flash ethnography: observations of a doctor’s use of mobile tech with a patient
I took my grandma to the doctors for her annual today. The doctor that we have been with for the last 5 years moved to another office. So today we had a new doctor. I gave the new doctor a brief overview of the last 5 years of my grandma’s medical history. Our new doctor was wonderful, personable, and attentive.
During the entire updating process, the doctor was primarily talking to me because I was translating and I have been the primary overseer of my grandma’s health for the last few years.
I noticed that she was carrying around a new netbook. She was typing my notes in the netbook while constantly referring back to my grandmother’s file that contained her entire medical history being various doctors.
I noticed that the entire time we talked, it was very hard for her to have any direct interaction with my grandma. Her back was faced towards her as the netbook was placed on a stationary built in counter. As she typed the notes, she looked at me and then would periodically turn her entire body around 360 around to smile at my grandma and then immediately turn back to her netbook.
When we were done with the exam, I chatted with the doctor for a few minutes about the netbooks. She said that the office was trialing these netbooks out and had rented them for 6 months. She seemed ambivalent about the netbook, as if it was forced upon her. She said,
“Well I can take it with me everywhere and look up notes on each patient, but the file of the patient’s history still isn’t on the laptop so we still have to pull up files and deal with a lot of papework. It just feels like another thing to carry around and keep track of.”
When I asked her how it affected her interaction with her patients, she said that this was her primary reason for not liking these laptops. She showed me that using the netbook meant that she had to spend more time with her back towards her patients. I asked her if she had tried sitting down and putting it in her lap so that she could face the patient, but she said that was also inconvenient because of all patient history paper file. She then want on to explain that she preferred the stationary big screen desktops on carts at her old office because it was on a table that could face the patient or be moved around within the room.
Post observation thoughts?
spatial layout of material objects matters
I think a big fix in the problem would be the way rooms are designed. Spatial layout of an office/room matters for the introduction of a new technology. Therefore, the reception and usage of a new technology, such as this netbook, will vary across different offices. And it’s cool to think about how even minute furniture and room layouts can make a difference.
In this instance, the only place for the doctor to place her netbook in such way that her physical paper files could also be accessed meant that her face-to-face time with her patient was compromised. Imagine if there was an extra cart in this room with a big computer screen and each doctor could plug in their own netbooks. Or imagine if all the stationary computers in each were networked so doctors didn’t have to keep track of their netbooks. This was a such a great learning moment for me in terms of witnessing how the consideration of spatial layout is especially salient for conducting comparisons in technology usage for a new tool across communities.
This reminds me of the time I spent working in the projects of the South Bronx. I had noticed that the layout of a small apartment that housed 4-8 people would’ve made it impossible for a student to use a desktop computer with broadband the same way as a student in larger apartment or home of middle-high income families.
the extent of digitization of info matters
the mobility of laptops were useful for accessing only recent notes because most of the files had yet to be scanned into computers. For all the promises that mobile tools deliver to professionals in service industries, it’s difficult to take full advantage of these tools when the entire information base of an organization has yet to be digitized. As the doctor had explained, she still had to rely on physical paper files for the patient history. The netbook was only useful for accessing recent visits. I wonder what she would’ve thought about the laptop if ALL patient histories was on it. Would she have sat down and put the netbook in her lap so that she could have more time with the patient?
human connection matters
decreased face-to-face time was the primary issue for the doctor. This was such a great example of when a technology appears to offer more mobility may work to compromise other forms of interactions that may be more valued in a certain social setting.
Mobility as a feature is neutral
There is a lot of excitement across HCI and CSCW for studies on mobilites and how digital tools can complement a more mobile lifestyle. Aside from my observation that most of these studies are on elite Western (usually Anglo) travelers or mobile workers and tend to undervalue informal economy workers who rely just as much on mobility - I think this is such an exciting area of research that has pushed me to bring the concept of mobility closer to lived practices of mobilities.
That being said, I think that it should not be considered a priori that mobility is a “good” or “desired” aspect of X. In the case of the doctor’s office, having a mobile laptop seemed to be novel technology that the doctor was obligated to carry around. Of course it was not an ideal office with patient history files still on paper format and badly designed patient rooms - but that is just the point. Rarely are technologies introduced into ideal or perfect settings. So it’s good to think more critically about the role of mobility for a specified audience and what mobility means to them. In this case, increased mobility of note taking and accessing for doctors compromised personal connections with their patients.
One of the ways I thought about this in the past was trying to think about the other end of mobile cellphones as mobility saviours - so what groups wouldn’t want to be as mobile - what situations would mobility as an option not be valued?
What came to my mind?
• cheating spouses who don’t want to be located
• paraplegics
• people who hate cellphones
yah ok this is a totally lame list - I couldn’t really come up with any other groups because I think my problem is that I live too much in a paradigm where mobility is valued and an absolute! I am one of those working professionals who travels a lot and would stop breathing if I didn’t have my cellphone or my laptop on a work day.
ok so here’s some things questions in conclusion:
• How do new technologies affect work flows?
• How do new technologies affect client/patient interaction?
• What are the compromises that are made for a more mobile lifestyle/interaction?
• How does spatial placement of objects affect technology usage?
Useful Links
• Microsoft Research on Health and Wellbing
Ethnography and Healthcare
• Multi-tasking in practice: Coordinated activities in the computer supported doctor–patient consultation. International Journal of Medical Informatics, Volume 74, Issue 6, Pages 425-436. M.Gibson, K.Jenkings, R.Wilson, I.Purves
• Clinician style and examination room computers: a video ethnography. W Ventres, R Marlin, N Vuckovic, V Stewart - Fam Med, 2005 - stfm.org.
• Mapping the integration of social and ethical issues in health technology assessment.
Lehoux P, Williams-Jones B. Int J Technol Assess Health Care. 2007 Winter;23(1):9-16.
• Making a Case in Medical Work: Implications for the Electronic Medical Record. M Hartswood, R Procter, M Rouncefield, R … - Computer Supported Cooperative Work, 2003 - portal.acm.org
(Rant Alert) Spatial geographies of the World Wide Web: China is NOT the Wild Wild West
I can’t tell you how many times I’ve been at a technology conference when a white male asks me what I research, and when I say something like “technology use in China,” they will at some point say, “oh man China is like the Wild Wild West.” I usually respond by saying, “no, it’s not.” And then often they proudly respond with, “ya you’re right, China is the wild wild east!” By then I try to get out of the conversation as quickly as possible.
So here is a more well thought out response that I would like to give the next time I hear this.
No, China isn’t like the West nor is China wild. During the Wild Wild West era in 18th and 19th century US, expansionists justified the take over of the western part of the US with the belief of Manifest Destiny - that it was America’s mission to bring democracy to the rest of the unconquered west. This is a misleading and pernicious metaphor to employ because it perpetuates a colonial view that those who are not like us and places that we have yet to conquer are unruly. It’s a metaphor simile thats says we are tame, they are wild.
The western part of America back then wasn’t so wild - it actually was filled with hundreds of thousands of Native Indians. It was filled with a complexity of knowledge systems, colonial histories with Spain and Mexico, and ongoing movement of people.
This space was the “West” for the colonizers with a capital W - a place with its own myths and a place for to carry out Manifest Destiny. But for the people already living there, it was their place, not the West. It confuses me when we (Americans) glorify the Wild Wild West Era without honoring the people who died during this period. Sure tons of technological feats were achieved. But it was an era of imported indentured slaves (Chinese) and a full slave production in the South that financed the companies that pushed for the fulfillment of Manifest Destiny through the massive genocide of Native Indians (Trail of Tears). American became rich, dirty rich during the Wild Wild West period. And as an America, I’m not proud of how we made our riches in the early years of our empire.
Employing such a deprecating metaphor simile of the Wild Wild West renders China a place to be conquered, civilized, and remade. It reveals the underlying myths and stories we tell about China - an unruly land of wild, lawless, people who will benefit from order, rules, and culture, just like how we once envisioned the West as a land full of animals, property, and uncivilized natives. It also frames China as a place frozen in time as people often draw upon China as the oldest and and continuous civilization on earth. The metaphor simile also culls up a way of thinking that not only says this place needs order, but is a worth our time for us to be the arbitrars of order.
There is a reason why we don’t call Nigeria, Antarica, or Figi the wild wild west - it’s because we don’t see these places as worthwhile markets of investment.
One of my favorite theorists, Doreen Massey, says that Westerners have a tendency to see space as a smooth flat surface from our own vantage point— a smooth space in which to roll out our ideas, technologies, and policies.
It sometimes seems that in the garadene rush to abandon the singularity of the modernist grand narrative (the singular universal story) what has been adopted in its place is a vision of an instantaneity of interconnections. But this is to replace a single history with no history…deathlessness.” ( 2005, pg 14 in For Space.)
So by saying that China is the “Wild Wild West,” we are assigning it one narrative—ours. Massey proposes that we see space as a production of relations, as the co-temporal existence of multiple people, competing histories, and contesting forms of knowledge. Space is a process that is continually being remade.
What is at stake here if we don’t stop thinking of China as the Wild Wild West? Many things - but the most important thing for me is that how we think about space actually influences how we interact with others who occupy the space. So thinking of China as the Wild Wild West will influence how you interact with Chinese people and institutions and I’m arguing it’s an undesirable way to interact if you really want to create understanding to accomplish whatever your project.
Ultimately what’s at stake is power and domination is understanding because if we imagine the world as places with singular narratives waiting for our discovery, then this serves a colonial project and legitimizes policies that end up harming the people in these places.
Massey says that all space is regulated. So with that being the case, I see that it’s up to us how this happens. And in a globalized world of networked digital technologies, it’s inevitable for dialogues about how a space is regulated to become more public as more of these conversations take place online. As American companies, IP lawyers, entrepeneurs, marketers, technologists make their way to China, I ask you to see China as part of the World Wide Web as opposed to the Wild Wild Web. It’s a very simple re-orientation in the mind, but it can be very difficult when Americans grown up in a country that believes that democracy is best delivered through free-market mechanisms and is the best way of life.
update June 9, 2010: Kenyatta Cheese and I were discussing the techcrunch article on how Web 2.0 companies are learning from their past failed attempts in China. Kenyatta made a point that it would’ve been even better if the article said something about the existing, exciting, and thriving web 2.0 culture in China and
“to at least mention that it isn’t unchartered territory — that there are thousands of Chinese web 2.0 companies already competing in the space.”
I totally agree.
update June 14, 2010 - I just Mike Hudack’s blog post - very relevant:
“Ultimately, the entire universe will become saturated with our intelligence,” he continues. “This is the destiny of the universe.” — Merely Human? That’s so yesterday. NYT (via idlaurenn)
This quote pissed me off more than anything else in that article. What hubris! I can imagine a European explorer saying the same of the New World centuries ago. “Ultimately, the entire planet will become saturated with Western European intelligence and culture and religion. This is the destiny of the planet.”
Yes mike I totallllllly agreeee! pisses me off to to read this quote from Raymond Kurzweil of Singularity at this Google funded talk. This kind of thinking will be the topic of my upcoming talk that I’ve giving at The Humanities conference.
