In Silicon Valley there is a concept called friction. It’s the idea that you need to eliminate all the hassle or work that makes digital interaction difficult. It’s about making things easier to do. Reducing friction leads to superior conversion which means it will make you do what the app wants. I’ve been thinking about friction in health.
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Of course, reducing friction makes sense if you are part of a machine. Because fat makes everything work better. But the idea of friction in technology equates human beings (scratch this, users) to mechanical parts. And in a world of algorithms designed to understand what you want and, in turn, lower your threshold to subscribe, buy, or commit, you’re very much a gear of a machine.
And for the technologist, there is nothing more terrifying than the idea of friction.
Kevin Roose warns about what friction can do to us in his new book, Resistant to the future:
The biggest problem with frictionless systems, however, is what they do with our autonomy. Like recommendation algorithms, they drag us toward the center of the bell curve, training us to choose the most popular option, the most likely outcome, the path of least resistance. We are rarely encouraged to do the hard and counterintuitive or to pause to examine our own impulses. And reinforcing what technology critic Tim Wu calls “the tyranny of convenience” —the idea that the best solution is always the easiest — can make us overlook things we might value more in the long run, like trying new experiences. , or overcome hard obstacles.
I experienced this last month.
My son goes to college in Fort Worth, Texas. When I travel to visit it, my map software does a great job helping me find the most frictional route.
Returning home from a visit last month, I had missed my morning coffee and halfway home I decided to go a few miles down the algorithmic route to find a small cafe I had seen on the map. When I finished, I decided to make my own trail south through some of the smaller cities in central Texas. I was alone and had all day to go home if I wanted to. And it turns out that my deviation was an unexpected surprise.
Peaceful and secluded, the new route offered a time travel with old farms and houses from the early 20th century. I had time to go ahead and take pictures and just look around. Best of all, it was March, high season for the Texas bluebonnets. And that day I had never seen so many bluebonnets. And there were none of the crowds trampling the flowers as is usually found on the side of the road on the main routes. Although I had often made my trip without friction in record time, this deviation added almost two hours to my trip. But I think I will never forget it and it allows me to see a part of our state that I didn’t even know existed.
The paradox of speed
Friction can fit in with other parts of our lives. How to think and write.
I always have a paper notebook with me. My friends have a really bad time with me because I write a lot about digital tools, but I carry this piece of medieval technology. Now almost all of this email has been written to my MacBook Pro. But, like every writer, I sometimes get hooked on ideas or concepts and therefore turn to paper. Writing and sketching on a soft, silky piece of paper with my bold 1mm Uni Ball sign allows me to discover a few things I can’t get across to my laptop or iPad. I find that the same goes for the big blackboard in my office. Sometimes scribble and scribble open me up to new connections and ideas.
Corbin Cunningham, a Google user experience researcher, has it identified that it may be the slowness of the paper that allows me to see and create new things. The paper provides instant information where people can capture an idea and start working on it instantly. Paper allows you to think about your ideas. And studies show that individuals who take long-term notes, compared to non-computer keepers, perform better in follow-up tests with conceptual questions.
Cunningham refers to it as the speed paradox. When we write, we are forced to process what we write and write. Creating on paper creates a level of constructive friction that makes us more involved in the information we try to obtain, process, or create. It seems that the artifacts we can touch and hold force us to see and experience our ideas differently.
The magic of friction in healthcare
All this idea of better, faster and frictionless has made its way into healthcare. It seems like all apps and platforms are working to create the perfect experience of going from sick to healthy at the push of a button. First Virtual Healthcare wants to shape care as an end-to-end online experience where you don’t have to leave the couch. Text-based communication allows us to access professional contributions at the current rate.
But it’s not that simple. The format or platform we use to interact with patients it has to depend on the type of care they need. And this is where Silicon Valley has found the workings of medicine at ground level to be lacking. I will follow the different types of encounters we have in health. But to simplify, we have it transactional encounters and involving deeper, perhaps more critical conversations.
While filling a medication should be as frictional as possible, there is much more involvement in a meeting around the new diagnosis of Crohn’s disease. Therefore, minimizing friction in the sense of Silicon Valley should be the furthest from our minds in this second case.
Of course, many of these new transactional tools offer channels of communication and access to care that were not previously available. But sometimes a careful connection and a little friction outweighs the convenience.
The idea of intentional friction in health care and devoting more time to clinical meetings has led to the slow medicine movement. More than a cry for demonstration to humanize the decline of the traditional office visit, slow medicine is a vision for visit design that prioritizes human needs. The idea and spirit of slow medicine is in great relief against Silicon Valley’s drive to shape a Uber-like healthcare experience.
I’m just raising the idea that we need to consider how people care should be produced rather than how we can make it look like a consumer transaction.
Some things to think about
- Think about where you need to design friction for the health meeting.
- What transactions should really be deeper experiences, whether in health or in other parts of our lives?
- In your own life, how can you intentionally look for ways to add friction to our lives? When did you do the long route or did you miss the map?
Friction can be good. Friction in healthcare can be good. It can keep us connected and thinking. It allows us to be part of the process we are involved in, whether it is to return home from a visit to college, to use paper to sketch a newsletter, or to connect with a patient.