In any case, design thinking was influential in clarifying a mindset for thinking about user and customer experiences called human-centered design (HCD).4 In HCD, the process is focused on improving the user experience and usability. A great deal of variability in the theoretical underpinnings and practical applications of HCD remains, but broadly, HCD focuses on three steps—inspiration, ideation and implementation. In these three steps, there is convergent and divergent thinking, in which new ideas are generated and are then winnowed to get toward a solution.
As we’ve been redesigning The Rheumatologist, we’ve been adopting the process of design thinking and the mindset of HCD. We have nestled the three steps of HCD into the five, non-linear stages of design thinking (i.e., empathize, define, ideate, prototype and test).5 In the process, we’ve challenged assumptions and conventions to serve you better.
But how does this work in a busy rheumatology clinic? I am a relative newcomer to design thinking, but I would contend that all healthcare team members are designers at heart and that, at a very deep level, we instinctively understand the principles of design thinking and human-centered design, even if we don’t know the lingo.
Empathize: The First Duty of the Physician
Sir William Osler, the 19th century pioneer of American medicine, once counseled his trainees to “Listen to your patient; he is telling you the diagnosis.”6 Although many things Dr. Osler said and did have aged poorly—even the rather presumptive “he” in this quote—his advice is worthy of meditation. After all, what Dr. Osler is getting at is empathy. Listening to patients and truly trying to understand their circumstances in the context of their disease is the ideal goal of any healthcare team member. The same is true for design thinking. Empathy is the core and essential first stage in design thinking.
Arguably, empathizing is the hidden part of the iceberg in all our interactions. In this context, empathy means more than having the ability to understand another’s feelings. Empathy here refers to a deep understanding of another person, their wants, needs and objectives. Good clinicians, like good designers, are interested in not only matters of the mind, but also issues of the heart. What makes us feel this way or that way? Which assumptions are worthy of examining and reexamining? Can we find points of similarity and difference in lived experiences?
Conventional ways of understanding patients (or people in general) have employed surveys. They remain a mainstay of understanding sentiment. An extensive science, backed by psychometric data, shows the important role of surveys in characterizing those we serve. And yet, these numbers, comforting as they are, do not help us truly empathize because they reduce people to a set of mostly noninteracting, nondimensional scales. And that’s not even taking into account poorly made surveys whose results are as questionable as their questions.7
