Do you get the world you build?

I’ve been attending DATE (Design Automation and Test Europe) conference this week in Grenoble and became ill, so I had a chance to experience the French urgent care system. In many superficial ways, it resembles the system I’ve used in the US-but with less lighting. However, there are some really interesting differences in procedures. See what you think and then consider the implications on system design.

I arrived at the urgent care facility straight from the event by taxi. The driver’s English was minimal and so is my French. The driver first took me to a medical office building full of doctors and dentists. Nope, I didn’t need any orthodontia nor do I have rheumatism. Obviously the wrong place. After some mobile phone consultation with the DATE exhibition staff, we climbed back into the cab and backtracked about 10 blocks to a facility that was clearly the right one. It had the French equivalent of “Urgent Care” in big red letters (”urgent” is the same in French) on the side of the building. The taxi driver walked me into the building and waited until I was recognized by the admitting nurse, explaining the situation to her in French. She took my name and asked me to wait.

In less than five minutes, a triage nurse had set up a station in the admitting area that looked like it was the go-to place when things got busy in back. She then took my vitals, much like the US: temperature, blood pressure, heart rate, quick history. The blood pressure cuff and IR thermometer she used look just like the models used by my health-care provider in San Jose. Everything was good, she told me.

Then she took a glucose reading after explaining that she was going to jab my finger in broken English. No poking needles without the patient’s understanding and permission. The glucose was good and so we knew a lot that wasn’t wrong before I even got past the big electric door to the business end of the clinic. The glucometer would not have looked out of place on the shelf behind the counter at Walgreen’s pharmacy in San Jose.

The nurse who led me to an exam room spoke a lot more English. She took more history on a computer, just like in San Jose. I was having several problems and you don’t need those details. Let it be said I was somewhat uncomfortable, but not really in pain. A second nurse joined to take my vital signs again. Same equipment, but she wanted me to tell her what the equipment was named in English after she used it.

“Blood pressure cuff” I said, which got a smile. “Sphygmanometer” didn’t elicit the same smile. “I know too many words,” I thought, “best not to get too technical.”

“Thermometer” I said. Another smile. “Infrared thermometer”-no response.

Seeing that I was not going to conk, the nurses left me to lay down and wait for a doctor, who arrived a long time later. Busy day at the urgent care clinic. The doctor read the history from the computer display, “hmm”ing a few times to himself. Then he started to ask questions. In French. He had no English to speak of, particularly in medical terminology and I’m completely off the map in a medical clinic with my movie French, even if I did see two French films last week at Cinequest in San Jose. (I cheated, subtitles.) But the doctor was determined and we found a way to communicate. The doctor ordered tests. First up, urinalysis. Well, that made me snort quietly because I’d just found a new intersection between French and English: pipi.

That test started the usual way. Here’s the cup, there’s the toilet. However, where we usually hand the cup over to a lab where it mysteriously disappears, here in the French urgent care clinic we take the cup back into the exam room and the nurse dunked in a test strip. We both watched things develop. She helped me interpret it. Stuff in there that’s not supposed to be there.

I got the results before the doctor.

“That’s something different,” I thought. It’s actually how I‘d like to be treated all the time. I want to know what’s going on instead of having the lab be a roadblock between patient and results. Usually at home, I’m content to have things the way they are-because that’s the way they’ve always been. I prefer to be engaged as I was here, I think.

Based on the urinalysis result, the doctor decided that he needed some imaging. At first, he wanted an ultrasound test but later decided to get a CT scan instead. “I hope my credit card can take this,” I thought. I was waiting for the CT scan tech to come fetch me, but the ultrasound tech got me first. It had been 30 minutes-not much of a wait. The ultrasound tech hadn’t been told that he’d been scrubbed from the mission, and I didn’t argue cause it’s just ultrasound. I lay down, pulled up my dress shirt, and the ultrasound tech squirted goop on my abdomen. He quickly asked me about issues so he’d know what to image, and then he did something that was again different from my US experiences. He intentionally turned the imaging screen so I could see my insides along with him, and I wasn’t even having a baby!

The ultrasound tech looked where the doctor wanted him to look. We also looked where I wanted him to look. Neither of us saw anything out of the ordinary. But what would I know anyway. I couldn’t even figure out what organs we were looking at. Ultrasound images sure are murky. Interesting anyway. By the way, that ultrasound imager isn’t any different than the ones I’d see in San Jose.

While I was still on the ultrasound table, the CT radiologist strolled in to find me in the wrong diagnostic procedure, which we’d just completed. I got up and got ready for the CT scan. Again, exactly the same model CT scanner as the one my urgent care facility uses in the US-with one obvious difference. When it’s time to hold your breath, the French version of the scanner speaks in French. Better know the drill ahead of time if you don’t speak French. Deep breath. Hold it. Let it out. Do it again.

I was at the clinic for another two or three hours and you don’t need the details. However, I was impressed by the care I got, by the close engagement with everyone at the facility. Every doctor, nurse, and tech engaged me as a person and not as a patient. They didn’t dumb anything down, they didn’t withhold results, they didn’t flinch at messy stuff. Just matter-of-fact “this is what you need to do, any questions.” I liked it.

So what’s this little slice of life doing in EDN? What’s the connection? On the TGV from Grenoble to Paris, reviewing this tableau in my mind made me think a lot about how we design systems. I know that sometimes designers will dumb a product down because there’s an explicit or implicit assumption that the user is stupid or that the user will be scared by complexity. Don’t want to scare the user. We see that a lot in the US. Automobile gauges have all but disappeared, partly for cost and partly for a general de-complexification of the art of driving. Race drivers don’t need “check engine” lights; they have full telemetry sent to the pit by wireless. All of our new cars now have full telemetry too; we’re just not allowed to see it without a $1000 on-board diagnostic tester.

Now, not all de-complexification is bad. Some of it is very good. The first minicomputers I used had to have boot loaders toggled in by bat-handled switches before they’d boot off disk (if there even was a disk) because there was no such thing as boot ROM. We don’t need that kind of complexity anymore and that’s a good thing. I’m happy just to press the “on” button, as long as the computer boots.

However, I think that the relentless pursuit of de-complexification might be a bad thing.

Will people live down to your expectations? Do your system-design decisions make for dumber users? Are your assumptions driving things the wrong way? I don’t mind seeing a test strip dropped into my own pipi or seeing my insides in real time but others might. Are they like that because it’s inherent? I don’t think so. The French don’t seem to mind. In fact, the French aren’t bothered by a lot of things that bother us in America. So the sensitivities must be shaped by societal expectations. (Not making a value judgment here, just an observation that I’m sure rubs two ways.)

Think about that the next time you develop the definition for a product.