Bad Patient

Hiding from the sun under a floppy hat with a pouty scowl,       

then later being buried by a toddler.       

What is it about being told you can't do something that makes it that much harder to resist? In the deep recesses of the human psyche, everyone has a primal urge to bend rules. I don't have any formal research to prove or disprove this, other than the anecdotes of others and my own experiences, but I'm guessing most people can relate.

Having no history of skin cancer in my family, or even that many moles to speak of, I assumed my overall risk was fairly low. In any event, I decided this year I would finally go for a screening. It felt like something I should do as a responsible adult, along with recycling, investing, and backing up files to the cloud.

To my surprise, I had one case of mild dysplasia. Since its a very low risk this type of mole would ever evolve into anything more serious, the dermatologist gave me the option to excise it, or to leave it alone and monitor for changes. Not wanting to risk the wrath of future Carla if this thing ever became an issue, I went ahead with the excision.

The whole procedure lasted all of 9 minutes, with an added 10 minutes spent sparring with the dermatologist about activity restrictions that would follow for the next 2 weeks. This is where the struggle begins between the rational, educated, healthcare provider, evidence based part of my brain and the defiant, fitness enthusiast, autonomous, stubborn part - the part that I try to keep in check.

Its true that you don't always appreciate all the things your body is capable of until a restriction is placed upon it. The most distressing part of every injury I've sustained has always been the immediate realization that my life (which is happiest when active and in motion) will be put on pause for any given number of days or weeks to heal. I'll survive the next 2 weeks, and can certainly appreciate how trivial this whole ordeal is compared to the restrictions one might face with a more complex procedure.

All the same, its going to be a cranky couple of days around here until I'm back on my grind. Though, after reading a few disturbing posts on the #livestrong message board relaying the horrors of burst stitches and delayed healing time, I'm going to try and be a good patient.

Not All Talk Is Cheap

This was part of an ad posted in the subway. It was eye catching, not only because I had a 17 minute wait for the G train to peruse my surroundings, but also because it speaks a certain truth.

Early Morning Motivation

Great ad. Definitely made me push a little harder in the gym this morning as I spotted it for the first time on TV.

Coaching Communication

I was drawn to OpenIDEO's recent design challenge which asks the question "How might we all maintain well-being and thrive as we age?"

While a little late to the party, I managed to draft up a concept to submit with 46 hours left on the clock. There are some kinks to work out, but overall I was happy to be part of the project and am looking forward to seeing how it evolves.

I highly recommend getting involved in an OpenIDEO challenge to any of you reading. You'll find it rewarding, I promise.

In a nutshell, my concept proposes crowdsourcing the valuable advice of subject matter experts in a wide variety of health & wellness disciplines. Its called, Braintrust. Anyone from a cardiologist to a tai chi practitioner would be part of the network. Similar to the TaskRabbit model, these experts would be vetted through formal channels, and paid, to provide objective information to users which in turn could better equip them for future communication with their doctor, therapist, social worker, etc...

How many times have you left the doctor's office and kicked yourself for forgetting to mention something that worried you, or frustrated by the limited time you had to engage in a discussion? Its often about asking the "right questions"when attempting to get the most of an interaction with a health care professional. Having worked in health care, I now find myself coaching my parents before appointments with their physicians to make sure they exhaust all avenues.

Below is a quick mock-up of what the site could be.

Ergonomics For New Parents

This month you can read an article in the print edition of Fit Pregnancy (in which I was interviewed) which emphasizes ergonomics in the home and nursery following the birth of a new baby.

I'm not a parent, so I do admittedly feel a bit sheepish telling my friends (who are parents) how to do anything related to child care. However, it just so happens that when confronted with a huge new responsibility, the last thing a new parent is thinking about is themselves. This is where I'm able to offer some insight as someone who understands the necessity of ergonomics in any context.

Here is a preview of the article below. Enjoy!

Art in an Unlikely Environment

Untitled 2012
NYC

Would you buy this piece? I would.
Would you believe its actually a series of drawings produced by a bored hospital patient on paper napkins? You should, because this is exactly what I encountered this past weekend while working. Even though I was wearing my therapist hat that day, the quality of this effort was not lost on me.

It immediately caught my eye upon walking into the room. The artist was humble about the work, unwilling to admit that their wall treatment had added significant value to an otherwise 'artistically-bankrupt' room.

This seemingly simple statement was a way for the patient to exert some influence and possibly even minor control over their environment. This is understandable, in a place where your sleeping, bathing, socializing, eating and elimination are controlled and monitored at all times. When I asked the patient about the work, they confessed that they are an artist by trade and that they found doodling to be an enjoyable way to pass the time. The more I probed, I found out that the patient also found this practice comforting.

The infusion of individual influence on the immediate environment has a therapeutic value, and is an inherent psychological response. Whether adding artwork, arranging items in space, or changing the color of a wall, its evident that we all have preferences that resonate in our personal space, even if that space is only temporarily personal. In the case of my patient/artist, there was something calming and enjoyable about being surrounded by visually interesting stimuli. For others, it could be a certain type of music, or quality of light.

Promoting and encouraging this phenomenon in healthcare settings is entirely feasible and seems like a worthwhile venture, especially in a place like NYC where artists are possibly our best natural resource. In addition, allowing personal influence over space would likely impact quality indicators such as patient satisfaction scores. 

Pinking & Shrinking: Design For Women Gone Wrong

Many of you undoubtedly read about Honda's newest woman-focused car "She's". Honda replaced the apostrophe in the name "She's" with a heart, because they realized that secretly all women would prefer that their vehicles were designed by Lisa Frank.

Honda Fit 'She's'

After getting past the name, which was a bit of a struggle, I took the time to learn more about it before passing judgement too early. Then I read about the features that made She's a truly feminine vehicle according to Honda:
"available colors: pink and eyeliner brown"
"UV protective windshield to prevent wrinkles"
No mention of She's performance, fuel efficiency, engine power, or safety features (beyond the ones that maintain facial beauty).

Judgement passed.

Its been a tough couple of months for us women, between all of the 'legitimate rape' rhetoric of late, 'women in binders', and now a car geared towards women that touts superficiality over actual performance and reliability. Its become exceedingly difficult not to become frustrated as a woman who was raised to expect so much more from society and herself.

Honda is not releasing She's in the US, because they're familiar enough with the market to know it may not go over so well in a country where female subservience is less acceptable.
Maybe that's a small victory in disguise, but the fact that they've still manufactured a vehicle under the assumption that She's (with all of its cosmetic treatments and superfluous features) is what women would prefer is disturbing on many levels.

Not to say that automotive design shouldn't consider the needs and interests of female consumers, because there are differences between men and women...but also between women, and between men. Human factors including height, weight, reach, grip strength, reflexes, and reaction rates, apply to every human that operates a car. Also, why is UV protection only touted as a feature in the She's? Don't men like protection against skin cancer too? And are gender roles still really so separate that the color of a car defines whether a man or woman drives it?

When "pinking & shrinking" effects the quality or performance of a product, its not only often poorly done, its bad business. 

Honda isn't the only company guilty of pink washing products in an attempt to woo women. Maybe some women do feel more feminine and beautiful when holding a pink rifle, and that's fine. Just don't insult that woman by selling her a rifle designed to double as a handbag, that improves her ability to attract men,
when all she's really trying to do is shoot with accuracy.

The Power of 'Perceived Benefit': Kinesio Tape and Other Curiosities

Kinesio Tape was mentioned in NPR's health blog, Shots, and as a therapist it caught my attention. The article, entitled "Kinesio Tape Plasters Olympians, But Not All The Science Sticks", discusses the increased use of the product and questions the validity of its claims.

As a clinician, I would venture to say that most therapists see Kinesio tape not as curative, but as a treatment modality. It is one of many methods used to treat a patient depending on various factors, including the diagnosis and patient compliance. Some patients do experience benefits from the support taping provides, which allows them to return to peak performance more quickly, and some do not.

Whenever I see ads in trade publications for Kinesio Tape training clinics, I think about what a big business this product is, between profits from clinics, to the fees for their intensive training seminars, to the unpaid endorsement provided by professional and olympic athletes seen wrapped in Kinesio Tape during competition.

All of this is fascinating, especially when you get to the last few paragraphs of the article...

Even Good [international director of the Kinesio Holding Corporation]admits that the science hasn't caught up with the anecdotal evidence and the results that athletes have seen with Kinesio tape. But Powell [associate professor of sports medicine at the University of Utah School of Medicine] says that in the athletic community, a lack of hard evidence may not even matter.

"Anything that [athletes] perceive as an edge, they'll try, whether it's scientific or not. And the athletes are convinced that [Kinesio tape] is really helpful," she says. "It wouldn't be the worst placebo in the world; it's not doing any harm."

Of course one could argue that the actual harm lies in the false sense of security provided by a modality that hasn't been clinically proven to benefit the user in the way in which it claims. 

Still we look to find a reason to believe.

We subscribe to certain diets, embrace the latest exercise crazes (shake weights?), take the newest 'miracle' supplements, and believe in the healing powers of countless non-evidenced based treatments.

Here is where my design thinking starts to kick in. Caution, worlds are colliding.

Do things sometimes work better because we want them to? Does wishful thinking play a role in a product's success? Clearly to some degree, the answer is yes. Clever marketing, branding, and even packaging all help in shaping our perceptions of products and services. However, the real driver in the case of products like Kinesio Tape is the power of innate human motivation, and perhaps psychosomatic influence resulting from the placebo effect.

So why is Kinesio Tape such a successful concept? What lends to such a strong perceived benefit? Here are my observations...

1. Some evidence of legitimate science

In the case of Kinesio Tape, the method of tape application is based on the anatomy of our joints, tendons, muscles and ligaments. It mimics lines of pull, agonistic and antagonistic movements, and range of motion. I don't doubt that there is some scientific foundation behind the development of Kinesio Tape, given the anatomical rationale behind the product's clinical application. 

2. Engages the senses

It resonates on a sensory level, giving us immediate feedback during our every movement. One can feel the pull of the tape on the skin, and the pressure it applies to the body. It seems that if nothing else, the tape increases body awareness as it draws attention to movement patterns and anatomy. The bright colors grab your attention, almost showcasing your battle wounds with pride and flair. 

3. Minimally invasive

It doesn't require a prescription, or a medical procedure. Being an over the counter product makes it much less intimidating.

4. Positive associations

We see it on professional athletes and olympians in radiant neon colors. Its a lot less bulky and restrictive than a brace, splint or sling, and not associated with severe injuries. 

5. Expertise required

Kinesio Tape is applied by a trained professional, giving the patient a much greater sense of security and thus significantly adding both real and perceived benefit.

Obviously, understanding the different aspects of motivation, perception, and actual benefit, can inform design strategy. Ideally, it would be nice to see 'actual benefit' be the priority.

Design in Clinical Environments

Here is a recent article from McKnight's Assisted Living discussing design considerations in clinical spaces. Too bad the author got my credentials wrong, but at least she didn't spell my last name 'Jasper'.
http://tinyurl.com/bul9fbg

Featured in Metropolis

The Mainframe, an object which adapts to serve three different functional purposes depending on user needs, was featured in Metropolis!

 

A recent read on Fast Company

I came across an interesting article on Fast Company regarding an observation on the structure and function of US pharmacies

www.fastcodesign.com

Upon reading the article, I started thinking about my personal experiences at the pharmacy, and how I would access a pharmacist if I needed consultation. You can read my comments posted below the article itself.


Would it be possible to apply a system modeled after a 'doctor-patient' relationship, in which the patient (or pharmacy customer) has consistent interaction with a specific pharmacist who understands their medication regimen? 


Most drug store pharmacies operate sort of like an emergency room, with the first available clinician tending to patient needs as they arrive. While this is necessary when dealing with high patient volumes (a definite similarity in both instances), might the consistency of return customers in the case of the pharmacy be an opportunity for clinical familiarity over time? Especially if the customer is known to the pharmacist through both direct contact, as well as contact with their prescribing physician. 


Similar to an ER, a pharmacy could also benefit from a person to handle triage, determining which patient questions demand a pharmacist's attention and which could be addressed by anyone else on staff.


Consistency seems to be of interest, due to the opportunity for increased familiarity between pharmacist and patient, and ultimately improved service. 

Why should you care about EHR?

Having worked in several hospitals over the past 10 years, only twice have I used electronic health records (EHR) for documentation. 


Seem crazy? It is. Especially being from a generation that grew up with computers. It is archaic and unfathomable to my peers, (who work outside of health care) that institutions as important as hospitals would still use paper records. 

A recent article from Bloomberg provides more background on the issue.

(*this article was published before the Patient Protection and Affordable Care Act was upheld.  previously, the HITECH Act addressed the necessity of EHR)

I wish I could photograph some of the hospital charts I work with and post them on this blog... to share with others the hieroglyphic-like handwriting of doctors that I'm somehow expected to decipher. Not only is it unreasonable and ridiculous, its unsafe. If I miss a 'Hold tx' order for a test to rule out diagnoses like neuro-vascular accidents, I could potentially jeopardize patient safety through my intervention. 


Speaking from experience as a clinician familiar with EHR, it significantly improves your ability to provide quality care. Having immediate access to legible notes from every medical team involved in the patient's care (*typically there are several specialties involved in a patient's plan of care) allows you to quickly develop an informed clinical picture that guides your rationale for treatment. It also increases productivity, allowing you to digest twice, if not thrice as much information in one sitting.


In addition, your records are always more in depth because you're able to type so much quicker than you write (shocking!). Thorough documentation is helpful to everyone else who interacts with the patient throughout the day, and paints a much more detailed picture of their status from hour to hour. 


Conversion to EHR is an ongoing evolution that will require a lot of patience, effort (read: money) and time. However, its estimated that under new legislation which incentivizes computerized documentation, 50% of private practices and hospitals will be functioning on EHR by the end of this year.


For my designer friends out there, think about the possibilities of creating a system that adheres to HIPAA standards, allows doctors from various health systems to exchange information, and offers a simple interface that is sexy and easy to learn (two elusive terms in health care vernacular). Surprisingly enough, this magical system doesn't yet exist, and several of the largest software companies in the world are still trying to resolve the issue. In an attempt to dominate the market, each company has created their own system which doesn't communicate with other systems (sounds familiar). So what are you waiting for, designers? 

Stretching the boundaries of Design

Recently, I wrote an article in collaboration with Omhu, to emphasize the influence of perception on individual choices and behavior. Read the article which ran in both Advance for Physical Therapy & Rehab Medicine, and Advance for Occupational Therapy !




The take home message reinforces the need for design language that acknowledges object relevance in a variety of contexts. As designers, the ability to focus our energy on meeting anticipated needs that may develop over time, requires an understanding of our functional trajectory throughout the lifespan. We also need to be aware that the onset of mature age does not automatically mean we all of a sudden like surrounding ourselves with depressing artifacts!


It also brings up an interesting point on patient compliance. Might people be more accepting of an assistive device (ie. cane, walker) if the form was generally accepted to be beautiful or luxurious? I find this compelling, since patient compliance is typically a major safety risk and accounts for needless falls, injuries & subsequent medical care.


Seems like an interesting area of research, no?


Hopefully this article motivates Therapists to gain greater awareness of objects and services which are relevant to their clients' needs, without the negative stigma that has been present in assistive devices for far too long. As for Designers, hopefully it encourages them to push the limits of their concepts to satisfy the needs of today and tomorrow.

Words That Inspire Design

My ongoing film tangent

This movie has been out for quite a while, but I rediscovered it again this week, recalling how much I loved it the first time I saw it. Bill Cunningham New York is a lovely film about Bill, a long time photographer of everything fashion. We've all seen his spreads in the Times, and perhaps at times even been influenced by his observations. It is an inspiring story about a remarkable person, still doing what he loves well into his 80's. Since living in New York, I've always secretly hoped someday I'd wear something brilliant enough to catch his eye...someday Bill, someday!

Reelabilities Film Festival in NYC

Starting next week on February 9th, the Reelabilities Film Festival will feature a series of works
which portray various disabilities, increasing awareness through artful & beautiful story telling.

From Reelabilities.org :

"ReelAbilities: NY Disabilities Film Festival is the largest festival in the country dedicated to promoting awareness and appreciation of the lives, stories and artistic expressions of people with different disabilities. Initiated in NY in 2007, the festival presents award winning films by and about people with disabilities in multiple locations throughout each hosting city. Post-screening discussions and other engaging programs bring together the community to explore, discuss, embrace, and celebrate the diversity of our shared human experience."

Personally, I have my eye on Aphasia, and Girlfriend.

Check out the list of featured films here.

If you're annoyed, chances are others may be too

Great article in the Times featuring Marc Newson today. A person who's earned respect for his successful approach to design in various applications, Newson demonstrates the benefits of infusing actual Design in universal design.

In the article, Newson states that '99% of door handles bug him'. His design response is lauded by design enthusiasts, and perhaps more importantly addresses accessibility without sacrificing a design language consistent with his usual touch of simplicity and sophistication.


Perhaps the best part about the design is the fact that Newson was compelled to re-design the handle because it annoyed him. Nothing is more motivating than designing something you know can be done better. Plus, if it annoys you, there's a good chance that it annoys someone else out there, too.  What could be a more effective way to channel negative emotions (i.e. being annoyed) than to respond with a productive solution? Being annoyed with the frustratingly bad design of hospital environments is what initiated my pursuit of a career in design. Being annoyed brought people to Zuccotti Park for the OWS protests. It seems that 'being annoyed' can compel people to do powerful things, when channeled effectively.


So the next time you find yourself cursing some inefficient banal object, environment, or situation, harness your annoyed state (and creativity) and make something happen...or consult a designer.

Scale project updates & progress

As I continue to develop my scale concept, I've started to make some progress in the way of finding a technology that is low profile and will provide the desired response. Check out the latest and greatest little load sensor!

Now that the technical part is resolved, I can focus on making it something you could comfortably live with in your home. I did a quick comparison study between the wheelchair 'footprint' and the natural stance (feet shoulder width apart). See results below...

(top left: wheel chair point of contact // top right: feet in natural stance within the footprint left from the wheelchair // bottom left: wheelchair footprint // bottom right: anatomical vs. natural stance)

 Its seems like a low profile platform of ample dimensions could be a comfortable solution for everyone given that not many of us stand "at attention" in anatomical position, especially not as we age and often require a larger base of support to maintain our balance.

Earlier today, I can across a scale that was featured on the website Spinalistips. I was in awe of the work that went into crafting this adapted model, but also felt that it illustrates quite strongly the relevance of my project, as there are not many options for consumers in wheelchairs.

Home Ergonomics

Read a recent piece I'm quoted in discussing ergonomics for the home. Most of us don't realize just how much of an impact simple adjustments can make.
http://gettysburgtimes.ctwfeatures.com/home/home_20111012_ergonomics.html

To read the rest click the url above!

Evening at NYC Resistor

Tonight I went to Craft Night at NYC resistor to get some technical advice for the scale I've been developing as part of thesis. I've designed a scale that is extremely flat, almost level with the floor, to be effortlessly accessed by stepping or rolling onto. The design considers that not everyone weighs themselves standing, and that most bathroom scales are not useful to those using a wheelchair. Also, since not everyone is able view the floor display, a wireless display is visible from the wall or counter.

So after studying varied user needs, the next step was to hack a scale I bought on Amazon...

The very helpful group at NYC resistor offered some suggestions for making a working prototype.

      

So the next step is finding either a solution with piezo conductive fabric, or flat load cells, or both?

More to come...