Running doctor appointments like the best-designed meetings
When you go see your doctor, there are multiple people in a cramped, stuffy room; communication happens mostly through talking and gesticulating; there are grave misunderstandings. It’s a meeting!
In my work as a designer, I’ve been to a lot of meetings. I’ve seen them go poorly and I’ve seen them go well. I’ve seen people walk out after meetings rolling their eyes and mouthing words like ‘painful,’ and I’ve seen people stay seated and not want to leave the room because we’re having so much fun and isn’t this much more fun than work?
There are a few key things you can do to make meetings productive and satisfying. I’m currently reading the great book Meeting Design for Managers, Makers and Everyone by Kevin M. Hoffman. I’ll discuss some tips from this book along with experiences I’ve had in my work, and I’ll examine how these things apply to doctor visits.
First, a few strategies for creating better meetings
Prepare and design appropriate activities
Great meetings don’t just happen. Someone has thought about the goals of the meeting — what are we trying to accomplish, and what are the best means of doing so? Productive, satisfying and fun meetings don’t follow the same template as all other meetings; they are specifically designed. For instance, if I want to get a whole team on the same page about our end users are and their needs, I’m not going to have one team member get up and drone over a powerpoint while everyone else zones out. We’re going to workshop it and get everyone participating.
And this meeting preparation — it takes time. I would never show up to a meeting unsure what I want to talk about or what we’re going to do. What a waste! As a designer and facilitator I have spent a lot of time and energy making sure that team meetings have a point, that the activities are well-designed, and that there is chocolate on the table for morale and endorphins.
Make things visual
Great meetings are always visual. Research has shown that people can only hold about four pieces of information (or the last 30 seconds of things they’ve recently heard or seen) in their ‘working’ memory at one time. Visuals can help:
“Listening to someone while looking at a complimentary photograph or drawing increases the likelihood of committing something to working memory.” (Meeting Design, p.22)
“Your brain finds more meaning by combining listening with seeing or touch” (Meeting Design, p.32)
Visual facilitation can also help ensure the people in the room have a common understanding. In many meetings I’ve jumped up to the whiteboard to sketch out a diagram or simply jot down key points; this serves as a visual prototype of the conversation we are having and allows me to get immediate feedback if I’ve gotten something wrong. This practice has appeared useful for the people in the room; I’ve observed that they usually glance back at the board often and refer to it repeatedly while talking.
Invite participation
Effectively involving meeting attendees in discussion, brainstorming and decision-making is an art. The default in most meetings is freeform talking, which gives more verbally-oriented people all the attention, while others sit quietly and don’t have a chance to share their thoughts. The best way I’ve learned to invite participation is to incorporate quiet time during which everyone writes down their ideas on sticky notes, and then afterward go around the room so each person can share what they wrote. It’s a great way to make sure everyone’s ideas are surfaced, and it helps us avoid narrowing our world of possibilities too soon.
Get the right people in the room
A common issue with meetings is that there are too many people or the wrong people in attendance. Thinking through the goals of a meeting helps determine who should be there; and if there’s no goal or point to a meeting, canceling it is the smartest and most productive thing to do.
Some unfortunate things about doctor appointments
- Usually, there is little preparation. Patients are not encouraged to do much prep before they come in; it’s just not part of our medical culture and workflow. It would probably require a lot of energy from the doctor’s office, and patients are accustomed to showing up and doing what they are told. This actually causes a lot of problems: patients aren’t ready to tell a coherent story, they haven’t distilled their goals and priorities, and this makes it harder for doctors to do their job.
- They’re mostly verbal. This is not a very effective or creative means of getting information across. For many people, talking meetings are not the best way to absorb and remember information for later. “A study by the Department of Psychology at Allegheny College found that 40% to 80% of the medical information provided by care providers is forgotten immediately, and the greater the amount of information shared the greater the percentage forgotten.” (wsj article) The short duration and rushed timing of doctor meetings also means that information can be delivered in a fast-paced ‘firehose’ fashion, further reducing the likelihood that the patient will commit the information to memory and recall it later.
- Many doctor appointments follow the same format. For example: patient makes appointment; patient comes to the doctor’s office; patient fills out some paperwork; doctor peppers patient with questions and instructions; patient forgets most of what is said; patient leaves a little mystified. A consistent pattern that provides consistently sub-par results.
“Exclusively relying on conversation and human memory is a single pattern for executing a meeting, and often a faulty pattern that creates disagreement where none may exist.” (Meeting Design, p.12)
- Participation is uneven. Medical appointments place most responsibility on the doctor’s side, but patients have the most expertise in their own condition, body, and daily life. Patients have a wealth of information that is not currently being sufficiently tapped.
- The right people aren’t in the room. Many doctor meetings include two people: the doctor and the patient. But for many patients, their medical care incorporates family members, friends, and medical staff like nurses and social workers. Because patients forget such a large amount of what is shared in doctor meetings, it would be helpful to have support people in the room to increase the chances that everyone will be in agreement on the next steps.
Let me take a quick time-out to say I completely empathize with what doctors and staff are dealing with. They are on limited time, dealing with high documentation loads, and stuck inside a system that doesn’t give them much room to streamline their processes.
But — what if we could start over and design doctor visits however we wanted?
What would well-designed doctor meetings look like?
If we had all the resources in the world to run doctor appointments like the best meetings and workshops:
- Patients would be expected to prepare beforehand. Patients could put together questions, priorities and goals; they could also reflect on any changes or events that had happened since the last appointment. If a patient (or caregiver) did not have the time or mental capacity to prepare, someone could be assigned to help them.
- Doctors would have time to prepare in advance. In a perfect world, doctors would have more time to prepare and reflect before a patient appointment.
- Activities would be designed for specific purposes. New patient visits would include ways of helping a doctor efficiently get up to speed on a patient’s full history; ongoing visits might incorporate home data-tracking reports. Doctors have often told me that it’s very hard for them when a patient comes in with many diverse, un-prioritized concerns. Imagine a doctor pausing to ask a patient to write down their top 3 concerns and then circle the top one. Or perhaps we could incorporate sticky note brainstorming and manipulation to help determine priorities and solidify next steps. With some creativity, these types of activities could save time and help everyone agree faster.
- The meeting duration could be flexible. Depending on the activities and purpose of the meeting, the duration could grow or shrink as needed without being stressful on the doctor or staff.
- Slower pacing would allow better information absorption. Imagine what well-timed pauses, slower pacing, and visuals could accomplish. More information getting into more brains.
- There would be more visuals. Patients would ‘show’ how they were feeling and what happened; this could happen through drawings, diagrams, self-tracking and digital health apps, photos, videos, and more. Doctors would likewise use visuals to communicate about how the body works, what the risks are for certain treatment plans, and more. (Many doctors already do this, but the practice could be expanded.)
- The people in the room would be deliberately selected. Great doctor meetings would incorporate other important stakeholders like caregivers, other friends and family, and healthcare staff like nurses, social workers, navigators, etc.
- Appointments could happen asynchronously. Sometimes an in-person meeting is overkill and our communication could be accomplished through a quick email or text. Our system should compensate doctors for these interactions so that in-person meeting time could be freed up for those who truly need it.
- We’d be smart enough to know when we don’t need a meeting. Sometimes the best meetings are the ones that are canceled, giving everyone their time and energy to put toward other things. As our health system matures and remote monitoring becomes more feasible, I hope we will start to understand when doctor meetings are unnecessary and give everyone their time back.
Outcomes
What outcomes could we expect with improved doctor-patient meetings? Here are some hypotheses:
- There would be lower rates of misdiagnosed and undiagnosed illnesses
- Doctor-patient relationships would be improved
- Burnout rates would decline among doctors and medical professionals
- Patients and caregivers would retain more information after doctor meetings
- Patients would have more confidence (both in their own ability to communicate and in the health system at large)
- Patients would become equal participants, with equal responsibility; a culture change that would have greater implications on how patients think about themselves and their health
In short, better-designed doctor meetings would help improve some of the biggest problems we are facing in healthcare today.
What do you think — what ideas do you have for designing better doctor meetings?
This topic matters to me because I’m a patient, designer and meeting enthusiast, and I’m working on Pictal Health, a way to support patient-doctor communication during appointments. We’re especially focusing on the visual elements of storytelling and cognition.
