Merci bien, Prof Witteman. Despite BuzzKillerSmith's odd comment here, it seems to me that you have hit upon a critically important link between reality and wishful thinking, between homeowners and your father-in-law contractor, between both patient and physician. (And if these tradeoffs were being as effectively addressed in day-to-day health care as BKS seems to believe, we wouldn't have stent-happy cardiologists implanting all those unnecessary stents, would we now?)

Your quote "designing for the way people are, not the way we wish they were" seems especially appropriate in the discussion of health care and emerging technology. When I attended Stanford University's 'Medicine X' conference last month, I was astounded by the number of young, tech-savvy "Quantified Self" proponents gushing over The Next Big Thing in health care technology - particularly all those self-tracking smartphone apps. (I shouldn't have been astounded - we were in the epicentre of Silicon Valley, after all!) Completely missing was any insight from the health tech startups onstage that the demographic most likely to "need" this kind of technology (especially older users living with multiple chronic diseases) is clearly the group least likely to actually use it. More on this at: "When The Elephant In The Room Has No Smartphone" - http://myheartsisters.org/2...

So the tradeoffs in emerging health technology are, just as you are doing in both your career and in your diagnosis, to respect the fine line between what's out there and what we need to do.

Your comment was so on target, I couldn't resist adding it to a blog post today.
Hoping, just hoping, you don't mind.

Yes, of course Janice. Pls let me know when it's up.

Prof. Witteman, Do you realize that the tradeoffs that you write about are explicitly addressed by us docs and patients all day every day? I hope your tenure committee doesn't find out.

Of course I do. I’m sure you are an excellent physician and do an admirable job of helping patients make difficult decisions. As a frequent patient myself thanks to a couple of chronic autoimmune conditions, I always deeply appreciate when clinicians take the time to talk through decisions with me.

Unfortunately, not everyone is so fortunate as to have a compassionate and caring provider who knows them well and can truly help them through the process of making tradeoffs. Thanks to brief appointments, problems with comprehension, fragmented care, information riddled with uncertainty and ambiguity, normal human susceptibilities to heuristics & biases, and so on, there is still plenty of room for improvement.

Buzzkillersmith, did you actually read and understand the entire article? Given your response, I'm not sure that you did. Had you actually read and understood the part where Holly says: "But as someone living with chronic autoimmune illnesses and..."; you would have realized that not only is she posting as a researcher with a vested interest in this topic, she is also posting as a PATIENT with a vested interest and significant experience in this topic.
So does she realize that the tradeoffs are a reality? I would say that not only does she realize it, but she lives it almost every single day. Given the information presented and the manner of presentation, I would hope that her tenure committee DOES find out.