Page 9 - CUAJ Dec. 2022
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EDITORIAL The sacred doctor-user-interface-patient
relationship
Michael Leveridge was the kid in the mid ‘80s with the Sega Master System and not the Nintendo.
I became excellent at Shinobi, Outrun, and Wonder Boy while most of my pals
c
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CUAJ Editor-in-Chief I ushed Mario, Contra, and Blades of Steel. A curious thing happened with the
crossover smash Double Dragon, however; I knew exactly what to do (kick dude in
neck; jump over dude; club dude in head) but when I played on my buddy’s NES, I
Cite as: Leveridge M. The sacred doctor- was hopeless, as was he on my Sega. We both flailed when feeding quarters into the
user-interface-patient relationship. Can Urol console at the arcade. Of course, it wasn’t an issue of different rules but of different
Assoc J 2022;16(12):383-4. http://dx.doi. controllers determining how our intention to kick necks became kicked necks on screen.
org/10.5489/cuaj.8202 It was the user interface (UI) — in this case the controller design — that baffled us on
unfamiliar systems.
Forgive me if this isn’t obvious, but you may have heard that new robotic surgery
systems are beginning their global rollout, and I got to thinking about UI and how an
expert in robotic partial nephrectomy would be vexed if asked to hunker down at a
novel console and treat a patient. I recall this bafflement early in fellowship, when
my Baumrucker TUR expertise met a perplexing Iglesias setup, and I treated the back
of a few bladder walls like the Punch-a-Bunch board on The Price is Right. Again, the
issue isn’t knowledge, intention, or skill, but of the UI that links said intentions with
action inside the patient.
Surgical instruments have so far filled the gap between surgeon and patient; the
action of the hands translated directly to the field. One could get semantically fussy
about intermediaries like lasers and cautery and retractors as force multipliers, but there
remains a stimulus-response straight line to the action. Calipers-as-pincers, clutches,
and motion damping feel like they transfer the surgeon’s intentions to the field, but
the wire connection is a fundamental shift that we may come to see as the thin edge
of the wedge of a very different way of being for surgery. I’m not sure we think often
enough about what it means to have third-party design choices and software positioned
between us and the effectors of our work.
We are most often faced with UI design decisions when navigating our EMRs. These
Byzantine frustration engines universally sacrifice usability for comprehensiveness. If I
want to check on a CT, pathology, GFR, and last clinic note in my EMR, I’m bobbing
for data with sequential dives into menus with titles like “Interdisciplinary/ambula-
tory ALL” to extract single details, then up for air to plunge back three more times to
achieve something that software ought to serve up with a click or two. In the clinic,
we know that UI design is a driver of our productivity and our external brain. When
the computer system fails, so goes the clinic.
This is no blanket critique of technology and design liaising between doctors and
patients. Organizing and sifting through paper charts is a pain, and patients spangled
with hemostats instead of pinch-burns does not sound like a golden age of surgery.
Technology is helpful! Better dexterity, less invasiveness, and 3D optics rule! The point
is not that all UI are bad, but that we must contend with the fact that we are their
subjects as much as they are ours; we can only wrestle with them within their design
constraints. The further we integrate proprietary technologies and UI into our practices,
the more fragility builds. When a company withers on bad bets or management, is
acquired and sunsetted, or pummeled in market competition, so might go the ability
of skilled surgeons to ply their trade or of doctors to manage patients.
So, we’ve established that tech UIs break the direct link between operator and subject
and influence how inputs become outputs. Let’s have some philosophical futurism fun
with this. I envision two possible futures for UI design. The first is one that iterates to
become so intuitive as to be second nature. User intentions convert to action with no
friction; the software serves the user with total fidelity. The second is that the interface
slowly becomes less visible and its inputs fewer and fewer as greater numbers of tasks
are accomplished on board the system after simple instructions.
CUAJ • December 2022 • Volume 16, Issue 12 383
© 2022 Canadian Urological Association
