To design for the user you have to ask!

Consultation with users is key
Consultation with users is key

Last month I told you that I needed to really understand the science before I had any hope of solving a medical problem.

This month I’m telling you that the science allowed us to come up with ideas for the technology that could potentially solve the given medical problem but that we really needed to understand the physicians and the patients (our users) in order to design the product.

When I speak about the product, I am not only referring to what the thing has do, but its specific purpose for a specific patient. In my opinion, which obviously has yet to be informed by my future experience, the product is every bit as important as the technology, and while the technology is informed by the science (anatomy and physiology), the product is informed by the users (physicians and patients). The user information is often harder to garner from scientific papers.

This month I realized that while I was enamoured by the science of the diseases we were looking at, we had to develop just as good an understanding of the patients if we wanted to develop a product that was worthy of adoption. What surprised me, and may surprise some of you, is that this epidemiological information (all of the factors controlling the presence of a disease) is not easy to find in the scientific literature. That is not because it cannot be studied, but rather because it is not interesting or useful to study until there are alternative therapies available. Scientific studies will often tell you the incidence (how many new cases per year) and prevalence (how many people are affected) of a disease, and that the average patient lives with the disease for a certain length of time. From that information you can determine how many times per year the average person is affected. What you can’t tell is the distribution of those people; how many are affected 10 times per year, versus those that are affected once in 10 years.

What if I now tell you that people live with the issue for 10 years and some people only seek help once, while others seek treatment 100 times. While the people who come in 100 times may be a very small population, they are a very valuable population because of their cost to the health care system. As a designer, they are also a very valuable population because they present a new need: prevention of recurrent attacks.

For me, this finding came in my investigation of heart failure, a disease in which some patients come into the hospital once, while others come back every three months. For this population there are two products we could design: a product to help the person who comes to the hospital and a second product to help prevent recurrent attacks in the much smaller population of people who come fairly often.

What was most surprising to me was that the information about true patient flow was not easily found in the medical literature. It was “camouflaged.” It came to light when we spoke with the physicians and nurses who manage these patients and know the “frequent flyers” by name. After speaking with physicians we were able to uncover the studies that we should look at to confirm or disprove our hypothesis. Without speaking to people “on-the-ground” but I don’t think we would have even been able to come to this hypothesis.

In some ways I am in the same spot as other posts: excitedly overwhelmed by what lies ahead. In other ways I am in a new spot, I have gained an appreciation for how iterative this process must be. It is not iterative because I got the wrong answers to the initial questions. Rather, it seems to be iterative because I didn’t know the right questions to ask the first time around. Like focussing a camera lens, I think that with each cycle the patient population will become more defined. As it does so it is likely to become narrower. If we chose a big enough problem to begin with than hopefully one of these sub-populations will be worth designing for. If not then I will have to get used to a lesson I am sure to arrive at in a not-so-distant future, that some projects will have to get dropped even after you have invested a lot of time.

Until I hit the sunk cost calculation, I am continuing to run at the problems we have on our hands!

Email me or post any questions!
A girl attempting to innovate a bit,

Further Reading

Missed a post? Catch up on my progress through the one-year “Biodesign” fellowship at Stanford which focuses on finding needs, inventing and implementing new biomedical technologies.