Using design and systems thinking to diagnose complex health problems


In the following example, our patient came with a finger injury that wouldn’t heal and using our process we were able to understand not only why it happened (she overtrained due to stress) but how short- and long term treatment within her personal lifestyle could be approached — immobilizing the finger, applying stress mitigation techniques, fixing sleep, eliminating inflammatory foods and finding a more supportive social environment. All of it, from interviewing the patient to writing up their individual report, took only around 4 hours. The results were extremely interesting.

In order to run this whole thing we use tools like Miro (remote whiteboard), Typeform (easy to use questionnaire), Zoom (user friendly video chat) and Notion (feature-rich writing). All of them attempt to re-create tools we know from the real world in a digital way in order to collaborate remotely. In this case Tyler and me were the “experts” but they can be physicians, nutritionists, fitness trainers, psychologists, etc. The combinations are case-specific and are decided after reviewing the patient health history form (see below).

The process of diagnosis and research is highly structured and time-boxed. This is very important to eliminate waste of time or overthinking, while being highly productive and fast.

The process effectively looks like this:

  • Pre-Sprint:
    Patient fills out a health history form
  • Day 1 — approximately 2 hours
    Patient and experts talk together on video chat to clarify details from the history form and understand the patients lifestyle. This takes 30 minutes.
    Experts write down everything the patient says and prioritise the symptoms by apparent importance. (~15 minutes)
    Experts do individual research on what these symptoms might mean. Without discussing any solutions, all research gets presented among the group to share any findings. (~60 minutes)
    Experts individually write up suggested short term treatment and long term solutions. (~15 minutes)

In case any tests (blood work, cortisol saliva tests) need to be done, the patient is directed to find his local GP and run those.

  • Day 2 — approximately 2 hours
    Experts individually review test results.
    Experts individually write up a report based on all observations and how they would individually treat the patient (short- and long term).
    Experts post their writing onto a remote whiteboard for everyone to read. After everyone has read through it, they vote on the most useful data.
    Experts combine all highest voted results into one information sheet.

The results are being sent to the patient and a follow up call is suggested for an in-person review.

Based on this process, each expert gets a chance to view the patients symptoms from their perspective and make up their own mind without interfering with other specialists. All results are democratically combined into a single treatment plan, thus merging all points of view with no discussion.

Now let’s go into a bit more detail on how it looks:

Traditionally, doctors gather enough about their patient prior treatment to understand their medical history, any possibility for genetic components and allergies — on paper. There are many cases where this paper gets lost, turns out unreadable or doesn’t even get read. So we took a more modern approach, using a software called Typeform.

It’s extremely user friendly and accessible from any mobile device. And if we need to change anything in the form, we can just do it. In the Typeform we ask about the persons symptoms, what their lifestyle is like and about any conditions in the past or family.

The first interview happens in Zoom and should help the specialists/experts talk to the patient. Given the experts have high empathy skills, listening to their voice and seeing their face helps understanding how the patient actually feels when they talk about their symptoms. In this case, the patient described her finger injury but also started talking about her diet. After asking more specifically about her dietary choices, we learned that she had an eating disorder she would normally not speak about. Apart from that we understood her extremely active lifestyle (she is a daily climber) and that her circumstances made her make very emotionally driven choices (cutting off her splint from a doctor in order to be able to climb again).

As you can see, what we wrote down, were much deeper, underlying problems than the joint fracture she primarily complained about.

The collaborative work of the experts (us) relies on a few very strict principles. There should not be any talking or verbal exchange of information, except it’s part of the process. We first spent about 30 minutes researching what these symptoms could mean, based on our personal sources and from our own perspective. These are very individual and differed due to our backgrounds.

After 30 minutes, we posted them on the same board, presented them to each other and clarified questions. Again, no solutions were shared or discussed at this point, only presenting what has been found.

After sharing the research we both disconnected and worked asynchronously on our individual solutions. These should be readable without needing to explain and were in the format, which the eventual report should be:

  • What we observed
  • What that could mean
  • Short term treatment
  • Long term therapy

After we were finished, we uploaded our results and without discussion mutually voted on the bits which seemed relevant from our perspective.

The tiny red dots on the articles represent the votes. It’s easy to see what exactly has been highlighted by how many experts and gave us a basis to merge together the highest voted bits.

The final report was a merge of the individual work, based on the research and experience the experts would have from past cases. We worked in a highly structured process alone, but the results are as if we worked on it together — because we did.

You can access the full report here:
Health Sprint Nora — Final Report

The structure and process are far from perfect, but even this result after only 4 hours shows the difference between what a patient would receive after weeks of referrals and follow-ups. None of the experts need to spend more time on the patient and are incentivised to find the best treatment for the patient. The financial reward is paid out for the full result, not for unquantifiable results over time. There is always full exchange of information among all experts without arguing or emotional discussion. Everyone can focus on what they do best — solve problems.

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