Technological determinism
Why technology can do more harm than good if not designed appropriately
Dave Pao
2 min read
November 2023
‘It’s not that we’re a bunch of Luddites who don’t know how to use technology. I have an iPhone and a computer, and they work the way they’re supposed to work, and then we’re given these incredibly cumbersome and error-prone tools.’
- Critical care specialist at a US Senate hearing on electronic health information (2019)
Every year the dissonance grows between the digital tools clinicians use at work and those they use at home and on their smartphones. Today, more than a century after Veblen (1857–1929) first described the concept, the pervasive presence of technological determinism in EHR interface design is palpable [modified for the clinical domain]:
‘The machine throws out anthropomorphic [clinical] habits of thought. It compels the adaptation of the workman [clinician] to his work [EHR interface], rather than the adaptation of the work [EHR interface] to the workman [clinician]. The machine technology rests on a knowledge of impersonal, material cause and effect, not on the dexterity, diligence, or personal force of the workman [clinician].’
Sydney J Harris (1917-1986) simplified this when he said: ‘The real danger is not that computers will begin to think like men, but that men will begin to think like computers.'
This dissonance is a direct consequence of the genuine difficulty in understanding 'how clinicians think'—and it introduces serious, large-scale individual and endemic risk to patients and populations of patients. It underlines the subtle but pervasive influence of technological determinism in shaping the cultural trajectory of medical practice.
Muriel Cooper (1925—1994) was one of many who attempted to warn us about, and steer us away from, interface technological determinism. A visual pioneer and co-founder of the Massachusetts Institute of Technology (MIT) Media Lab, she was quick to spot the transformative effect of screen-based digital technology. Ahead of almost everyone else, she saw that digital required a wholesale rethinking versus paper: ‘The shift from a mechanical to an information society demands new communication processes, new visual and verbal languages, and new relationships of education, practice and production.’
In Cooper's last interview, her work was summed up in two words: ‘Beyond Windows' (Abrams, 1994).
Abrams, J. (1994). Visible wisdom. I.D. Magazine. [Online]. Available at: https://g-e-s-t-a-l-t.org/media/pdf/Visible-Wisdom.pdf [Accessed 13 August 2023].
US Senate. (2019). Implementing the 21st century cures Aact: Making electronic health information available to patients and providers. [Online]. Available at: https://www.help.senate.gov/hearings/implementing-the-21st-century-cures-act-making-electronic-health-information-available-to-patients-and-providers
