I am clueless about many things. As in the definition: “Lacking understanding or knowledge.” As in the sentence: “I have no clue!” As in the 20+ years I spent living with a research scientist and enduring mind-numbingly torturous dinner party conversations about zinc and copper sediment in the Fraser River estuary.
That kind of clueless.
There are some things about which I do have a clue, as is true with even the most profoundly clueless among us.
For instance, with decades of experience working in public relations behind me, I know quite a bit about organizing news conferences, writing speeches, doing interviews with journalists, teaching classes in things like Crisis Communications and Reputation Management, or whipping up a media plan that will guarantee your CEO a mention on the 6 o’clock news.
And as a Mayo Clinic-trained patient advocate, I know a wee bit about cardiology in general, and quite a bit more about my particular obsession: women’s heart disease.
As such, I do have a clue about what it’s like for many of us who live with a chronic and progressive illness.
So I can’t help but notice that the difference between me and a surprising number of other people out there seems to be that I am exquisitely aware of both what I do have a clue about, and what I have no clue whatsoever about on any given subject.
I usually try to keep my mouth shut as much as possible whenever encountering the latter.
The same cannot be said, alas, of some tech-types working in the digital health field – and here’s why I dare to make that observation.
Consider, for example, that the developers, designers and hype-meisters who are making a living selling health tracking technology seem confused by the differences between the keeners of the Quantified Self movement (“Self-Knowledge Through Numbers!”) and what daily life is actually like for Real Live Patients out there.
The first group includes those outliers who genuinely enjoy tracking (and then often sharing) every possible health indicator that’s remotely trackable in life – diet, weight, exercise, mood, sleep, temperature, blood pressure, pulse, hydration, sex life, stool contents (seriously!), etc. When it comes to tracking health indicators, these folks largely represent the self-absorbed worried well.
Real Live Patients, however, are those who live every day with a medical diagnosis that can impact many areas of life which non-patients may take entirely for granted. Why is this? Because when it comes to appreciating an actual patient’s life, non-patients are often quite clueless. Well-meaning maybe, but generally clueless. See also: ‘Healthy Privilege’ – When You Just Can’t Imagine Being Sick or “We Are All Patients!” No, You’re Not.
Physician Dr. Brennan Spiegel at Cedars Sinai Hospital in Los Angeles is a self-described “technophile who loves wearables, mobile health apps, patient provider portals, and all things electronic.” But in an aptly-named recent column he called, “I’ve Never Heard a Patient Ask to Be ‘Empowered’ by Technology”, he bemoaned Technophiles (“with a capital T”) who make sweeping statements about how digital health is “transforming” medicine forever, “democratizing” healthcare for the better, and, most notably, “empowering” patients like nothing ever before.
A good illustration of this flawed hype is an overview in The Atlantic by Thomas Goetz called The Diabetic’s Paradox, in which he offers this caution to the tech vogue of self-tracking.
The original self-trackers, he explains, are people diagnosed with Type 1 diabetes. They have been tracking their blood sugar levels and diet for decades, yet according to a 2012 study, “they largely loathe the experience”:
“Self-monitoring is increasingly being recommended as a panacea for all sorts of health conditions, from obesity and heart disease to sleep and mood disorders.
“The boom in mobile devices has created an ecosystem of sensors, apps, and other self-tracking instruments, all of which are being hailed as a boon to changing people’s behavior and improving their health. A host of new companies are hoping to ride self-tracking to better health and startup wealth.
“But it’s easy to let the futuristic allure of technology obscure the fact that people with diabetes have been tracking their own health for 30 years now. They are the real early adopters here, and their jaded experience challenges those – like myself – who would argue that self-tracking tools are the salve for so many conditions.
“In short, the paradox is this: If self-tracking is so great, why do people living with diabetes hate it so much?”
It’s not just self-tracking for Real Live Patients that Silicon Valley types may be clueless about. The most recent example was this image (courtesy of the brainiacs working at a Silicon Valley company called Medrio), explaining to research clinicians what makes a good clinical trial patient. It seems pretty clear to me (and to all of the other patients who reacted on social media to this boneheaded idea of patients as pigs) that nobody working at Medrio had actually talked to a Real Live Patient before producing this piece of crass stupidity. At the height of the firestorm reaction online, Medrio was forced to issue a public apology.
This kind of clueless helps to explain why sensitive tech-types who are busily inventing the self-tracking technology that’s meant to help the very people who “loathe the experience” of self-tracking might be feeling understandably gobsmacked by such revelations.
Imagine how clueless they might feel if they only bothered to ask questions of somebody like Natasha Gajewski, the uniquely qualified Heart Sisters reader who once contacted me on a similar topic.
Not only is Natasha a Real Live Patient herself, but she happens to have the tech savvy required to design her own health app (unlike the rest of us who have no clue about this).
When she needed a tool to help her perform the task of recording her symptoms as requested by her doctor, she told me that she’d assumed there must already be an app for that already out there:
“But there wasn’t, so I went about making my own. Because I was actively sick at the time, I knew certain things that a healthy person might completely miss – something as simple as not using sliders on a screen because they’re harder to activate (and require more thought) than a button.”
Her insider’s awareness of practical preferences common to certain patient groups (like sliders on a screen, for example) should already be common knowledge among tech start-up types, too. If they don’t know and haven’t bothered to find out, this knowledge gap suggests that they just might be clueless.
They might also be clueless if they haven’t yet looked into the groundbreaking work of those like Dr. Victor Montori and his Mayo Clinic-based team who are studying an initiative known as Minimally Disruptive Medicine to address “the burden of treatment“ among patients living with chronic illnesses. He explains:
“A patient’s education level, literacy, state of depression, pain, fatigue, social connectivity and supports, financial status – all of these affect a patient’s capacity to do the ‘work’ of being sick.
“This workload can simply exceed capacity to cope.”
Are Silicon Valley tech-types even remotely clued in to Dr. Montori’s important work, do you think? See also: An Open Letter to Health App Developers and Their Funders.
The bottom line: people whose very careers are devoted to attracting venture capital, media hype and profits are highly unlikely to change course in midstream just because some pesky patients are trying to get their attention – unless we are prepared to speak out and help educate them whenever we see blatant examples.
They don’t need to listen to the problems of patients, because they already have the solutions.
If only they were not quite so eager to prove it.
Q: Have you run into examples of clueless healthcare communication/products not designed for Real Live Patients?
NOTE FROM CAROLYN: This post originally ran in The Ethical Nag: Marketing Ethics for the Easily Swayed. Read more about what I learned about clueless tech types in my book, A Woman’s Guide to Living With Heart Disease, published by Johns Hopkins University Press. See also: “How a $5 Tim Hortons gift card changed my life“