Knowledge organization systems that made me go 😍 (pt. 1)

on intake forms and how information design makes all the difference

One of the reasons why I want to get better at organizing my thinking around complex systems is because I want to apply this skill to improve cities and urban planning.

There are very few examples of good system thinking applied to cities (Doxiadis may be one of the very few) so while I am still doing my own research on cities and the good life, I am also studying how others have organized their thoughts around systems in other domains.

This past week I encountered two exceptionally interesting system organization examples which I’d like to share with you here.

The Intake Form for a Naturopathy Doctor

My health is not terrible, but it can be much better. While I am very grateful for the mostly free healthcare that we enjoy in Canada, many family doctors leave much to be desired in the realm of “looking at the big picture”. Their approach of treating symptoms with quick fixes is especially lacking for gnarly issues like “low energy” and “chronic pain” that have no single clear cause.

Therefore I have been seeking - and have found - a naturopathy clinic to help with some of these things. I had an intro call with an ND and it felt great to talk to someone who I philosophically felt I aligned with on a health front. I want someone to help me look for patterns among all the symptoms to identify potential root causes, and then treat the root causes. (I frankly don’t quite get why all medicine isn’t practiced this way, but ok. Every domain and profession has its dysfunctions I suppose.)

While filling out their intake form, there was one part that really made my PKM lightbulb go off in my head.

It was called “A Review of Systems”.

Located near the end of the already long form, it asks you to do a mental check on the following systems to make sure you were as exhaustive in your self-evaluation as possible.

While these sub-systems are indeed completely enmeshed in our bodies and form a singular biological system, whole systems thinking helps “pull out” and categorize these major themes while still thinking of them as highly interactive components.

Here’s the list of vitals to check if you want to run through them for yourself:

• Constitutional (e.g. fever, chills, dizziness, weakness, energy)

• Eyes (e.g. pain, discharge, blurring)

• Ears, Nose, Mouth, Throat (e.g. soreness, nose bleed, tinnitus)

• Neurological (e.g. headache, neck pain, numbness and tingling in extremities)

• Respiratory (e.g. shortness of breath, coughing, pain with breathing)

• Cardiovascular (e.g. chest pain, palpitations, lower extremity edema)

• Gastrointestinal (e.g. appetite, nausea, vomiting, pain, bloating)

• Genitourinary (e.g. frequency, urgency, nocturne, hematuria, dysuria)

• Integumentary (e.g. swelling, bruising, contusions, abrasions, lymphangitis)

• Muscoloskeletal (e.g. joint pain, muscle pain)

• Hematological/lymph (e.g. bleeding, bruising, swelling of nodes)

• Psychological (e.g. memory loss, confusion)

• Endocrine (e.g. fatigue, weakness, thyroid, diabetes, adrenal)

• Immunological (e.g. asthma, allergies)

This is such a great checklist for doing an initial “inventory” on all your body’s critical systems.

Now you might be thinking: “but Fei, don’t we all do this whenever we see a new doctor’s office? Even conventional doctors have these on their intake forms too!”

Yes and no. Yes, I have encountered a similar list at other doctors. No, because the list was presented in a different way.

What was the difference? It had open fields to fill out, not just checkboxes.

How I detest going through these run-on lists of random, disorganized symptoms

Just the way the survey is presented changes everything.

Checkbox surveys rely on the survey designer to have a pre-populated list of symptoms that match a patient’s symptoms exactly. But by making the criteria for symptom match so strict, doctors are missing out on a lot of potentially important patient information that fall outside their narrow spectrum of symptoms listed on their forms.

They do have an option for “Other Symptoms” but by the time you get to that option, your mind is primed to look for these other specific things only, making it hard for the patient to recall any other symptoms you may have that are not listed here. It puts patients, who are not used to thinking in these terms in the first place, at a disadvantage already… and they haven’t even seen the doctor yet!

The better way to jog a patient’s memory is by making the survey more open-ended.

Sure, your data will be messy. But, so is health. And within that mess lies a wealth of high quality information that you’d never get from a simple, sterile checkbox.

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Thanks for reading about my experience filling out an intake form for a doctor! The intersection of healthcare and information is fascinating to me, mostly because of how “scientific” we think it is, but still isn’t, because we continue to operate with an incomplete picture of the domain. Urban planning is very much the same.

Give this letter a ❤️ if you enjoyed it!

And as always, stay safe and stay curious.

—Fei🪢