011 
Flaw:It’s too
long & wide &
where’s the
app to go w/
A designer would
never say,
“It’s the user’s fault”
“Fix the Design and
then its no longer
the “Patient’s” problem”
-Joyce Lee, MD, MPH
Medical Designer?
“Patient” problems
are really
“Design” problems
-Joyce Lee, MD, MPH
DEO* (Design Executive
*Check out @mgiudice for the def’n of a DEO; she’s the one
who told me that I could call myself a DEO :)
Could Doctors have something to
learn from Designers?
As a medical designer (MD),
instead of seeing the
world like this:
Wood, 2012
of children fail to meet
recommended blood sugar goals in
Type 1 Diabetes
I now see the world like this:
75%of health care providers/systems
fail to help children achieve
recommended blood sugar goals in
Type 1 Diabetes
Clinic is a Design Thinking
Problem every 15 minutes
Book knowledge is still
important, but is probably
not as critical as…
Empathy for our Patients
If we as health care
providers do not think like
designers, we will fail in
our mission to serve our
B you are a true “design thiker”;
thanks for
teaching me so much
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!
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Doctor as Designer?

Editor's Notes

  1. Any and all opinions that I express about any products are unfettered by any monetary influence
  2. 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.
  3. I specialize in pediatric endocrinology, so that means I mostly take care of kids with type 1 diabetes.
  4. 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.
  5. I started a blog focused on the intersection between design thinking and health. I will be sharing excerpts of posts throughout this talk.
  6. 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.
  7. 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.
  8.  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.
  9. 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.
  10. 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.
  17. 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.
  18. 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.
  19. 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).
  21. 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
  22. 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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  37. Tools providers, clinics health systems
  38. 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