Here is something I learned this semester: you can be good at executing a project you don't care about. I think that is a dangerous thing to be good at. It's the realization that made me drop the project I started the semester on and pivot to a new one.
I figured this out a few weeks into NSC 325, a class that reframed a lot of how I think about systems design and human behavior. The project I pivoted to was a health literacy intervention my group called the "Blue Card," and the premise started with a jarring statistic: 67% of patients leave the doctor's office confused. But as we dug deeper into prototyping, I realized this isn't just a healthcare problem. It is a fundamental issue of behavioral architecture, power dynamics, and UX.
Here is a recap of the project, our failed experiments, and some thoughts about the class.
Foucault and the Architecture of Silence
If you are in a group setting and someone asks for a volunteer, the natural human default is silence. The group takes the path of least collective effort unless a disruptor forces a change. It is the bystander effect in action.
I actually watched this happen in real time. One day in class we needed two people to plan a potluck, with the fallback being that everyone just brings something small. I volunteered to be one of the planners, and then there was just... silence. Nobody jumped in for an uncomfortably long beat (two people eventually did). It wasn't that anyone was unwilling; it's that the room had a default, and the default was to wait. Changing it took someone breaking the pattern first.
This exact dynamic mirrors the modern healthcare system. Patients default to the path of least resistance, nodding and staying quiet, because that is the established, easy group dynamic in an exam room. This is basically what Thaler and Sunstein call a default in Nudge: the path that gets taken simply because it's the one requiring no action. It takes a conscious, uncomfortable disruption to change that default setting.
This was the realization that pushed me to actually build something. My first project had been going fine, which was exactly the problem: I was executing it competently without really caring about it. So I pivoted. The Blue Card started as my idea: I pitched the problem to my professor and recruited a team to build it with me. For someone who usually keeps her work to herself, that recruiting was its own small exercise in breaking exactly the kind of silence this project is about. From there, looking for a way to think rigorously about the power dynamics of the exam room, I landed on Michel Foucault's The Birth of the Clinic.
Foucault argued that modern medicine created the "medical gaze": a power dynamic where the doctor observes the patient not as a person, but as a vessel for a disease. The architecture of the room inherently silences the patient. To a busy clinic, a quiet patient looks like "efficiency." In reality, it is a systemic failure.
The Blue Card was designed to be that necessary disruption: a question framework that gives patients the vocabulary and the permission to interrupt the doctor and take up their time.
Acute "Gobblygoob" and Isolating Variables
To test if the Blue Card actually worked, we ran a "Safe-to-Fail" (STF) role-play experiment. But we ran into a massive confounding variable: how do you know if a patient is staying quiet because they actually understand the medical jargon, or because they are just too intimidated to ask?
Our professor, Charlee Garden, gave us a brilliant constraint: don't use real medical terms. We told our test subjects they were diagnosed with "Acute Gobblygoob."
If you tell someone they have hypertension, they might just nod along because they think they should know what it means. But if you tell them they have Acute Gobblygoob and they still don't ask what it is, we have successfully isolated the variable. We proved that the barrier wasn't a lack of medical knowledge; it was a lack of agency and confidence to question authority.
It is sort of the scientific method applied to Hans Christian Andersen's The Emperor's New Clothes. The intervention isn't about teaching the townspeople about textiles; it is about giving them the psychological safety to point out that the emperor is naked.
Goodhart's Law and the Hawthorne Effect
Of course, innovation is rarely linear. When we scaled up our STF role-plays to test group dynamics using my high-achieving (maybe too competitive) friends, the experiment completely broke.
The day after the experiment, a friend asked me, "Did we do a good job? Were we better than the other teams?"
We had accidentally gamified the medical visit. Because they were surrounded by peers, performative competition took over. They weren't asking questions to simulate medical vulnerability; they were trying to get a "high score" in our simulation.
In economics, there is a concept called Goodhart's Law, often summarized as "when a measure becomes a target, it ceases to be a good measure." We wanted to measure patient agency, but it became a target for the students to hit. In psychology, this is known as the Hawthorne Effect: people change their behavior simply because they know they are being observed. It proved to us that we had exhausted the utility of the "college student sandbox" and needed to move our intervention into the ungamified world of real community clinics.
Throwing Raw Eggs (and Shifting the Systemic Burden)
My favorite metaphor from the entire semester came from a warm-up activity where we threw balls at each other, and then we tried the same thing with raw eggs!
When you throw a raw egg, the physical dynamic of the room instantly shifts. You naturally step closer to the other person to create trust and intimacy. Right now, the medical system is hurling complex diagnoses (raw eggs) across a massive, sterile room. Doctors toss medical jargon from 20 feet away, and stressed patients are frantically trying to catch it without it breaking. The Blue Card is a mechanism to lower the literacy barrier, effectively forcing the doctor to step closer before tossing the egg.
But we also realized our initial design was flawed. A physical card feels "too much like homework." If you read Don Norman's The Design of Everyday Things, a core principle is that you cannot add cognitive load to a user who is already stressed.
So we had to shift the burden from the patient to the system architecture. This is where the most useful idea of the semester came from, courtesy of a guest speaker: the difference between a user and a customer. The patient is our user, the person who needs the intervention. But the patient is not the one who adopts a tool into a clinic's workflow or pays for it. If we want the Blue Card to survive in the real world, we have to pitch its value to the economic customer: the clinic administrators. That means not just selling the moral good of health literacy, but showing them how it solves an institutional problem for them. Concretely, if we integrate the question framework directly into an Electronic Health Record (EHR) digital check-in, we intercept the user where the data already lives, building it into the intake process so it never feels like homework at all.
That distinction, between the person you're helping and the person who actually says yes, is the thing I keep coming back to. It is true of a clinic, and it is true of basically any product anyone tries to get off the ground.
Figuring out how to pitch to that customer taught me something too. Over a few rounds of pitching our project to guest experts, our framing quietly evolved. The first pitch was basically word vomit, us trying to show off everything we'd done. By the third or fourth, we'd flipped it to "here is where we are stuck, how would you fix this?" The lesson stuck with me: if you pitch to prove you are right, you get a pat on the back; if you pitch to find out where you are wrong, you get free consulting.
The Limits of the Frame
One conversation this semester reset my sense of the problem's scale. While pitching the project, someone told me they'd gone many years without seeing a doctor at all, because their family hadn't had health insurance. It made me realize our driving statistic, that 67% of patients leave confused, is in some sense a metric of privilege. It assumes you made it into the exam room in the first place. For people who are uninsured or underinsured, the barrier isn't confusion; it's complete exclusion from care.
The Blue Card doesn't solve that, and I don't want to pretend it does. It addresses the literacy gap for people who are already in the room. That's a real problem worth solving, but the conversation was a good reminder that the health system has layers of access gaps stacked underneath the one we picked, and that staying honest about what your intervention doesn't touch is part of designing it well.
Silence is safe, but it is static
The thread running through all of this, I realized near the end, is silence.
A quiet patient is the exam room working exactly as designed. A quiet group is the potluck defaulting to least effort. And, if I'm honest, a quiet version of me was the person who used to keep her projects to herself rather than recruit people into them. The Blue Card is, at its core, a tool for granting permission to break a silence that a system is quietly built to keep in place. Building it made me notice all the other places that same silence shows up, including in myself.
There's a line I wrote in my class notebook early in the semester that I keep returning to: silence is safe, but it is static. Growth is noisy. Working on the Blue Card was the noisiest, most uncertain, most rewarding thing I did this semester, and I think that is exactly why it mattered.
Built with Tehzeeb Grewal and Devraj Therani, for Professor Charlee Garden's NSC 325 (AI / Ethics / Health Outcomes) at UT Austin.
Things I referenced
- Michel Foucault — The Birth of the Clinic (1963)
- Richard Thaler & Cass Sunstein — Nudge (2008)
- Goodhart's Law (the popular phrasing is Marilyn Strathern's reformulation)
- Don Norman — The Design of Everyday Things (1988, originally published as The Psychology of Everyday Things)
- Hans Christian Andersen — The Emperor's New Clothes (1837)