This year I interned at Dr. Ziauddin Hospital during my biomedical engineering studies. Much of what I learned there was not to be found in books. At the moment it was standing next to a machine, doing its job perfectly, and the patient attached to it, looking totally lost.
Medical devices are manufactured to perform accurately. They have to be quick, believable to the physician that reads the number, fail-safe, and satisfy regulatory requirements that require years to pass. Everything counts and nothing is incorrect. But hardly any of this is designed with the person below the sensor in mind.
I remember a patient that was connected to a monitor that beeped every time a reading went over a certain limit, and it did that a lot, because this was the limit that was programmed to be a clinical warning, not the limit that a frightened person would hear when a machine near her bed started sounding. She was not told what the beep was. She was merely listening and took it to mean something was amiss. It functioned just as it had been designed. It was created with the nurse in mind, not for her comprehension.
This is not a one-off. Pulse oximeters, infusion pumps, ECG leads, even the paper-nabbing technology such as check-in kiosks, almost anything is built around the person using it, not the person it’s attached to. In user-centered design, the user typically is the clinician. The patient is not a user at all but an object being measured.
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I don’t believe it is done out of negligence. The clinical accuracy must be first, and engineers are working on the constraints that they are given: regulatory, cost, integration with the hospital system and clinician workflow. Patient experience is not often a requirement that’s listed, and it is not often engineered for. It’s up to the nurse who gets to explain what the machine is doing in his/her spare 30 seconds, and hospitals don’t have 30 seconds to spare.
What would you consider the designs if understanding of patients was afforded as a real design need, rather than a problem in bedside manner? A small display monitor that not only alerts the nurse’s station but also displays the meaning of the alarm in simple terms. A pump that is programmed with markers to change colors so the patient can see, not so the tech can! Nothing of this nature is rare, exotic. It’s primarily interface rather than new hardware. It’s not a technical barrier, it’s that no one in the room who is making decisions about what is built knows what the patient will understand.
I’m no clinician, and I’m not pretending my few months in a hospital makes me a clinician. Engineering and writing have shown me the same thing in two different ways: The person that you didn’t design for will experience what you created, regardless of whether you designed for them or not. You’ve got a clinically perfect device that leaves a patient terrified and confused; it has failed in some respect, even if it’s not on a compliance checklist.
The treatment of the body is improving. I think it would be a good idea to ask each time a new device is approved, whether or not the person’s understanding of their own care was asked.
Adeena Anwar Khan is an undergraduate student.
