[Note: Simulations are a key piece of the Health for America at MedStar Health fellowship. Given the many dimensions of stroke, the 2016-17 fellows participated in a range of stroke simulations. Below, King reflects on his experience. You can read other perspectives here and here. ]
When people ask the difference between sympathy and empathy, I offer the following scenario:
Imagine finding a person who is stuck in a hole. If you are sympathetic, you remain above ground, looking down into the hole and asking how the person is feeling. If you over-identify, you jump into the hole too and commiserate in the direness of the situation. If you are empathetic, you go out of your way to climb down into the hole, and eventually help the person climb out.
In health care, well-intentioned solutions are oftentimes short of empathetic. The Health for America (HFA) at MedStar Health fellowship is one-of-a-kind because it looks at healthcare problems through the lens of empathetic and user-centered design. During the latter stages of our exploration phase, we executed patient simulations and immersed ourselves in the conditions and experiences that stroke survivors face.
For the first part of the simulation in which we focused on the disability component of stroke over the course of three days, I was assigned a patient profile that included left-side weakness on both my arm and leg. To simulate this disability, I wore a foot brace, knee immobilizer, and arm sling, balancing myself with a quad cane while I walked. While in full gear, I experimented with several activities of daily living: taking a stroll in the park, riding the Metro, cooking dinner, and getting in and out of a cab. Each of these was extremely difficult to complete. For instance, while walking in the park, I noticed that I was fatigued more easily because coordinating my movements took more energy. Moreover, when downward hills were ahead, I was more mindful of potential falls because I impaired my balance through my simulated disability. When it came to cooking, I found myself struggling with basic things such as carrying kitchen equipment and chopping vegetables with only one good hand or moving from point A to point B with my cane. Multi-tasking was out of the question: I couldn’t, for example, hold my mug securely while standing because I needed my good hand to hold on to my cane. Imagine managing your diet as a stroke survivor: restaurant food is convenient but often unavoidably high in sodium, yet cooking at home while recovering is, as my simulation experience revealed, a daunting task.
The second part of the simulation, which lasted two weeks, focused on the primary and secondary prevention measures recommended for at-risk populations and stroke survivors. These include daily exercise regimens and dietary habits (e.g. low-sodium, low-cholesterol, high-fiber, low-carbohydrate) that prevent the first-time onset or recurrence of stroke. My persona during this part of the simulation was that of an at-risk 50-year-old individual who recently had a transient ischemic attack, otherwise known as a “mini-stroke.” To hold myself accountable to my lifestyle changes, I used an app called MyFitnessPal that kept track of my sodium, cholesterol, carbohydrate, and caloric intake for every meal I consumed. I engaged in light exercises such as yoga and calisthenics at home. Monitoring my blood pressure twice a day and taking 13 fake pills every day were also part of my routines.
Much to my chagrin, all of it was easier said than done. Being the carnivore and Filipino-American that I am, it was hard to forego the savory dishes that I grew up relishing. When I cook, I indulge in traditional Asian ingredients such as soy sauce, fish sauce, sesame oil, and coconut milk. Needless to say, the two-week lifestyle change became grueling. It would also be remiss of me not to admit that after a few days of healthy (and, by my standards, tasteless) meals, I would go to the closest fast-food joint and binge on fried chicken, burgers, and the like.
All in all, the simulation phase was eye-opening in more ways than one. The challenges I faced during the two-week simulation are just cross-sections of the real, long-term challenges stroke survivors and at-risk populations face in their day-to-day lives. That said, I now possess a more nuanced understanding of the types of problems we’re hoping to tackle during our ideation and implementation phases. As the HFA fellows approach these phases, we aim to incorporate design-thinking principles into our work by grounding our next steps in our takeaways from the simulation. As the opening illustration of empathy demonstrates, a novel user-centered solution can be achieved only if we understand the situation from the perspective of our end users, be they patients, families, or physicians. If we are to succeed in this fellowship, we have to remain rooted in empathy as we use the tools and resources available to us to work alongside our stakeholders in creating this kind of user-centered solution.
See a few more photos of my simulation below! And stay tuned for reflections coming from other fellows.