There’s a concept in Silicon Valley called friction. It’s the idea that you need to get rid of any inconvenience or work that gets in the way of digital interaction. It’s about making things as simple as possible. The reduction in friction translates into higher conversions, which means you can do what the app asks you to do. I’ve been thinking about friction in healthcare.
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Of course, it makes sense to reduce friction when you are part of a machine. Because fat makes everything run better. But the idea of friction in technology equates humans (scratches, users) with mechanical parts. And in a world of algorithms designed to understand what you want and thus lower the threshold to subscribe, buy, or commit, you are a cog in a machine.
And for the technologist, there is nothing more terrible than the idea of friction.
Kevin Roose warns of what friction could do to us in his new book Futureproof:
The biggest problem with smooth systems, however, is what they do with our autonomy. Just like recommendation algorithms, they pull us to the middle of the bell curve – they train us to choose the most popular option, the most likely outcome, and the path of least resistance. They rarely encourage us to do the difficult, contradicting things or to pause to question our own impulses. And by reaffirming what technology critic Tim Wu calls “the tyranny of convenience” – the idea that the best solution is always the simplest – they can lead us to overlook things we might appreciate more in the long run, like this Trying out new experiences or overcoming difficult obstacles.
I saw that last month.
My son is in college in Fort Worth, Texas. When I travel to see him, my mapping software helps me a lot in finding the smoothest route.
When I came home from a visit last month I missed my morning coffee and halfway home decided to deviate a few miles off the algorithmic route to find a little cafe I’d seen on the map. When I finished I decided to make my own way south through some of the smaller towns in central Texas. I was alone and had all day to come home if I wanted. And as it turned out, my detour was an unexpected surprise.
Quiet and secluded, the new route offered a journey through time with old farms and houses from the early 20th century. I had the time to stop and take pictures and just look around. Best of all, it was March, high season for the Texas Bluebonnets – and I’d never seen so many Bluebonnets that day. And there was none of the crowds trampling the flowers as you normally find them on the side of the road on the main routes. While I’d made my trip smoothly many times in record time, this diversion added nearly two hours to my trip. But it’s one that I believe I’ll never forget, and it allows me to see a part of our state that I never knew existed.
The speed paradox
Friction can fit into other parts of our life. Like thinking and writing.
I always have a paper notebook with me. My friends give me a hard time because I write a lot about digital tools, but I carry this medieval technology with me. Now almost all of the writing for this email has been done on my MacBook Pro. But like any writer, I sometimes get stuck with ideas or concepts and therefore turn to paper. When I scribble and sketch on a silky smooth paper with my 1 mm thick Uni Ball Signo, I can discover some things that I cannot do on my laptop or iPad. I find the same thing happens with the big whiteboard in my office. Sometimes the scribbling and scribbling opens me up to new connections and ideas.
Why is that?
Corbin Cunningham, a user experience researcher at Google, found that it may be the slowness of paper that enables me to see and create new things. Paper provides instant feedback, where people can grasp an idea and start working right away. Paper allows you to think about your ideas. And studies show that people who take handwritten notes do better than computer typists on follow-up tests with conceptual questions.
Cunningham calls it the speed paradox. When we write, we are forced to process what we write and scribble. Creating on paper creates a constructive friction that draws us more into the information we’re trying to record, 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
This whole idea of better, faster, and smoother has found its way into healthcare. It seems that every application and platform is working to create the seamless experience of going from sick to healthy with the push of a button. Virtual First Healthcare would like to design care as a continuous online experience where you don’t have to leave your sofa. Text-based communication enables us to access professional input at today’s speed.
But it’s not that easy. The format or platform we use to deal with patients should depend on the type of care they need. And here the Silicon Valley missed how medicine works on the ground. I will follow the different types of encounters we have in healthcare. But to make it simple, we have transactional encounters and those that involve deeper, perhaps more critical, conversations.
While refilling a drug should run as smoothly as possible, the encounter around the new diagnosis of Crohn’s disease is far more complex. In this second case, minimizing friction in the sense of Silicon Valley should be the furthest away from us.
Of course, many of these new transaction tools provide channels of communication and access to medical care that were not previously available. But sometimes a careful connection and a bit of friction trumps convenience.
The idea of deliberate friction in healthcare and more time for clinical encounters gave birth to the slow medicine movement. Slow medicine is more of a rally call to humanize the decay of traditional office visits. The idea and spirit of slow medicine are in stark contrast to Silicon Valley’s drive to create a homogenized Uber-like health experience.
I’m just talking about how human care should be done, not how we can make it look like a consumer transaction.
A couple of things to think about
- Think about where friction needs to be built into the healthcare encounter.
- Which transactions should really be deeper experiences, be it healthcare or other areas of our lives?
- How can you deliberately seek ways in your own life to add friction to our lives? When did you come the long way or “lose” your card?
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’re involved in, whether it’s coming home from college, using paper to sketch a newsletter, or connecting with a patient.
Photo by Bill Oxford on Unsplash
