Photo by Lisa Fotios
We are flooded with information and are addicited. To news. To social media. To research articles on how AI is revolutionizing the way we code and write content.
In this post, I look at information addiction in healthcare. I will propose a method of controlled messaging based on Knuth’s Literate programming in order to reduce cognitive load.
In other words - reduce the amount of noise around us.
Why do we believe we are not getting the right answers from our doctor?
A study in the Tel Aviv Medical Center examined the phenomenon of perceived information quality and availability after realizing that in the hospital, many patients (and their family) felt they were not getting answers — even though the doctors and the medical staff felt that they (the staff) provide them (the patients and family members) with lots of information via interaction in the hospital, by phone, email, at the bedside and in formal letters.
The data from the hospital showed a gap between what the staff were doing and patients/family members prevalent perception that are not getting good enough information from the hospital staff.
The study uncovered that when patients do have a face-to-face meeting with a doctor in the quiet of the office, they almost always feel that they have been given valuable information, even if they are unhappy with the answers or want to seek a second opinion. A zoom session with the patient is good, but not a replacement for face-to-face interaction.
The key seems to be the setting of how the information is provided and not the quality or essence of the information itself.
Why does this happen? We can understand this by studying framing effects.
Utility is reference-based and not additive
As prospect theory predicts, utility (the value of a product or service) is reference-based and not additive.
What does that mean?
Reference-based value means that more data from medical staff and support groups is less valuable than data received when the frame of reference is a private consultation with a specialist.
Framing favors patients overrating the physical visit with a doctor and underrating generally available digital communications in social media and online search.
Framing suggests that more face-to-face interaction between patients and sites in decentralized clinical trials.may be key to the success of decentralized clinical trials.
Framing effects may also be related to cultural and societal factors. In countries where doctors function within a hierarchy, patients will tend value personal visits to specialists over email, social media, Dr. Google and online patient forums.
Framing effects create mismatched perceptions and expectations in an asymmetric relationship — where patients (at the bottom of the totem pole) get information but do not value it and doctors (the experts at the top of the totem pole) provide information and expect the patient to value the information and become frustrated when the patient downgrades the value of their messages.
2 anecdotes of how digital technology works in patient communications
There is a head of a CF Unit who gives out his mobile phone number to patients and gets over 400 calls/texts a day.
He does this for marketing reasons, because he feels it differentiates him from other specialists and gets him more private patients but his life is indentured to his phone.
Several years ago, because of pressure from patients to answer emails, the head of neurology found himself caught in a vicious cycle of patients getting email messages and expecting immediate answers. He also felt that the emails were not necessarily related to his clinical overview of the patient and possibly created risk exposure. He now writes a short summary letter after an office visit with a patient, prints it out, stamps it with his MD license number and snail-mails it to the patient, explaining that all their communications will be by letters in snail-mail. This slows down the pace, enables him to control the flow and stay focused on the clinical side of patient care.
He confesses that this feels like a retrogressive and archaic solution and wonders if this is the best that digital technology can offer him.
He is technology-adept and would love to adopt digital tools for his patient-doctor communications, but doesn’t see how the current messaging paradigm of email/short text breaks the paradox. As he put it, “if it looks like email, smells like email and functions like email, people will continue to have email expectations of receiving answers immediately.”.
Speculations on alternatives for better messaging
The problem of messaging not achieving it’s goals of making our lives easier has been studied extensively by Sherry Turkle and described in her book — “Connected but alone”. Turkle’s book is interesting but doesn’t offer any solutions.
Social and cultural factors are beyond our control; but the technology is under our control.
We need to consider design alternatives for messaging.
We might consider a different user interface for messaging, one that does not look and smell like email and one that will enable sender and receiver to agree on committed response times.
We may speculate about a drag and drop UI for exchanging messages with patients using a contract of mutually-agreed response time, for example a negotiated cycle time of 1 week for head of neurology and a negotiated cycle time of 10′ for chief of CF.
We may speculate that if the messages looked like formal letters in PDF format from the physician, then the value and risk management issues of email would be mitigated.
We of course can do the simple thing like writing letters, meeting in person and turning off our phones but it seems to me that the technology needs to be improved to enable us to govern the message flow to our own person cycle times, to interact with friends in small clusters and not be distracted by birthdays, food and pet pictures and advertising.
Controlled literacy and negotiated primary response times
There is a methodology created by Donald Knuth called Literate programming
The analog of this would be literate writing for messaging.
An ideal model for messaging would support both short message texting (low fidelity content) and literate writing (high fidelity content) and include negotiated cycle times between sender and receiver in order to solve the problem of unmet expectations.
A system of low and high-fidelity messaging with negotiated cycle times would reduce our cognitive load and enable us to pay more attention to problem solving.