St. God’s: Healthmaster Inferno

After Joe goes through triage, he is directed to the “diagnosis area to the right.” He waits in a short queue, and then enters the diagnosis bay.

The attendant wears a SMARTSPEEK that says, “Your illness is very important to us. Welcome to the Healthmaster Inferno.”

The attendant, DR. JAGGER, holds three small metal probes, and hands each one to him in turn saying, “Uh, this one goes in your mouth. This one goes in your ear. And this one goes up your butt.” (Dark side observation about the St. God’s: Apparently what it takes to become a doctor in Idiocracy is an ability to actually speak to patients and not just let the SMARTSPEEK do all the talking.)

Joe puts one in his mouth and is getting ready to insert the rest, when a quiet beeping causes the attendant to pause and correct himself. “Shit. Hang on a second.” He takes the mouth one back and hands him another one. “This one…No.” He gathers them together, and unable to tell them apart, he shuffles them trying to figure it out, saying “This one. This one goes in your mouth.” Joe reluctantly puts the offered probe into his mouth and continues.

The diagnosis is instant (and almost certainly UNKNOWN). SMARTSPEEK says, “Thank you for waiting. Dr. Lexus will be with you shortly.”

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The probes

The probes are rounded, metal cylinders, maybe a decimeter in length. They look like 3.6mm audio plugs with the tips ground off. The interface-slash-body-horror joke is that we in the audience know that you shouldn’t cross-contaminate between those orifices in a single person, much less between multiple people, and the probes look identical. (Not only that, but they aren’t cleaned or used with a sterile disposable sheath, etc.) So Joe’s not sure what he’s about to have to put in his mouth, and DR. JAGGER is too dumb to know or care.

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The bay

Modeled on car wash aethetics, the bay is a molded-plastic arch, about 4 meters to a side. The inside has a bunch of janky and unsanitary looking medical probes and tools. Around the entrance of the bay are an array of backlit signs, clockwise from 7 o’ clock:

  • Form one line | Do not push
  • (Two right-facing arrows, one blue, one orange)
  • (A stop sign)
  • (A hepatitis readout, from Hepatitis A to Hepatitis F, which does not exist.)
  • Tumor | E-Coli | Just gas | Tapeworm | Unknown
  • Gout | Lice | Leprosy | Malaria
  • (Three left-facing arrows, orange, blue, and magenta)
  • (The comp created for the movie tells…) Be probe ready | Thank you!

Theoretically, the lights help patients understand what to do and what their diagnosis is. But the instruction panels don’t seem to change, and once the patient is inside the bay, they can no longer see the diagnosis panels. The people in the queue and the lobby, however, can. So not only does it rob the patients of any bodily privacy (as they’re having to ram a probe up their rears), but it also robs them of any privacy about their diagnosis. HIPPA and GDPR are rolling around in their then-500 year old graves.

Hygiene

A better solution would of course focus on hygiene first, offering a disposable sheath for the probes. They should still be sterilized between patients.

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Because this is such as visceral reminder, I’m nominating this as the top anti-example of affordances and constraints for new designers.

Better affordances

Second would be changing the design of the probes such that they were easy to distinguish between them. Color, shape, and labeling are initial ideas.

Better constraints

Third would be to constrain the probes so that…

  • The butt probe can’t reach up beyond the butt (maybe tying the cable to the floor? Though that means it’s likely to drop to the ground, which is clearly not sterile in this place, so maybe tying it the wall and having it klaxon loudly if it’s above butt height.)
  • The mouth probe can’t reach below the head (maybe tying the cable to the ceiling)
  • The ear probe should be smaller and ear-shaped rather than some huge eardrum-piercing thing.

And while modesty is clearly not an issue for people of Idiocracy, convention, modesty, and the law require us in our day to make this a LOT more private.

Prevention > remedy

Note that there is an error beep when Joe puts the wrong probe in his butt. Like many errors, by that time it is too late. It makes engineering sense for the machine to complain when there is a problem. It makes people sense to constrain so that errors are not possible, or at the very least, put the alarm where it will dissuade from error.

Also, can we turn the volume up on those quiet beeps to, say, 80 decibels? I think everyone’s interested in more of an alarm than a whisper for this.

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A hidden, eviscerating joke

In addition to the base comedy—of treating diagnosis like a carwash, the interaction design of the missing affordances and constraints, and the poop humor of sticking a butt probe in your mouth—there is yet another layer of stupid evident here. Many of the diseases listed on the “proscenium” of the bay are ones that can be caused by, yep, ingesting feces. (Hepatitis A, Hepatitis E, tapeworm, E. “boli.”) Enjoy the full, appetizing list on Wikipedia. It’s a whole other layer of funny, and hearkens back to stories of when late-1800s doctors took umbrage at Ignaz Semmelweis’ suggestions that they wash their hands. (*huffgrumble* But we’re gentlemen! *monocle pop*) This is that special kind of stupid when people are the cause of their own problems, and refuse to believe it because they are either proud…or idiots.

But of course, we’re so much wiser today. People are never, say, duped into voting for some sense of tribal identity despite mountains of evidence that they are voting against their community, or even their own self-interest.

Fighting the unsanitary butt plugs of the Idiocracy

“Action by action, day by day, group by group, Indivisibles are remaking our democracy. They make calls. They show up. They speak with their neighbors. They organize. And through that work, they’ve built hundreds of mini-movements in support of their local values. And now, after practice, training, and repetition, they’ve built lasting power on their home turf and a massive, collective political muscle ready to be exercised each and every day in every corner of the country.”

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Donate or join the phone bankers at Indivisible to talk people into voting, and perhaps some sanity into Idiocrats. Indivisible’s mission is “to cultivate and lift up a grassroots movement of local groups to defeat the Trump agenda, elect progressive leaders, and realize bold progressive policies.”

St. God’s: Intake

In their forecasting workshops, the Institute for the Future trains practitioners to sensitize themselves to “signals,” something that may seem banal but on reflection foretells great change or deep meaning. That story about the arctic penguins who accepted a furry remote controlled camera as a chick is one of mine. Still wrestling with its implications. This interface is another.

After Joe walks past the FloorMaster and Insurance Slot Machines, he finally makes it up to the triage desk. It’s labeled CHECK-IN, and the sign devotes a large portion of its space to advertising. He speaks to the employee there, named Biggiez, who blankly listens to him talk about how he’s feeling. As he talks, she looks down at a wide panel of buttons, floating her pointing finger above the unlabeled icons that kind-of describe common ailments.

When Joe says, “I don’t even know where I am,” she finally pushes an icon featuring a stick figure, shrugging, with two question marks floating in the space beside its sad face. In response, it lights up, we hear a ding, and a SMARTSPEEK device on Biggiez’ blouse says, “Please proceed to the diagnostic area on the right…and have a healthy day.” Joe moves on to the diagnosis bay, which I’ll discuss in the next post.

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A shout-out to these icons

While I normally stick to the canon of what actually appears in the final edit, these are hilarious, and the designer has published the lot of them online, so feast your sense of humor on the whole smörgåsbord.

Behold them. They are, literally, 9 kinds of funny.

  1. Some are slapstick. Squirting hole in butt cheek. Hole in gut. Ow, my balls.
  2. Some point to the stupidity of the patients. Baby drop. Things-what-damaged-my-head (lightning, knife, nail, gun, bump). All the evisceration.
  3. Some point to the stupidity of the maker of the panel. Options for gender include and are limited to (rather than, say, the much more reasonable 63:
    • I cannot tell. (Alternately: They are feeling gender dysphoria.)
    • They are hermaphroditic/intersexed.
    • They are a female to male transsexual.
  4. Some point to not-hospital problems. Feeling angry.
  5. Some point to not-problems. Thinking of atoms. I recycled.
  6. Some are nigh-impossible. Hello, I am dead by decapitation. Have I drowned? I am in such pain that I have gained a third eye.
  7. Some show how slipshod the QA on this thing was. Two left/right arrows (when there’s nothing), two guns-to-head
  8. Unhelpful nuance. My arm is chopped off. My leg is chopped off. My scalp, arm, and lower leg are chopped off.
  9. Some are inscrutable. An asterisk. A takete (with no baluba). Updown.

That’s graphics carrying quite a bit of comedy load here. Readers interested in behind-the-scenes will like to know they were made by designer Ellen Lampl. (A significant portion of her portfolio is film graphics, so be sure to check it out.) In 2014 she had an interview with Phil Edwards which you can read on triviahappy.com, where she tells more about her process.

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The set is even funnier because of course how could the breadth of human problems be reduced down to 48? (And these 48.) There are 14,400 codes in IDC-10 alone. What is Biggiez supposed to do if Joe was complaining about being struck by duck? IDC can handle that. (No really.)

But aside from praising the comedy, let me do my due diligence and discuss four (off the top of my head) improvements that could be made if this was a real system. Even for morons.

How about labels?

Yeah. Not a single one of them are labeled, introducing way too much ambiguity. Labels don’t always provide the specificity they need, but not having them on icons practically assures it.

Allow multiple ailments

Another failing of the panel is that is doesn’t appear to handle multiple ailments. In fact, Joe complains about hallucinations (R443), a headache (R51), and aching joints (need some help with that one, but her finger is so close to the knee icon), but she only indicates the one about confusion. You’d hope there was some way for her to touch an icon for every ailment, and then submit them but that just doesn’t seem to be the case. Maybe patients just have to keep coming back to check-in to care of each thing, one at a time.

Rank urgency

The purpose of triage is first to rank the urgency of the need medical care. The gal with the baby dropping needs to be seen now, but the gal who just has some questions can wait over there for a while. How would this panel code urgency?

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Urgency might be just part of the code (gun to head less than knife buried in head), but that would mean this panel would have to have separate icons for light scratch to the scalp and a gaping free flowing head wound, and they just don’t require the same levels of attention.

The panel seems to have a simple pain scale on the left of [happy | sad | neutral], but since Biggiez doesn’t touch them, it’s not clear that these work like a chorded button or some separate code for someone who comes in complaining about their base emotional state.

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A better system would let you identify the problem and pain scale separately, as different facets of the complaint.

Chunk stuff

Just to make sure I’m saying the 101 layout principle: if you really had a panel of flat options, chunking them into groups helps the user understand, recall, and find items.

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This points to an opportunity

So of course there are lots of reasons why this is funny as hell, breaking lots of fundamentals for a funny, body-horror kind of joke while Joe figures things out.

But I think the reason this interface has really stuck with me is that it would pass a usability test. As in, Biggiez finds it perfectly easy to use. She can scan the icons, tell them apart, select one with ease. Hell, the SMARTSPEEK even makes sure she can’t mess up telling the patient what to do next. This would get a very high Net Promoter Score. It would do well on any self-reporting satisfaction measure. And it still sucks.

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Sure, it would fail an efficacy test, but what if we took on the hubris of rethinking the role of the interface here. To the point, this interface lets Biggiez just stay dumb. (And we have way too much of that in the world as it is.) What if it could make Biggiez smarter?

First draft: What if two nurses listened to the patient’s complaints side-by-side, and their codings were only revealed to each other when they’d both completed them. Then, as the patient went through diagnosis, a fedback loop rewarded the nurse who was most correct. The reward could be money, or rankings amongst peers, or almost anything really? Biggiez would have incentives to not just do the task (or have the task done for her.) She would have incentives to get better and smarter at her job.

This may not be the best actual design proposal, but I’m intrigued by this possibility. What if our interfaces could make everyone who used them smarter? Faster? Stronger? (Musical break.) What if every technology was like this? With technology everywhere, what if technology made us better instead of treated us like petri dishes for colonizing?

I am thinking about it.

Fighting Idiocracy

Another way you can help fight American idiocracy is to sign up to volunteer your time for the last weekend. As The Last Weekend notes, “Study after study shows that the most effective way to get people to vote is by having conversations with them in the four days before Election Day (Saturday, November 3rd – Tuesday, November 6th).” It’s a short commitment for that last big push before the election. Sign up now at https://thelastweekend.org/.

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St. God’s: Insurance Slot Machine

The other depressing thing besides the FloorMaster that Joe sees as he walks through St. God’s lobby is the insurance slot machines.

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He sees a man with a blank expression and a bleeding head wound above his left eye, who stands a bank of slot machines. The backglass of each has diagonal logos advertising BLAKDIX capsules (n.b. the wallpaper advertises BONERAX), telling players they can play while they wait, and that they can WIN FREE MEDICAL CARE. The reel strips don’t show bells or fruit, but rather, pills. The blood from the head wound shines in the lights.

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This is the future that the GoP and insurance companies want.

Games and games of chance don’t obey standard usability principles. The point of them is that you don’t know if you’ll get what you want. So a regular analysis won’t do.

Slot machines are fairly standardized, and the only things these particular ones seem to be missing is a paytable. If you don’t know your slot machine lingo, that’s an information table, presented on the backglass, explaining what combinations of symbols pay out and how much. Three z-packs? Congratulations! You don’t have to die of sepsis today! No player should put money in a slot machine without knowing what the payout might be. And these machines don’t have them. In the real world, this wouldn’t fly. But in Idiocracy, it’s perfect. Let me explain. Of course it’s going to get political fast.

The shock of this half-a-second beat comes from the immediate recognition that the man is bleeding, and the half-a-second later realization that he’s standing at a slot machine to try and resolve his problem. Why isn’t he getting care? Why does he accept this? Why would anyone? This is stupid, you think. And you’re right. It’s stupid and inhumane that the richest country in the world would not use some of its wealth to take care of its citizens. Yet 44 million Americans have no insurance and another 38 million have inadequate insurance. That means nearly one-third of Americans are just hoping that they don’t get sick. If they do, they risk either getting that help and going bankrupt, or living in pain, getting worse…maybe dying. Also, you know, their kids.

No one wants to get sick. So in our system, we have the uninsured gambling with their lives.

This isn’t just how it has to be. Thirty-two of the thirty-three developed nations have universal health care, with the United States being the only exception. There’s an idiotic idea that America somehow gets great medical care in exchange for this, but that’s just a self-serving lie. The Commonwealth Fund did an extensive comparison of the healthcare in 11 developed nations, and the U.S. fared the worst. And individually, we pay about twice as much per capita than other developed nations. So our system is the most expensive, AND the worst, AND abandons ⅓ of our citizens to rolls of the healthcare dice. How can it be this way? Who is in favor of this? Healthcare for profit, of course, and that’s a GoP speciality.

We know that Democrats lead the way on healthcare reform. The Affordable Care Act was remarkable for how far it got with Obama facing a historically obstructionist Republican Congress, and the GoP has been trying to undo it since. Insurance companies know that the GoP is their friend. In 2012, the insurance industry donated nearly $55 million to parties and candidates and 68% went to Republicans. They know.

Which brings up back to the slot machines. People who stand at a machine that looks like it might give them healthcare (gosh, it looks like a slot machine. It must pay eventually, right?), without any indication that it actually will, are idiots, and any system that allows this is an Idiocracy.

We have one tool to combat making this image any more of a reality, and it’s a vote.

Fighting Idiocracy

Voter suppression tactics (undertaken in the bad-faith argument against voter fraud) include closing polling places near traditionally Democrat strongholds. What can you do?

Drive them yourself

If you have seats to spare make a broadcast on social media channels. Or offer to people who may face transportation challenges.

Join Find a volunteer driver group

Carpool the Vote seems dedicated to this cause, but is currently not accepting any more sign ups, but it would be worth checking in on the site to see if they open up again. I couldn’t find an alternate system, but if anyone knows it, speak up in the comments.

Share information about discounted and free ride-shares

Lyft is offering 50% off rides to and from polling locations on election day. Unfortunately I can’t find a way to donate to Lyft so they can make it free, so I will note that Uber—though a company with a much worse track record as a corporate citizen than Lyft—has promised free rides. (People have to have the latest version of the app, so also encourage them to update it.) Get that word out to people who can use it. Post on neighborhood Facebook groups, Slack, and NextDoor channels.

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Get people to the polls so they exercise their right to vote.

Healing chamber

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After Johnny was mistakenly reported as killed, the next time we see him he is in a healing chamber, submerged in green-underlit translucent fluid, resting on form-fitting clear plastic supports. He breathes through a tube, and a pair of small robot arms work busily to regenerate the damaged tissue in his leg.

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The main reason to discuss this chamber on a blog about interfaces is the material choice of the outside of the chamber. By being surrounded completely in a transparent material (glass? plexiglass? transparent aluminum?), it means that physicians can keep an eye on progress, and he can have visual interactions with visitors, as we see when Dizzy and Ace visit to share with him his mistaken death certificate (and for Dizzy to leave him a kiss.) Additionally it gives Johnny something to look at during the long hours of recuperation.

I’m not sure why the green light is necessary. The scene implies that it could serve some part in the healing process, but if not, I wonder if an amber light might signal a more human, nurturing warmth to Johnny and visitors. Narratively, you’d want to avoid anything too yellow or run the risk of the audience’s first interpretations drifting too far to the Andres-Serrano-esque.

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