Episode One Hundred and Fifty One: Not That Way; Against Empathy; Just Don’t

by danhon

0.0 Station Ident

PDX Airport, 6:30am, another day trip down to San Francisco, this one for another Undisclosed Reason that I might or might not be able to talk about later. I didn’t manage to get this episode out last night, so I’m hoping to be able to write a quick one this morning, and then another one tonight. Because, practice!

1.0 Not That Way

So we’re not sure if I broke my toe or not. Probably not. Maybe. I’ll get an email from a radiologist today and we’ll see what they think; but for those of you who don’t live in the US, here’s what happens when you think you break your toe and you think you should probably get it looked at.

There’s a healthcare/doctor franchise in Portland called Zoomcare that’s kind of aimed at, for lack of a better term, millennials. Or at least it’s aimed at the kind of people who don’t want to spend ages looking (researching, comparison shopping) for a “primary healthcare provider” (ie: register with a GP) and just want to be able to book a same-day appointment to see someone for something like a possible broken toe, a cold, feeling “unwell”, a burning sensation or something itching. Basically: the kind of stuff that you’d be comfortable seeing *any* GP for, and not looking for chronic, long-term care or management.

I booked an appointment online – I had to wait until after 8pm on Monday night to be able to book an appointment for Tuesday. Turning up at Zoomcare and registering is pretty easy if you have insurance – I just needed to show my insurance card, a photo ID and a valid credit card to make sure I was good for payment (which turned out to be a $15 co-pay in the end). On Tuesday night, I was promptly seen by a physician’s assistant (a PA-C) – not a doctor, but someone who’s certified to perform diagnosis. He quickly figured out that we’d need x-rays, and they don’t have a radiologist on-site after hours, so he set me up with a FastPass – an arrangement that Zoomcare have with a hospital system in Portland – Legacy Good Samaritan – where I could get an x-ray done: I’d take myself over to the emergency room, get myself admitted there, get an x-ray done, and then take the films back to Zoomcare for my PA-C to look at them.

This meant driving over to the hospital (or a fifteen minute walk), and then taking about fifteen minutes to get registered with the Legacy Good Samaritan system: another credit card, insurance card and photo ID check, social security number, emergency contact, confirmation of address, phone number, three signatures and three initials. The signature process is pretty interesting: you don’t see machines like this in the UK that often, but they’re basically signature blocks: small resistive monochrome LCD displays that are like a signature strip: all they are is a space for you to sign. What happens is the registering attendant tells you that they’re “offering you” the various documentation like their terms and conditions or their privacy policy and that you have the opportunity to read it and then to sign it.

The bit that is just-the-way-the-world-works is the whole information sharing aspect that’s undoubtedly in some part due to regulations in the US like HIPAA[1]. HIPAA gets blamed for everything from being a barrier to innovation and disruption in the US healthcare industry to being the reason why you don’t get to see photos of all the newborn babies at doctors offices anymore[2].

There are no people with giant multi-touch walls flinging digital x-rays around. They get printed out and put in a manilla envelope for me to take back to Zoomcare.

So, this is a long way of saying: for all the visions of technology that we get sold to us, hardly any of them actually deal with better process. And even the word “better” is a bit of a weaselly word because you have to do the hard work to define what “better” even means. Is it better for billing? Is it better for the patient? Is it faster, cheaper, easier to use? Is it more accurate? Does it reduce errors? Does it allow you to get more done in less time? Technology promised us an easy way out – the out-of-the-box solution, even when you have to bring in a whole bunch of system integrators. But it turns out that that might not be the case unless you really, really know a business inside out, and what its needs are.

The real world doesn’t work the way they show us in corporate vision videos. The real world still has people emailing the wrong version of a Word document, of people who don’t know how to use Track Changes, of people who don’t know how to center text and just hit the spacebar a bunch of times, of mis-named files, of mistakes in Excel spreadsheets.

[1] HIPAA – HHS.gov
[2] Baby Pictures at the Doctor’s? Cute, Sure, But Illegal – NYTimes.com

2.0 Against Empathy

I’ve written a lot about empathy, and given a couple of talks (and am planning a few more) about this idea of an empathy gap (I’d originally written that phrase in capitals, but in retrospect, it feels a bit like cheating to capitalise something when it’s not entirely thought through yet. A bit of a hack to give legitimacy to something that may not deserve it yet).

If I think about it, what I’ve been describing in this newsletter and in my talks has been in parts a corporate/organisational lack of empathy in the high-level sense (ie: not considering the position of another), but also related concepts that follow on from that, like lack of trust and respect. And sometimes, empathy might not even be the right term – does AT&T or Verizon or British Gas need empathy for your position, do they literally need to *experience* the world as you do? Or do they just need to *understand* your position and to act sympathetically, and to alleviate the position that you find yourself in, if that’s their stated goal?

This has been niggling away in my head ever since Matt Jones sent me a note that I should check out Steven Pinker’s The Better Angels Of Our Nature, with the broad overview that perhaps sympathy and reason are better tools than just “empathy” (I haven’t read the book yet, but that’s what Jones has told me).

And then yesterday, Paul Bloom’s article in the Boston Review[1], in which he comes out as writing a book about empathy, coming out against it. Bloom’s position is significantly more nuanced and developed than mine, but I suppose he’s looking at it from a different perspective. There’s an interesting point in Bloom’s article where he talks about the difficulties of empathy – that because it’s something that exists in our minds and is a product of the physiology and neuroscience of our brains, it’s also subject to the various hacks and biases that our brains subject our selves to: “we are more prone to feel empathy for attractive people and for those who look like us or share our ethnic or national background” and at the same time, Bloom points out that empathy “is narrow; it connects us to particular individuals, real or imagined, but is insensitive to numerical differences and statistical data.”

Bloom is concerned about being able to override the empathic response in situations that, for example, call for long-term thinking or impose costs on individuals for the benefit of the many, citing climate change and child vaccination.

So I suppose here’s the outline on what I mean by the empathy gap in organisations and corporations: it’s the outward appearance of a failure to understand, consider and then act upon the situation of a user, customer or person. In some cases, the outward appearance of failure is down to not understanding a user, and in other cases, it may well be down to understanding a user’s need and deciding not to act upon them anyway. Examples like AT&T requiring you to opt-out of arbitration via letter rather than Dropbox’s method of allowing you to do so easily online fall in the dark-pattern group, to my mind. So I think I’m using the naive meaning of empathy: the lack of understanding of another’s position.

[1] Against Empathy – Paul Bloom, the Boston Review

3.0 Just Don’t

Accenture Australia’s Public Services division popped up in my Twitter timeline this morning with the following copy:

“How can Customs agencies create #digitalborders for #digitaltrade? Read more. @AccenturePubSvc ow.ly/ABhbc”

The white paper[1] is even more egregious than the tweet itself, titled “Digital Borders: The Key to Survival for Customs Agencies”. Never mind piracy, lost tax revenue from digital goods may well be the impetus to requiring deep packet inspection at the ISP level to make sure that “digital borders” can be enacted so Customs Agencies can survive.

It’s not that Customs Agencies need to survive – the question that Accenture poses in their paper is “How can [customs] agencies handle digital’s disruptive impact on national and fiscal security to deliver public services for the future?”

More on this later tonight, I expect.

[1] Digital Borders: The Key to Survival for Customs Agencies? – Accenture

8:36am, at 30,000 feet again. See you on the other side tonight.