In this article, we’ll discuss the concept of design which is applied to medical diagnosis or medical arts. In particular, we’ll examine the way that design questions and tools play out in clinical settings, specifically around what is a “best practice”, “standard”, and how best to apply them.
The field of design is concerned with the generation of ideas and the making-into-reality of those ideas. The etymology of the word “design” is from the Latin ‘to mark out’ and from the French ‘to conceive’. In a variety of disciplines, Design is an activity that interprets needs, generates ideas and transforms them into objects. It includes a wide range of occupations, including such fields as industrial design, fashion design, interior design and landscape design. Many engineers use designing when they are working on a new product or building: they will think about how things work together for their clients or customers. In the medical arts we can recognize that there are some similar processes at play but in slightly different contexts.
The terms “design” and “diagnosis” are relatively interchangeable, but there is important distinction here. A patient may have a bad reaction to something, for example they get a cold and develop a sore throat: the clinical diagnosis of sore throat is indeed suitable for this situation. But a doctor will also perform an investigation into their medical history, what symptoms they’ve had before and how these might fit in with the description of illness. This is how things are diagnosed: by using clinical examination, tests such as blood tests or X-Ray which will provide information about disease or conditions concerning health status. These tests form the basis of the diagnostic procedure performed on patients. Design does not only consider the needs of the end user, but also puts into practice a method of eliciting needs from users by questioning them about their own experience. It is a formal, structured method of understanding what people need.
Best Practice, Standard and Measurement
Standard medicine is just that: it sets the bar. The standard for HIV treatment in South Africa has been changed from AZT to 3TC and then to Combivir. The standard before this was AZT or none at all. The essential notion that is missing from these standards is feedback. The standard for treatment is not set according to what percentage of infected people need certain medication, but what percentage of people who have been exposed to HIV and still remain healthy need the medicine. Others describe the standard as a “trial-and-error” process in which new drugs are tested in hospitals and then recommended for wider use. This is how we do it in fashion: try something, see if it works (without knowing why).
The idea of a standard is important because it asks two questions:
1. What do you need?
This is one of the main aims of design. It looks at the measurable aspects of a patient, such as what they weigh or how tall they are and then makes something for them. The question is what they need, and in discussing this we move into the subject-matter for this article: design in medicine diagnosis. Design does not only involve the generation of ideas but also the making-into-reality and making use of those ideas in a practical context on patients. Designers do not just concentrate on conceptualization; they want to make something real that can be used as a tool by practitioners such as doctors.
2. How can we achieve this?
This is the more general and difficult task of design. How do you get people who might not be able to afford it, or have a disability such as long term illness to access things like food, housing, or health care in a way that works for them? It is important for designers to look at the specific ways in which people use things: how they use their existing kitchen utensils and bedding. Can they afford new bedding? Or perhaps new kitchen utensils because of the extra work needed by the elderly? Or perhaps, it’s not about what should be done right now but rather what they do currently, and this can be improved. The question is how best to reach them.
The best practice for health practitioners is to figure out what you need and then how to achieve this: the second question is more general and goes beyond the needs of the patient, it is a question about how a doctor might function and act in a medical setting. And as designers move their attention—at least in part—over to medical settings, there are some interesting questions around best practise that we ought to discuss. Designers have been much more involved with clinical applications over the past decade, or so. In a lot of design education it has taken on an almost-obsession with making things look pretty: appearances have become almost paramount when really they are not that important (in comparison). Designers ought to understand that the user experience is more than just what you see and feel; it’s also how you use it, how you live with it, and ultimately, what happens to you as a person when you use a product or service. Designers are not used to thinking about the end-to-end processes required for the user of their product or service: they are only concerned with making things look pretty. But these things do not work in isolation: there is no separation between design and what people consider “living”.
Medical arts don’t have standardization. New drugs are designed by pharmaceutical companies and then tested in hospitals to see if they have an effect on patients before they are approved and recommended for a wider use. How it is used, how the doctors decide what drug will work best for a specific patient, varies from hospital to hospital and doctor to doctor; there does not seem to be any one acknowledged way of doing it. The first step is diagnosis: there must be a way in which this is done right at the beginning. The first step is to know what that diagnosis is, but how do you know what the diagnosis is? Even with modern technology there are still some diagnoses which are a bit of a grey area.
Here, the process starts with an endoscopy: doctors take out a biopsy and then put it under a microscope and try to identify what it is. It can be quite difficult, even for doctors who have a lot of experience. A lot of the time they can identify where it is coming from but they are not sure exactly what it is, so they then use conventional methods to do a diagnosis. Some doctors might compare the tissue with medical records of similar cases, or look at the family history but often it’s a hit-and-miss process. There are also specialized tests which can be done, such as endoscopies with gastroscopes or endoscopies like colonoscopies where images are taken instead of biopsies. These give more definitive information and can be more useful to the doctors for treating patients.
So with modern technology the doctors have a better way of working, but ultimately the diagnoses and treatment will be subject to human emotion and judgement. Excellent medical care can be available to millions using the latest diagnostic techniques, but if these do not work for a patient then there will always be an element of uncertainty as to why. The best way to determine whether a diagnosis fits is through clinical experience and understanding; while doctors can acquire this through training, some may never achieve it. This does not necessarily mean that their judgement is faulty; it just means that they are not omniscient. A doctor should not be expected to provide a definitive diagnosis with a magic pill – just as they cannot treat everything using only the latest technology. Although it is impossible to be entirely sure, the doctors will attempt their best and if they do not know why then it’s because of their inability to find out and an inability to do more. The final judgement on whether or not it is a medical mystery comes from the patient – not from anyone else. Those who say otherwise are relying on someone else for their diagnosis. The patient judges whether the doctor is worthy of their trust and must be the last to judge their doctor – not their family members. If you are the ‘patient’ then the doctor should provide a diagnosis and allow you to find out for yourself if it makes sense or not. It will only be fair for both parties if they do this.