Technology and anxiety March 10, 2011Posted by Cameron Shelley in : STV202, STV302 , comments closed
Last month, I discussed how medical information technology is not a panacea, meaning that the mere application of high tech in medicine does necessarily lead to improved medical results. In the article in question, a medical doctor discussed the tradeoffs involved in computerizing existing medical practices. I chimed in that designers of the technology tend to overlook some of the disadvantages of computerization because of their optimistic attitude towards the technology itself. This phenomenon of optimism leading to exaggerated views of the advantages of computerization I put down to motivated design.
It was interesting, then, to see this article on the potential overuse of diagnostic technology in pediatric medicine. Dr. Sean Palfrey of the Boston University School of Medicine argues that pediatricians sometimes rely too much on diagnostic high tech and not enough on simple physical examinations and their own training. Dr. Palfrey notes that increasing reliance on diagnostic technology raises challenging questions:
The evaluation of a child with fever and cough is a good example. There are many possible causes, and we have a huge battery of available tests that might give us potentially relevant information. But why should we no longer trust our physical exam, our knowledge of the possible causes and their usual courses, and our clinical judgment? How much will we gain by seeing an x-ray, now, and how likely is it that the result will necessitate a change in our management? How dangerous would it be if we chose to perform certain tests later or not at all? Might our residents not learn more by thinking, waiting, and watching?
I can think of a number of reasons whey pediatricians might be risk-averse in their diagnostic practices:
- Doctors, parents, and people in society in general have a special concern for the health and well-being of children. When a child appears in difficulty, their doctors naturally want to take special measures to help.
- As a doctor, the pediatrician’s job is to restore their patient to health. The effects of their treatment decisions on others, or on society in general, is not their responsibility. So, they arrange for whatever tests they feel might be useful to decide on an appropriate diagnosis and treatment.
- Insurance requirements and professional standards may demand the use of a diagnostic technology even where it may not be warranted in the view of a doctor in a given case.
- Then there is a simple aversion to failure. My impression, at some remove, is that doctors are strongly success-oriented and thus particularly averse to the possibility of making a mistake. They see diagnostic technology as a means to avoid failure and so they make use of it.
All these reasons are coloured, to some extent, by anxiety. That is, doubt about the outcome is present, and the pediatrician must consider the (possibly negative) view that others will take of their conduct. The result is that they experience anxiety, for which diagnostic technology provides some relief.
(Image courtesy of US Navy Journalist Seaman Joseph Caballero via Wikimedia Commons.)
So, the uptake of medical technology is driven by a push-pull mechanism. One form of push is provided by the optimism of the designers of medical technology. A form of pull is provided by the anxiety that doctors experience in diagnosing the ailments of their patients. If the result is too much reliance on diagnostic technology, then we might consider alternative routes for satisfying the mechanism that produces it. Dr. Palfrey suggests more professional discipline from doctors and more education for patients. I would not deny the importance of such measures. Yet, it seems to me that designers and doctors should think about some way of increasing their confidence, appropriately, in existing and established diagnostic technologies, such as the old-fashioned flashlight and tongue depressor.
Edward Tenner at TED 2011 March 3, 2011Posted by Cameron Shelley in : STV100, STV202 , comments closed
Here is a short interview with Edward Tenner, author of Why things bite back and Our own devices, who is presenting at this year’s TED talks. I am looking forward to seeing the talk but there are lots of interesting tidbits raised in the interview.
(Image courtesy of EdwardTenner.com.)
Here is an example concerning unintended consequences:
On the other hand, our ability to innovate goes faster than our ability to model how things will behave over time. A New York Times story talks about a dam in California that is now considered to be in a dangerous condition. It was really state-of-the-art over 50 years ago when it was built, and these were the best engineers at the time. And yet there are things about the interaction of the soil [that have now made the dam dangerous] that are discovered only in the course of decades. That is an inevitable feature of innovation. All I think you can do is try to recognize these things as quickly as you can and address them earlier, because they may be cheaper to fix earlier than later.
It is true that the effects of innovative designs are especially hard to anticipate. After all, being innovative, the design is to that extent unprecedented. In the absence of experience with a precedent, the future can be all the harder to foresee.
However, I would not agree that this sort of problem is inevitable. Take, for example, th case of the Crystal Palace, designed by Joseph Paxton for the Great Exhibition in London in 1851. The building was one of the most innovative structures ever, being built from a relatively small set of standard iron and glass parts manufactured en masse and put together on the spot. No one had ever manufactured such an ambitious structure before, certainly not on such a scale. (It covered 990,000 square feet!)
(Image courtesy of Paul Furst via Wikimedia Commons.)
Even more amazingly, the Palace was disassembled, relocated, and reassembled some months after the closing of the Exhibition. Of course, the task was made easier because the building had no foundation, but the feat is still impressive.
Whether by chance or by intention, Paxton’s design left open many options for the future owners of the Palace. Because it could be disassembled, the design of the Palace did not lock in future caretakers to his own preferences or to the vagaries of the circumstances of the Exhibition. In modern lingo, it could be re-purposed with relative ease, even melted down if need be.
The same cannot be said of many big infrastructure projects. New buildings, bridges, roads, etc., are designed on the implicit and optimistic assumption that future generations will be only too glad to continue them for their intended purpose and in their given form. The result can be an awkward burden on future generations. Perhaps we should heed the lesson of the Crystal Palace and try to adopt designs that are adaptable and thus avoid locking in our successors to the unintended consequences of our decisions. More easily said than done, I know. However, I suspect that we can do better.
Medical information technology is not a panacea February 10, 2011Posted by Cameron Shelley in : STV202, STV302 , comments closed
In reading this TIME article about a doctor’s experience with medical information technology, I was struck by his conclusion that, although the technology can be a great boon, it is not a panacea. That expression provides a nice medical analogy to the claim, discussed before in this blog, that technology is just a tool. As noted previously, this expression has several, contradictory meanings but, here, it means that we have an obligation to be critical about computerizing an existing system.
(Image courtesy of Jejecam via Wikimedia Commons.)
In this article, Dr. Meisel makes it clear that health information technology has a lot to offer. He recounts when an elderly women was brought to ER obviously in a bad way but without medical records or family members. Thus, he had to treat the patient with almost no knowledge of her previous medical history. Had her medical records been available for retrieval on a distributed database, her care could have proceeded more immediately and accurately than it did.
However, although health information systems help to open some channels of communication, they tend to close others. Dr. Meisel mentions two:
- Patient status used to be represented in hospital wards on a giant whiteboard (which you may well have seen). Health IT systems replace this board with small computer monitor. Unfortunately, secluded monitors do not invite impromptu conferences among doctors and nurses in the way that the big whiteboards did. Such conferences could produce insights that helped with patient care. Has the computerized system unintentionally reduced this benefit?
- Previously, when Dr. Meisel ordered an X-ray, he would have to go to the Radiology department to get it. There, he would encounter the radiologist. They would often discuss the X-ray, and the conversation might reveal something that neither had noticed on their own. Now, X-rays are delivered electronically with the radiologist’s comments. Such a system tends to discourage casual discussion. What important information is going unnoticed as a result?
Computerization of health information systems can and does produce great benefits but important aspects of the previous, informal information system can get lost because they go unnoticed by the analysts designing the system, or because the analysts do not acknowledge their importance.
Why do designers make these mistakes? There are many contributing factors but I will comment briefly on one only: The designers are trained an paid to make the existing system more efficient by reducing it in various ways. For example, networking different medical record databases reduces the time and effort needed to dig up relevant information about a patient. Not a bad thing! However, the computerized system also reduces the number of channels through which information flows. This reduction makes things speedier but also reduces feedback loops, think casual meetings, built into the informal system. Since they are achieving desirable reductions in time and effort, designers may not think critically about whether all the reductions are a good thing. This phenomenon is an instance of what I have called motivated design. When designers aim to do good, they sometimes do not think through or properly evaluate the consequences of their work. If Dr. Meisel is right, this phenomenon may be adversely affecting patient care.
What can be done? Perhaps the designers of computerized systems need to develop a greater appreciation for the drama of human interactions in informal information systems. That is, what characters are involved in the informal system? What roles do they play? What happens when they interact? Is it important? If so, should it be reduced at all? Or, can it be accommodated in a computerized system?
Computers improve the voting experience in Ontario? October 28, 2010Posted by Cameron Shelley in : STV202, STV302 , comments closed
After the recent experience when University of Michigan students hacked into an e-voting website, and made it play the UofM fight song after each vote (among other things), I was interested to see how e-voting would be greeted in the recent municipal elections here in Ontario.
It was a mixed bag, as you might guess. Some observers were quite giddy with the immediacy and just plain coolness of having votes counted by computers. Here is a report from the Guelph Mercury:
Smart municipalities across Ontario, and Canada, are realizing that electronic vote counters make sense. They proved themselves again Monday night.
In Guelph, these machines were able to count 28,072 ballots more quickly than any human and told us who had been elected well before bedtime Monday night. Voters could tune in to the city’s website and get up-to-the-minute results as polls were entered into the system.
The city passed along updates as soon as it had them, getting the word out on its Facebook site and through Twitter updates. Polls closed at 8 p.m., and results followed shortly after. This is how an election should be run.
Forget spoiled ballots that can bog down polling stations. These machines spit them back out – and tell the voter to try again. Accepted ballots are immediately stored on a memory card, which is sent to election officials with the push of a button as soon as polls close.
The alternative, counting by hand, looks painfully archaic. In New Hamburg’s case, part of Wilmot Township, it was almost 2 a.m. before the final ballot had been counted and official results released. At midnight, almost half of the polling stations in the New Hamburg ward had still not reported, with tight races on the line.
Voting should be more like Tweeting, and it’s so futuristic!
Other experiences were less positive. Citizens in some Ontario municipalities found that their e-voting systems were not performing as expected:
Arnprior will have to wait until Tuesday night to declare its mayor after the electronic voting system used in many places across eastern Ontario crashed Monday night.
The online and telephone voting system was used by 33 municipalities, causing several problems across the region.
Arnprior resident Debbie Laventure was one of hundreds of voters locked out of the “Intelivote” electronic voting system.
“I tried on the telephone to phone in, couldn’t get through. I tried the computer; that wasn’t working, so went to the library and that didn’t work,” Laventure told CTV Ottawa on Tuesday.
Shortly before polls were scheduled to close, Arnprior’s returning officer made the unprecedented move to keep polls open for another 24 hours.
What a downer! Luckily, the machines were not to blame. According to a press release from Intelivote the problem was excessive voting:
“During the heavy load, the Intelivote system experienced a hardware server error that resulted in the entire load on the system being switched to the redundant load-sharing server,” the statement adds.
“A combination of the heavy voting activity and the administrative activity resulted in the system reducing the capacity to process voter activity over a 57-minute period.”
Damn! If only we could keep people from voting so much, or in such an unruly manner, e-voting would be so much easier!
Strangely, it seems that Ontarians are not totally sold on e-voting, according to the Law Times:
Already, places like Markham, Ont., have tried electronic voting with mixed results. There, participation at advanced polls increased dramatically, but overall turnout remained flat.
Given the concerns over the security and accuracy of such systems as well as their limited effect on participation, it’s clear that web-based options aren’t a panacea.
In short, digitizing an existing process may make it more futuristic, but it may not make it more engaging.
Perhaps the answer is to remove humans from the process altogether…
Choice blindness and the social nature of design August 17, 2010Posted by Cameron Shelley in : STV202 , comments closed
Cognitive psychologists Johansson et. al are publishing a paper entitled Magic at the marketplace: Choice blindness for the taste of jam and the smell of tea. Only the abstract is currently available to the public, but the content of the article has already been discussed in this Wired article. The article describes some recent work on the phenomenon of choice blindness. In brief, people are often unable to distinguish between items A and B, even though they purport to have a definite and justified preference for one over the other. The abstract of the article describes how the researchers used taste tests between two kinds of jam or tea to reveal this divergence between people’s statements and their actions:
We set up a tasting venue at a local supermarket and invited passerby shoppers to sample two different varieties of jam and tea, and to decide which alternative in each pair they preferred the most. Immediately after the participants had made their choice, we asked them to again sample the chosen alternative, and to verbally explain why they chose the way they did. At this point we secretly switched the contents of the sample containers, so that the outcome of the choice became the opposite of what the participants intended. In total, no more than a third of the manipulated trials were detected. Even for remarkably different tastes like Cinnamon-Apple and bitter Grapefruit, or the smell of Mango and Pernod was no more than half of all trials detected, thus demonstrating considerable levels of choice blindness for the taste and smell of two different consumer goods.
Pretty sneaky, eh?
It seems that our conceptual preferences write cheques that our sense perceptions cannot cash. We are convinced that we prefer Cinnamon-Apple jam over Grapefruit jam, say, when, in fact, we would be equally happy with either one. This work is profoundly unsettling for a number of reasons:
- We frequently make complex decisions based on calculations of what would make us most happy, reconciling a vast pool of potentially conflicting preferences. If we are indeed subject to extensive choice blindness, then these calculations could involve a great amount of wasted effort. We might be equally well off following a fairly simple method for making decisions.
- The process of design often involves creating a long list of explicit specifications that any successful design must meet. If we are subject to extensive choice blindness, then many such specifications are not relevant to the acceptability of the outcome. In that case, a great deal of design activity is wasted effort also.
Everyone designs who devises courses of action aimed at changing existing situations into preferred ones. … Schools of engineering, as well as schools of architecture, business, education, law, and medicine, are all centrally concerned with the process of design.
If choice blindness is a ubiquitous problem, then it seems that we will hardly know when we are successful in designing things that realize our preferences, or whether our preferences are even relevant. Is, then, much of the education of designers futile?
Yes and no. The argument assumes that, to be justified, preferences must be determined solely by each individual for himself or herself. In other words, your claim that you prefer Cinnamon-Apple jam over Grapefruit jam is justified only if you can tell the difference for yourself. Marketers have long known that this condition often does not apply. People prefer Coke over Pepsi based not so much on any difference in taste so much as what they believe other people think. If the taster wants to be part of the “Coke” crowd, then they tend to prefer Coke, for example. In general, individual preferences are influenced by social goals, goals like wanting to belong to a given social group.
(Image courtesy of Tim Wang; Wikimedia Commons.)
So, choice blindness is regrettable only if we decide that social goals should not influence individual preferences. In an individualistic culture, like the American culture, such influence seems unacceptable. Yet, as Sheena Iyengar points out, always forcing individuals to make choices without reference to the social group can be a burden, and make people unhappy. Moreover, as the Internet has taught us, there is sometimes wisdom in the inferences of the crowd. Why should we not say the same for the “preferences” of the crowd?
This conclusion should not lead us to be indifferent to choice blindness. Indeed, I think that this result should be discussed in the education of any designers in any serious design profession. It suggests that the “rational” model of design, in which a list of specifications is generated early on and largely held to and even expanded with time, is not as great as it might otherwise appear to be. Instead, designers need to be sensitive to the fact that their client’s preferences (and their own) are profoundly influenced by their social goals. Those goals must also be acknowledged and held up to scrutiny in the course of any important design project. Indeed, that is the burden of the concept of motivated design, which I have discussed previously in this blog.STV202 , comments closed
Probably you have heard that the government of Pakistan has ordered Internet service providers in the country to block Facebook access. The reason is a Facebook page that encourages people to post pictures of Muhammed:
The Facebook page at the center of the dispute — “Everybody Draw Mohammed Day!” — encourages users to post images of the prophet on May 20 to protest threats made by a radical Muslim group against the creators of South Park for depicting Muhammad in a bear suit during an episode earlier this year.
My point is not to comment on the Facebook event nor on the Pakistani government’s reaction to it. But there is an aspect to the controversy that connects to a technology-and-society concept, namely motivated design. The objection to depictions of Muhammed, as the Wiki page has it, concerns idol worship.
The key concern is that the use of images can encourage idolatry, where the image becomes more important than what it represents.
So, if people regarded depictions of Muhammed as merely a means to remind them of his life and activities, all would be well, I assume. The worry is that this means could come to be regarded as an end-in-itself, something desirable for its own sake: Believers would value the images instead of what they represent. A ban on depictions is necessary to prevent this from happening, or so the argument goes.
Well, the thought pattern identified by this concern is real enough. However, motivated design is a problem only when evidence against the acceptability of the design is readily discounted. I would guess that, because this Facebook event is manifestly a provocative show of disrespect for the beliefs of at least some Muslims, no one is likely to regard the images produced as idols.
PowerPoint: The enemy within? April 28, 2010Posted by Cameron Shelley in : STV202, STV302 , comments closed
A recent New York Times article comments on the now well-known deficiencies of PowerPoint. Besides the program’s interface and reliability issues, it often seems bound to confuse communications and distort the decision-making process.
Consider the remarks of General McMaster, who banned PPT presentations from his briefings in the Iraq war:
“It’s dangerous because it can create the illusion of understanding and the illusion of control,” General McMaster said in a telephone interview afterward. “Some problems in the world are not bullet-izable.”
Besides providing a procrustean bed into which information is to be lopped, PPT encourages the cramming of visual information into 8.5×11 graphics. Witness the graph below:
(Image courtesy of the New York Times)
While the graph may be accurate in some sense, it hardly aids understanding:
“When we understand that slide, we’ll have won the war,” General McChrystal dryly remarked, one of his advisers recalled, as the room erupted in laughter.
The article says little about why, given all its manifest shortcomings, PPT is so popular. The following is all that is offered:
The program, which first went on sale in 1987 and was acquired by Microsoft soon afterward, is deeply embedded in a military culture that has come to rely on PowerPoint’s hierarchical ordering of a confused world.
So, what is bad about the software is also what makes it attractive?
Perhaps the adoption of PPT by the military (and who knows what other organizations) is an example of what I will call motivated design. That is, we would like to bring a confusing and chaotic world into some kind of order to understand it. This desire motivates us to accept to accept tools that help to present an ordered and comprehensible view of things, even if we really know such a view to be misguided or even counterproductive.