While in some circles (radiating concentrically from Palo Alto, one imagines), design is, if not quite passé, at least associated with irrational exuberance and extravagant expectations (see this 2009 posting by Peter Merholz, founder of the user experience consultancy Adaptive Path, and the energetic dialog his remarks engendered), these principles have made only very preliminary inroads into medicine and healthcare.

For starters, medicine is far less "human-centered" -- that is, patient-centered -- than most observers appreciate. In the exact same way that well-intentioned engineers often go awry by creating features based on their own perception of what they perceive users must want, medicine has spent a lot of effort focused on a physician's idea of a patient, rather than developing a more nuanced view of life from the perspective of the patients themselves.

Physicians have surprisingly little visibility into a patient's day to day health experience -- doctors typically have no idea whether a patient actually took their prescribed medication (data suggest the level of adherence can be shockingly low), took their medication correctly (video studies of patients taking injectible or inhaled medicines reveal remarkable variability), or adhered to behavioral recommendations (you have to ask?).

Doctors also have little sense of a patient's daily experience with their disease -- their daily blood pressure, say, or ability to inhale deeply -- to say nothing of less concrete but arguably more important parameters such as mood or quality of life. The physician's episodic assessment of a patient's health, an occasional snapshot, may not always capture all, most, or, in some cases, almost any of the patient's actual experience with disease. Worse still (as discussed here), the absence of more granular knowledge of patients means that doctors have virtually no idea of whether they are providing effective care or not -- are patients even following their advice, is the advice doing any good, and are the doctors even focused on the issues most important to patients?

To be sure, some change is in the air; device makers are focusing more intently than ever on the user experience; equipment makers are trying to focus on the use of affordances to reduce human error; a number of hospitals are trying to pay more attention to the holistic needs of their inpatients; and a slew of mobile health companies are developing products that offer the promise of more continuous monitoring and assessment.

I've no doubt that design principles can -- and, hopefully, soon will -- help us all do better utilizing the resources (personnel, institutions, therapeutics) we currently have: an enormous accomplishment.

But Steve Jobs didn't die at the age of 56 because he didn't like his hospital johnny, or because he accidentally took the wrong pill, or because he wasn't getting the levels of some hormone assessed frequently enough. He died because he had cancer, and he needed an effective drug -- or similar intervention. What does design thinking have to offer here? Can it lead to transformative medical discoveries, to an implementable cure for a particular disease?