This post by Sasha Dichter articulates so well what drove me to write Doorbells, Danger, and Dead Batteries – why forwarding a culture of storytelling in user research is essentially to continuing to develop the field.

Storytelling, then, is not simply narrative. It is an opportunity to communicate values in a way that is resonant and memorable, allowing the listener to position herself in the story, see its relevance to her current situation, and then play forward a narrative about her role in the story of now.

How does this happen? It happens through stories in which a human protagonist is presented with an unknown and has to make a choice. At this moment of choice, the listener feels the tension of what might go right and wrong, projects herself into that situation and, in so doing, experiences the values with which the protagonist wrestles.
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This is why it our job to find our own stories, to explore the values that move us to act, and to practice uttering words that help others see and feel what we see and feel. This is the work of finding the language to describe the choices we have made and are making in service of our work, so that others can feel the hope that we feel, and so that they can learn to use this hope to deal with their fears, including fear of acting on our behalf.

A few articles about the practice of medicine echo each other in significant ways, but I share them here as a reminder that all of our work that increasingly relies on technology (e.g., developing digital products) will suffer terribly if we fail to engage the human who thinks, talks, listens and tells stories.

With Electronic Medical Records, Doctors Read When They Should Talk

Even if all the redundant clinical information sitting on hospital servers everywhere were error-free, and even if excellent software made it all reasonably accessible, doctors and nurses still shouldn’t be spending their time reading. The first thing medical students learn is the value of a full history taken directly from the patient. The process takes them hours. Experience whittles that time down by a bit, but it always remains a substantial chunk that some feel is best devoted to more lucrative activities.

Enter various efficiency-promoting endeavors. One of the most durable has been the multipage health questionnaire for patients to complete on a clipboard before most outpatient visits. Why should the doctor expensively scribble down information when the patient can do a little free secretarial work instead? Alas, beware the doctor who does not review that questionnaire with you very carefully, taking an active interest in every little check mark. It turns out that the pathway into the medical brain, like most brains, is far more reliable when it runs from the hand than from the eye. Force the doctor to take notes, and the doctor will usually remember. Ask the doctor to read, and the doctor will scan, skip, elide, omit and often forget.

Like good police work, good medicine depends on deliberate, inefficient, plodding, expensive repetition. No system of data management will ever replace it.

Why Doctors Need Stories

I have long felt isolated in this position, embracing stories, which is why I warm to the possibility that the vignette is making a comeback. This summer, Oxford University Press began publishing a journal devoted to case reports. And this month, in an unusual move, the New England Journal of Medicine opened an issue with a case history involving a troubled mother, daughter and grandson. The contributors write: “Data are important, of course, but numbers sometimes imply an order to what is happening that can be misleading. Stories are better at capturing a different type of ‘big picture.’ ”

Beyond its roles as illustration, affirmation, hypothesis-builder and low-level guidance for practice, storytelling can act as a modest counterbalance to a straitened understanding of evidence. Thoughtful doctors consider data, accompanying narrative, plausibility and, yes, clinical anecdote in their decision making. To put the same matter differently, evidence-based medicine, properly enacted, is judgment-based medicine in which randomized trials, carefully assessed, are given their due.

I don’t think that psychiatry — or, again, medicine in general — need be apologetic about this state of affairs. Our substantial formal findings require integration. The danger is in pretending otherwise. It would be unfortunate if psychiatry moved fully — prematurely — to squeeze the art out of its science. And it would be unfortunate if we marginalized the case vignette. We need storytelling, to set us in the clinical moment, remind us of the variety of human experience and enrich our judgment.

From October 2003, Diagnosis Goes Low Tech

“This technology has become a religion within the medical community,” said Dr. Jerry Vannatta, former dean of the University of Oklahoma College of Medicine. “It is easy to lose sight of the fact that still, in the 21st century, it is believed that 80 to 85 percent of the diagnosis is in the patient’s story.”

Yet medical educators say that doctors are insufficiently trained to listen to those stories. After all, there is no reimbursement category on insurance forms for it. It is this lost art of listening to the patient that has been the inspiration behind a burgeoning movement in medical schools throughout the country: narrative medicine.

The idea that medical students need an academic discipline to teach them how to listen may strike some as farfetched. After all, what should be more natural — or uncomplicated — than having a conversation?

But the narrative medicine movement is part of an ongoing trend in exposing medical students to the humanities. It is needed, educators say, to teach aspiring doctors to pay close attention to what their patients are saying and to understand the way their own emotions affect their perceptions, and ultimately their clinical practice.

The basic teaching method is to have medical students read literary texts and then write about themselves and their patients in ordinary language, rather than in the technological lexicon of the traditional patient chart.

Venerable medical journals like The Journal of the American Medical Association and Annals of Internal Medicine are increasingly publishing reflective writing by doctors, their editors say. And now some medical schools even have their own literary journals. At Columbia University College of Physicians and Surgeons, there is Reflexions; Pennsylvania State University College of Medicine publishes Wild Onions; at the University of New Mexico’s Health Sciences Center, there is The Medical Muse.

Columbia also publishes a semiannual scholarly journal devoted solely to narrative medicine, titled Literature and Medicine, which is edited by Maura Spiegel, a literary scholar, and Dr. Rita Charon, a professor at the medical school and a founder of the narrative medicine movement.

Alex Blumberg has a podcast about his journey to start a podcast-related business. A recent episode of This American Life included an excerpt from this podcast (called StartUp), in which Blumberg is half-heartedly pitching his idea to investor Chris Sacca.

They talk for a while, and Alex is having difficulty in explaining his idea and what he’s asking for.

Alex Blumberg: So it’ll take a million and a half dollars, I think. And–
Chris Sacca: Take out the “I think.”
AB: Yeah. It’ll take a million and a half– I’m looking for a million and a half to $2 million in seed-stage funding.
CS: No, no, no, no, no.
AB: Yeah.
CS: You were looking for a very specific amount of money.
AB: I’m looking for– [LAUGHS NERVOUSLY]

Finally, Chris decides he’s just going to show Alex how to pitch his idea and he very masterfully riffs a confident and coherent bit of persuasion. It’s certainly worth listening to, but here’s the excerpt from the transcript.

Hey, look, can I get two minutes from you? So here’s the thing. You probably know me, producer of This American Life, been doing it for 15 years. You know it’s the most successful radio show, top of the podcasts in iTunes, et cetera.

So here’s the thing. I realize there’s a hunger for this kind of content out there and there’s none of this [BLEEP]. It’s just a bunch of jerk [BLEEP] podcasts. Nothing’s out there.

Advertisers are dying for it. Users are dying for it. And if you look at the macro environment, we’re seeing more and more podcast integrations into cars. People want this content. It’s a whole new button in the latest version of iOS.

So here’s the thing. Nobody else can make this [BLEEP]. I know how to make it better than anybody else in the world. And so I’ve already identified a few key areas where I know there’s hunger for the podcast. We’ve got the subject matter. We’re going to launch this [BLEEP]. I know there’s advertisers who want to get involved with it.

But here’s the unfair advantage I have. Because of what I’ve done in my past careers with This American Life and with Planet Money, people are actually willing to just straight-up pay for this stuff. And I’m not just talking about traditional subscriptions. I’m talking– we did this T-shirt experiment at Planet Money where we got $600,000 coming in, where people actually gave us money to buy a t-shirt with our logo on it as part of the content. It was integrated directly. And I know we can replicate that across these other platforms.

So here’s what we’re doing. We’re putting together a million and a half dollars. That’s going to buy us three, four guys who are going to launch these three podcasts in the next 12 months. We think very easily we could get to 300,000, 400,000 net subscribers across the whole thing.

With CPMs where they are in this market right now, I know on advertising alone, we could get to break even. But as we do more of this integration, we get people texting in to donate to this stuff, buying some of this product, doing some of these integrated episodes, I know that we’re going to have on our hands here something that will ultimately scale to be a network of 12, 15 podcasts. The audience is there. They want it. Nobody else can do it like we can. Are you in?

It’s so painful to hear Alex stumble and when Chris takes over, I felt a sense of relief and a certain excitement, to hear an idea presented in a way that was designed to engage and persuade. This is a valuable skill in many aspects of professional life, especially when we’re in the business of sharing ideas. The superlative example in this podcast is quite inspiring.

The relevant section starts at 19:21 in the embedded widget below.

“Original Deadman” t-shirt, street market, Bangkok, 2006

I just learned the word Kayfabe. It describes the artificial story elements in professional wrestling. Beyond any discussion of the fights themselves (long dismissed as fake), kayfabe refers to the everything else that is fake, such as the feuds and rivalries. The word is probably a Pig Latin-esque version of “fake” (where by avoiding saying “fake” outright, it’s now a codeword to keep the fakery discussion only among those in the know).

Here’s more, from the above Wikipedia article

Many storylines make use of kayfabe romantic relationships between two performers. Very often, both participants have other real-life relationships, and the “relationship” between the two is simply a storyline. However, more than once, kayfabe romantic relationships have resulted either from a real-life relationship, such as between Matt Hardy and Lita, or ultimately developed into a real-life marriage (e.g., Triple H and Stephanie McMahon, who married in 2003, more than a year after their kayfabe marriage ended).

Whoah. Layers of meaning and truth and piled onto other layers of implication and lies. My brain feels like I’ve been pummeled with a roll of quarters. Layered conceptual devices are challenging enough, but there’s also interest in breaking kayfabe

To have certain non-fictional elements weaved into a storyline. They might be staged to look real, meaning that a real truth is being spoken, but are part of the script to make the rivalry look authentic or personal, and to make the feud much more interesting.

That’s some efficient use of a narrative framework. When you go outside the framework, you still have story (and meaning).

If you find this difficult to parse, join the team. At least having some labels (kayfabe, breaking kayfabe) make it easier to discuss.

Related: Canon, the defined world (characters, events, history, etc.) of a story. Especially notable in science fiction, with complicated story lines, detail-oriented fans, and franchises with sequels and prequels galore. Previously about Star Trek’s sprawling fan-driven post-TOS canon, and the person hired by Lucasfilm to maintain continuity as the Star Wars canon guru.

Related: Retcon is the portmanteau word for retroactive continuity, where a new story element is introduced that changes our understanding of previous facts. I would include It Was All A Dream (e.g., Dallas) as the laziest version. It can also be ironic as well as convenient, such as having Klingons in Star Trek explain their differing physical appearance over the various series (obviously the result of new production designers as well as budget and makeup technology) as part of the race’s own history. Many more examples are here.

Magnises is a new sort-of-credit-card that evokes an ultra-elite black card. It’s not actually a credit card, though. As they describe it

Each Magnises member carries our distinctive metal membership card, which extends and enhances their pre-existing credit or debit card, and provides perks, benefits, and access to numerous high-end brands. Upon admittance, Magnises will construct a card for each new member. Magnises will then extend the magnetic signature from the member’s personally owned credit or debit card onto their new Magnises card.

Yep, that’s right. You get a metal card that looks like a credit card but simply has the credit card data copied onto it – from the credit card you already own. While there are perks, no doubt, with this card, it is not actually the thing it denotes. It’s merely a gussied-up package for the quotidian plastic in your wallet (well, maybe not your wallet, if you are reading this it’s unlikely you are cool enough to qualify).

As a species, our ability to create meaning out of almost nothing – and then charge money for the performance of that meaning – is astonishing.

For more, see

Magnises Black Card Has Its Privileges (Well, Sort Of) [NYT]

In 2010, we conducted a public-facing study about the future of books and reading, called Reading Ahead. We raised many fascinating questions including the design implications for the digital book experience: which elements of the traditional experience should move forward and which should be left behind.

Looking at the issue a few years later is the New York Times, with Out of Print, Maybe, but Not Out of Mind

Some functions of physical books that seem to have no digital place are nevertheless being retained. An author’s autograph on a cherished title looked as if it would become a relic. But Apple just applied for a patent to embed autographs in electronic titles. Publishers still commission covers for e-books even though their function — to catch the roving eye in a crowded store — no longer exists.

What makes all this activity particularly striking is what is not happening. Some features may be getting a second life online, but efforts to reimagine the core experience of the book have stumbled. Dozens of publishing start-ups tried harnessing social reading apps or multimedia, but few caught on.
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Much of the design innovation at the moment, Mr. Brantley believes, is not coming from publishers, who must still wrestle with delivering both digital and physical books. Instead it is being developed by a tech community that “doesn’t think about stories as the end product. Instead, they think about storytelling platforms that will enable new forms of both authoring and reading.”

In the 90s, conceptual artists Komar and Melamid used focus groups and opinion-polls (then-current tools used in politics) to identify the best attributes of a painting, then created works that matched those criteria.

So why not apply something similar to film? The New York Times tells us all about it (although this is more about correlating with sales data than opinion data, it pursues the same conclusion – without irony here – that a combination of the right elements assembled together will create a successful whole).

A chain-smoking former statistics professor named Vinny Bruzzese has started to aggressively pitch a service he calls script evaluation. For as much as $20,000 per script, Mr. Bruzzese and a team of analysts compare the story structure and genre of a draft script with those of released movies, looking for clues to box-office success. His company, Worldwide Motion Picture Group, also digs into an extensive database of focus group results for similar films and surveys 1,500 potential moviegoers.

“Demons in horror movies can target people or be summoned,” Mr. Bruzzese said in a gravelly voice, by way of example. “If it’s a targeting demon, you are likely to have much higher opening-weekend sales than if it’s summoned. So get rid of that Ouija Board scene.”

Bowling scenes tend to pop up in films that fizzle, Mr. Bruzzese, 39, continued. Therefore it is statistically unwise to include one in your script. “A cursed superhero never sells as well as a guardian superhero,” one like Superman who acts as a protector, he added.

Heads, Oakland’s First Friday, June 2013

I do love this NYT Op-Ed (What Data Can’t Do) from David Brooks, especially

Data struggles with context. Human decisions are not discrete events. They are embedded in sequences and contexts. The human brain has evolved to account for this reality. People are really good at telling stories that weave together multiple causes and multiple contexts. Data analysis is pretty bad at narrative and emergent thinking, and it cannot match the explanatory suppleness of even a mediocre novel.

Of course, the qualitative narrative data is still data. It’s mostly the kind of information I work with. Perhaps it’s easy to conflate data with Big Data and succumb to the notion that if the approach to Big Data is limiting, then the approach to data in general must be limiting. But data is data – it’s what we use, in whatever forms, to inform and inspire and drive decisions.

The ethnographic research community is looking at the increasing reliance on quantitative data in business and questioning their role. Rich Radka proposes a “Yes, and…” mindset in this posting, no doubt one of many we’ll be seeing, as our business culture (and culture overall) evolves.

This past Monday was the Interviewing Users book launch party. It was a fantastic good time. The room was filled beyond capacity with people happily diving into yummy beer, wine, snacks and desserts. We gave away 20 free copies of the book, and had the first-ever live War Stories.

It was fascinating to see how these stories, originally written for the web, changed when told aloud to an engaged crowd. Each storyteller seemed somewhat surprised that their stories produced laughter, with several folks beginning by disclaiming “I’m not going to be funny” only to produce that reaction from the group. Real human stories that involve screwups, frustration, surprise and conflict can be funny even if it’s not something we wish on anyone else. There’s a humor of recognition and also the humor that comes from the way a story is told. And they all did a great job at telling their stories, not a skill to be taken for granted. I was so impressed!

Our storytellers:

• Kelly Braun, Senior Director, User Insights and Analytics at Walmart.com who told Pictures are language independent, about shooting fieldwork video and inadvertently getting the money shot.
• Diane Loviglio, CEO & Co-Founder at Share Some Style told Interrupted Interview, a reminder that participants are part of larger systems that we don’t have insight into when we’re recruiting them.
• Consumer insights professional Carla Borsoi told A dirty diaper sitting in the mud, where she encountered the outlier that illustrates a greater truth.
• Tom Williams, Principal of Point Forward dispensed with his original story (Go With the Flow) and instead told a (richly detailed) story about an interview we did together in 1998!

Also in attendance were War Stories contributors Jon Innes (Beware of Trap Doors), Rachel Wong (Subject Matter May Be Inappropriate) and Vanessa Pfafflin (DDoSed in Vegas).

See also Susan Dray’s take on what the body of War Stories has revealed for her.

photos courtesy of Tom Williams/Kate Edgar

Restaurants Turn Camera Shy [NYT] – While on one level this is a story about shifting norms, where an emerging behavior is deemed rude and disruptive. Where it is or not is another question, not really explored here. But there is at least one example of finding alternative ways to address the need rather than just banning what is considered wrong.

But rather than tell people they can’t shoot their food – the food they are so proud to eat that they need to share it immediately with everyone they know – he simply takes them back into his kitchen to shoot as the plates come out. “We’ll say, ‘That shot will look so much better on the marble table in our kitchen,’ ” Mr. Bouley said. “It’s like, here’s the sauce, here’s the plate. Snap it. We make it like an adventure for them instead of telling them no.” Mr. Bouley is setting up a computer system so that diners can get digital images of what they’ve eaten before they even get the check.

‘Friends’ Will Be There For You At Beijing’s Central Perk [NPR] – While in the west the show might be a somewhat-beloved artifact of a decade past, in another part of the world, the possibility for a different meaning is ripe. Perhaps, as the article suggests, this somehow embodies freedom that young Chinese are yearning for?

Tucked away on the sixth floor of a Beijing apartment block is a mini replica of the cafe, orange couch and all, whose owner Du Xin introduces himself by saying, “Everyone calls me ‘Gunther’ here.” Indeed, he is a Chinese version of cafe owner Gunther from the show, down to his giddy passion for Rachel (the character played by Jennifer Aniston). “I’m crazy about Friends,” Du says. “For me, it’s like a religion. It’s my life.” The extent of Du’s Friends obsession is clear on entry to Beijing’s Central Perk. The level of detail is scary: same window, same doorway. People sitting on the orange sofa are watching TV – reruns of Friends, naturally. The cafe only serves snacks mentioned in Friends, and the menus are even annotated.

The Role of Anecdotes in Science-Based Medicine – An imperfect but perhaps illustrative analogy to user research, about the relationship between stories and what some may call “proof.”

Here are two limiting factors in how anecdotes should be incorporated into medical evidence: The first is that anecdotes should be documented as carefully as possible. This is a common practice in scientific medicine, where anecdotes are called case reports (when reported individually) or a case series (when a few related anecdotes are reported). Case reports are anecdotal because they are retrospective and not controlled. But it can be helpful to relay a case where all the relevant information is carefully documented – the timeline of events, all treatments that were given, test results, exam findings, etc. This at least locks this information into place and prevents further distortion by memory. It also attempts to document as many confounding variables as possible. The second criterion for the proper use of anecdotes in scientific medicine is that they should be thought of as preliminary only – as a means of pointing the way to future research. They should never be considered as definitive or compelling by themselves. Any findings or conclusions suggested by anecdotal case reports need to be later verified by controlled prospective clinical studies.