Medical Design


The famous Eames Lounge Chair

The famous Eames Lounge Chair

Hello faithful readers (anyone left?), after a month-long stint as a toxicologist and recently a European vacationer, I’m back. With a vengeance. (And also now my residency class’s own personal expert on organophosphates/insecticides and warfarins/rodenticides.)

One can’t help but think about design and architecture after a trip to Berlin and London — the former with a ton of new and modern designs as a consequence of that whole “World War II bombing to smithereens and then Communist rule for 40-plus years” thing, and the latter with some very classic, still-standing buildings. I also happened to just finish watching a great design documentary called Objectified. Throw all that together with the reminder hanging over my head that very soon I’ll be back in the throws of caring for patients and voila, my thoughts led to the design of everything medical.

If there’s any designers out there, I’ll summarize medical design like this: PLEASE, HELP!

Now, this is not to say we haven’t made any progress in medicine (as I can vouch for after having visited London’s Science Museum’s Medical History exhibits), but boy could we stand to have some improvements. Giving the subject a moment’s thought without doing any formal reading on the topic, I posit that we have several requirements in medicine for our equipment. In order of arguable decreasing importance:

  1. Efficacy
  2. Safety for both physician and patient
  3. Interoperability with other medical equipment standards (like standard luer-lock port sizes)
  4. Ease of Use
  5. Comfort
  6. Environmental Impact (dead, dead last)

I’m going to focus on object design, specifically in the Emergency Department, because hey, write what you know — and we have several unique challenges that one might not have in say, an outpatient office. (I’m also going to focus on physical objects, because information and software/computer design is a whole other post.)

Efficacy is easy. We’d much rather have an uncomfortable, unwieldy device that works than one that is beautiful and easy to use but doesn’t fulfill its job.

Safety is an interesting one, as often it seems that making devices safer may compromise other things on the list. I always have trouble with the needle-locking devices on tuberculin syringes as well as the screw-on safety devices for our ABG kits. And that fact that some central line kits (luckily not ours) have safety EVERYTHING save for the straight needle sitting there to secure the line, when you’ve finally let your guard down because the hard part of the procedure is done. Or the fact that every year in every hospital in every city there’s that poor sod-of-an-intern who manages to lose a guidewire in a patient. (I do, however, love the fact that the intravenous pacer balloon auto-deflates unless you hold pressure on it to prevent an air embolism. Classy.)

Interoperability is obviously important, and thank GOD we don’t have some system with proprietary interfaces depending on who you buy the kit from, locking you into a certain manufacturer (in some fields, like pacemakers, we arguably do, but less-so in the ED). I’m always amazed at how many things Whit Fisher can get to work with each other in his Procedurettes videos (like the Mini-Suction maker), even if they’re not intrinsically supposed to. I do, however, wish that the 60mL syringes came with a luer-lock screwable nose — whenever you want to double-check an NG tube, you can’t find the tapered version, and vice versa with the luer-locking type.

Ease of Use is absolutely vital in the Emergency Department, because it’s the frantic crashing patient that needs to have the pacemaker/defibrillator just work when you need it to, or the ventilator to be easily adjusted, or to tell you why the hell it’s still beeping or else you’re just going to have to page respiratory again. In a sick patient with a flurry of doctor, nurse, and tech activity, if there’s a way to accidentally mess something up, we’re bound to be able to do it. (I can’t find the article right now, but I know there was something in the past year or two in Annals looking at defibrillator design problems, and how there’s still no standardized design. This is unacceptable.)

1559084181_fcee4f094aComfort is under-appreciated in my book. The classic key to a successful procedure is patient positioning, but I think “doctor comfort” is a close second. This is why senior residents and attendings are always pumping the bed up to make the intern quit crouching over to sew up the laceration. We probably all like to think we should just “tough it out” and “suck it up,” but comfort probably leads to better outcomes. If you’re comfortable, you’re relaxed, more confident, and more likely to get the procedure right on the first try. How often are your fingers throbbing from aspirating back on an awkwardly designed, uncomfortable syringe?

Environmental Impact is something that rarely even crosses my mind until I’ve had to do some draped, sterile procedure (hi, Central Line!), and see how quickly I fill a trash bin with my used supplies once I’m done. I wrote a bit about it years ago on my old blog, describing it as Green Medicine, not to be confused with medical marijuana “green” medicine. But the fact is we go through tons (literally) of non-degradeable plastic and metal on a daily basis in the name of sterility and in homage to germ theory. Obviously this is the Right Thing To Do ™, but consideration should at least be made by designers and manufacturers to other materials that might be more Earth-friendly but function just as well. It’s one thing when you’re designing a chair that you’re hoping will last for generations, but when the object you’re designing is, by definition, a one-time use and is supposed to be thrown away immediately after use, can’t you change some of the assumptions about that of which the product must be made?

After a bit of Googling, there are, in fact, medical design awards, but they appear to be focusing on mostly new products, not the improvement of existing ones. (Quickly perusing the site, I do like this Esterline Medigenic medical keyboard that tells the user when it’s dirty and needs an anti-microbial wiping.)

I find it hard to believe that we can be constantly improving kitchen utensils to make them safer, more effective, more comfortable, and better for arthritic hands but we can’t do the same in medicine. And you’d be hard-pressed to find anyone who wouldn’t want a better needle or a better syringe. There’s clearly a market, but perhaps too much focus on computerized medical technology that the simple and old-fashioned is getting ignored? (Or maybe I’m just unaware of it.)

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  1. #1 by madichan - November 29th, 2009 at 23:21

    Well, OXO did try to redesign the syringe: http://www.fastcompany.com/blog/cliff-kuang/design-innovation/oxo-redesigns-common-syringe

    It looks to be specifically targeted to those with Crohn’s disease or rheumatoid arthritis, so the “ease of use” goal focuses on that population, but it was interesting to see a company who has been working towards improving kitchen utensils attempt to transfer that to medical devices.

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