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The default option

Jay

I just created a new chart on my electronic medical record. I typed in the patient’s name, her date of birth and her phone number, and then I chose from the dropdown menus for sex and marital status. The blanks are automatically filled in, but this patient is a married woman so I had to change both, because the default option is male, single. And I can’t change the defaults.

Why do I have a feeling that the people who designed this program are male, single? It’s a small thing, but every time I create a new chart I am reminded that “female” is considered an aberrant state of being.

58 thoughts on The default option

  1. Word, Jay – there is so much of this everywhere, and pointing it out is often called ‘nitpicking’ by those who benefit. How hard would it be to put some kind of randomizer in there, or have the defaults based on the most likely values for those fields (maybe female and married is the most common patient type? who knows).

    I see this in language so much, too – feminine verbs/nouns are constructed as marked and derived from simpler (usually male) forms. I would love to see a language textbook put the female verb forms once, just for a change, to screw with people’s expectations a bit.

  2. That should be “masculine”, not “male”. I’m a stickler for using the correct terms with this kind of stuff.

  3. Interesting you mention that, micheyd. Publishers of roleplaying games have been tinkering for a while now with using both female pronouns and male pronouns, alternating back and forth. (Notably White Wolf, which I believe has a lot of queer employees.)

    Lisa Harney just mentioned this over in the new Trans 101 thread:

    I used to be surprised when I’d see men actually get almost abusively angry over books (roleplaying games, usually) that found ways to alternate masculine and feminine pronoun usage rather than use masculine all the time. Sure, they’d talk about how the masculine = default (feminine = other) was the Way Things Are and Should Never Change. And this was ground that had to be defended violently and loudly and never an inch given, because using feminine pronouns for indeterminate people was eroding the English language away to nothing.

  4. Pingback: Writing Software? Read this. : Elaine Vigneault

  5. Micheyd, I’d be OK with a randomizer, but I’d prefer if I could set the defaults. If I were a urologist, then having a male default would make sense (not all urology patients are male, but it’s about 90%). If I were an OB, though, I’d have to change every single one. And as it is my patients are about 70% female (and mostly not single).

    But that just wouldn’t occur to most people. Especially not docs, since most docs don’t do their own data entry anyway. And no one asks the data entry folks for input – they’re mostly women. I’m betting they’d give a different answer.

    Never mind that the only options for marital status (a term which is itself heteronormative) are “married, single, divorced, separated, widowed”, and so many people fall into some other category. It’s bad enough that we put people in categories in the first place – we could at least put them in the categories they choose.

  6. Well, it makes good human-interface sense for there to be a default (rather than no entry being given), because it saves you having to enter a value quite a bit of the time. And it makes good human-interface sense for the default value never to change, rather than being M sometimes and F other times, because of the principle of least astonishment.

    Therefore, I think it should default to female, since more humans present as female than male, and you should probably file a bug report.

    What I would really like to know is why people who commission databases are so interested in sex and marital status.

  7. And this was ground that had to be defended violently and loudly and never an inch given, because using feminine pronouns for indeterminate people was eroding the English language away to nothing.

    Feminine pronouns, text messaging, and Ebonics are, of course, all part of the Illuminati conspiracy to replace English with Esperanto, so as better to worship the Serpet God.

    Am I the only one who sees comments like the ones referred to in the comment that Holly posts about (did I get all those pointers right? I mean the people who are really angry that sometimes, a generic person is a she) as only one step away from being a 9/11 denying conspiracy nut?

  8. It’s amazing that, when you see lists of options — say, a list of provinces or states that you can choose, a list of cities or countries (with the exception that sometimes a few English speaking countries come first), lists of names of schools or companies, lists of positions available — they come alphabetically, lists and lists and lists like this, but male always comes before female because the alphabet is clearly wrong for this particular list.

    There is no reason for an end-user to be unable to personalise certain defaults.

  9. I think the principle of least astonishment can in some cases be overruled by say, an interface that learns adaptively what the most common choice is, and changes the default to that. A really well-designed interface would probably be able to tell that Jay is entering more female than male patients, and more married than single patients, so that when a threshold of those choices over a certain period of time is reached, the default would switch. Possibly with a little notification or confirmation, if you’re worried about astonishment.

  10. That’s… that’s weird.

    That’s not a very good design.

    First of all, how are the options organized? If there’s no compelling reason to have one option presented over another, they ought to be in alpha-numeric order. Which would put female first.

    The only exception is when there’s an option for “unknown” or “refused to answer” In that case, I usually put that as the default, and make everyone choose beyond that.

  11. There is no reason for an end-user to be unable to personalise certain defaults.

    I think it depends on the type of system. All of the systems that I create are web-based, and are used by a variety of people in a variety of offices. That means that it’s not practical or reasonable for me to let my end-users set personalized defaults, because all of my users are sharing one system and one set of tables. What one user might find handy and convenient, several dozen other users might find annoying. I could create personalized versions for each user, but that’s not efficient.

    I don’t know the system that Jay is talking about, but if, say, an entire hospital is using a web-based system like the ones I create, it wouldn’t be practical to let the users start setting defaults. A default set by Jay would then have an impact on users in other areas, or would require setting aside resources to keep track of each user’s personal preferences, which, where I’m at, is very low priority.

    Which isn’t to say that I disagree with the criticisms- it’s just to say that there are times when it doesn’t make sense to let users set defaults or have certain types of controls. There are sometimes compelling reasons why you don’t want users changing the ways that a system works.

  12. Holly, that’s what I was thinking – a smart system that eliminates an arbitrary default. Now, do we have any enterprising feminists willing to design it? 🙂

  13. I don’t like the idea of eliminating an arbitrary default because when I do form-filling I do it by rote and my speed would be affected if the form was different each time.

    I would prefer the default to be blank with all options available in drop-down. It wouldn’t add significantly to my work time (I would have to choose male, where I don’t now, but that’s not a lot of extra work) but it would allow me to work speedily and automatically without subjecting me to the bias of the programmer.

  14. maybe female and married is the most common patient type? who knows

    I’m pretty sure someone would call sexist a data entry system that assumed that women — with their natural frailty and troubleprone reproductive system… NOT — were most likely to see a doctor. A randomizer sounds like the fairest solution, but might irritate data entry people whose fingers are used to “pull down for f, do nothing for m” who now have to stop and think: “well what is it this time?”

  15. It’s a small thing, but every time I create a new chart I am reminded that “female” is considered an aberrant state of being.

    But using this logic, “married” would be too, no? So we kinda have a cognitive disconnect here.

  16. Please, randomisers are a bad, bad, bad and wrong idea. Software needs to be predictable for the users to use it. It also needs to be predictable in order for testing to be possible. It’s part of the principle of least astonishment. This is one of the first things you learn in a human-computer interaction class.

    In practice, I suspect most people doing serious heavy data entry are using keyboards and therefore would have to press *some* key to get past the field. So they may as well press M or F rather than have to tab past.

  17. Actually, women are more likely to see doctors, at least in the US (I’ve never seen studies in other countries so can’t comment). There’s another whole post in this, really, because it doesn’t have anything to do with frailty but it is driven by the way society pathologizes women and then blames that created pathology for a lot of patriarchal bullshit.

    Come to think of it, I’ve already written about that process here and here.

  20. I just created a new chart and realized that the drop-down menu has the marital status options listed in alphabetical order: divorced, married, separated, single, widowed. But the one that shows in the box before you pull the menu down is “single”. Sigh.

    The male/female choices are little boxes to check, not drop-down menus. And for the record, this is a program that’s loaded onto my computer and can be customized in virtually every other way, so I don’t see why I can’t change the defaults in the demographics.

  21. It’s amazing that, when you see lists of options — say, a list of provinces or states that you can choose, a list of cities or countries (with the exception that sometimes a few English speaking countries come first), lists of names of schools or companies, lists of positions available — they come alphabetically, lists and lists and lists like this, but male always comes before female because the alphabet is clearly wrong for this particular list.

    That was my first thought, too — why isn’t it alphabetized? Oh, right, because then “female” would be listed before “male” and that can’t be done.

  23. Perhaps it would make the most sense for the default fields to be blank or neither? Such as a drop-down menu in which the default option is the word “Sex,” and you click on it to select male/female/etc.

  24. Jay – may I ask who makes the medical record software you’re using? I’m curious because Mr. DiscGrace works for one of the large-ish medical software companies and I want to know if I need to yell at him for this (or perhaps see if he can bring it to the attention of the design staff he works with from time to time).

  25. “There is no reason for an end-user to be unable to personalise certain defaults.”

    Actually, depending on how robust the system is (or isn’t), there can be a lot of reasons for it. A more common approach is to have the defaults set *for* each end-user (or class of end-user), depending on the each user’s (or user class’) anticipated system usage.

    But that being said — if the system to which the OP refers is anything like the ERP software I’ve worked on for almost 15 years, changing defaults like that is a fairly simple and straightforward matter for a programmer or database administrator. In many cases, the defaults can be linked to certain heritable data classes (e.g. obgyn-linked data could default to female and prostate-linked data could default to male), but frankly, most of my clients didn’t see that sort of thing as a value-add and didn’t want to shell out the per-hour cost for a passel of consultants to set that up for them.

    Easier and cheaper to have a global default setting, and there you are — dissed by the budgetary constraints of the bean-counters.

  27. This is particularly poor user-interface design. I’d think that for sensitive applications like medicine you’d want the defaults to be blank or XXX or something like that, so in case someone forgets to change the default or information isn’t available it is clear.

  28. Most data entry is done 1. for the purpose of differentiating people. If medical, differentiating patients. If educational, then for differentiating students. But say you have 10 Mary Smiths, you must have more than just a name to show which one is which.

    But information on marital status is also necessary for statistical purposes. Investors and Donors want to know what kind of people are frequenting your establishment before they give you their money. Or if you have someone who wants to advertise with you. Or anything at all like that. They don’t want to know you or why your married or single. They want to know how many single people have chosen to come to a specific place, and how to get MORE single people there. Or married, that’s just an example.

  29. Speaking as a former data entry monkey, and former programmer, I’d argue that having a default in that context is just begging for dirty data. One slip of the finger, one brainfart, and you’ve entered incorrect data because of the default.

    No default, plus a check to ensure that all fields are filled, is the way to go if you want clean data, and I’d assume that for a medical database clean data would be quite important.

    Randomizing the defaults, BTW, is just plain a bad idea. In data entry its all about speed, and that means predictibility.

    On the subject of database design, clean data, etc, I present this cartoon

  30. There are sometimes compelling reasons why you don’t want users changing the ways that a system works.

    Here here! Blank would have been easy though 🙂
    Developers have a lot of power but when it comes to user interfaces, the customer or big important customers usually get what they want. It was just as likely an executive decision by some good ole boy in an important customer company.

    Or:
    Rar! Don’t blame us programmers! Rar!

  31. Department of Missing the Point:
    Why is marital status medically necessary?

    They always want to know if there is potentially another insurance company somewhere that they can bill.

  32. A medical program should absolutely default to female if there must be a default. Women see doctors more often, at least in the US. We also live longer. Whether we live longer *because* we see doctors or not, it also means we see doctors after our husbands are dead and not seeing doctors. So the “average” patient is female.

    But really, for male and female the default should not be set in the first place. Bad, bad software designer. No pizza for you.

  33. I also get the impression female is considered an aberrant state of being. My children received a guessing game with male and female characters on the cards. When I complained to the manufacturer that there were only 5 female cards and 19 male, I received the response that stated there were 5 cards with every characteristic: glasses, hats, etc. Yes, 5 of every “characteristic” except male! Sigh!

  34. When I worked in local government we used to use dates of birth to distinguish all the Mary Smiths. Much better resolution than marital status, and doesn’t change.

    And I still don’t see why investors or donors would want to know how many married or single people were going to a particular medical establishment!

  35. Two things: as a roleplayer, I thought some more detail might interest folks: at this point, the industry standard seems to be (though most books still clarify in the introduction so there’s no chance of misunderstanding) that the female pronoun is used for the gamemaster/storyteller/person who runs the game and the male for the player. That may make it clearer why some small-minded gamers object!

    I have a dirty secret: I like to take surveys. Something about pattern-forming? I don’t know. Maybe I just like to feel like my opinion is valuable. Anyway, recently I’ve taken a few with expanded options for marital status that have pissed me off: Married, Divorced, Separated, Widowed, Single, Cohabitating (in some order.) What pisses me off is that you can only choose one. So apparently I am not supposed to have a partner, because I’m divorced. Shit, I forgot I’m a dried-up failure who Will Never Love Again and shacked up. And I only have 1.5 cats!

  36. Actually, I programmed the current registration system for weather.com and defaulted the sex selection to female, as Marnanel proposed, becuase there are more females than males. Few have noticed.

  37. What annoys me is that Facebook gives you a fairly decent set of options (well, compared to the tiny set of political points of view it lets you espouse), including “In an open relationship” and “It’s complicated”. But then it only lets you specify one person in each case! You can’t be “In an open relationship with Robert and Susan”.

  38. Rxl, the reason most medical providers ask about marital status is because of a legal principal called the “necessaries doctrine” or doctrine of neccessities. In most states a spouse is responsible for medical care and other necessary expenses (food, shelter) incurred by their spouse.

  39. And I still don’t see why investors or donors would want to know how many married or single people were going to a particular medical establishment!

    Because married and single people often spend their resources differently, and you can find that out through — guess what? — statistical analysis. It’s the same reason they’re constantly asking for your age group and/or birthdate in the same screen.

    Any good statistician will tell you that you need to get as much information about a subject as possible and, like it or not, “married” is a legal status that impacts things like insurance coverage or tax liability.

  40. It’s amazing that, when you see lists of options — say, a list of provinces or states that you can choose, a list of cities or countries (with the exception that sometimes a few English speaking countries come first), lists of names of schools or companies, lists of positions available — they come alphabetically, lists and lists and lists like this, but male always comes before female because the alphabet is clearly wrong for this particular list.

    What about the number of times an international site – on this thing called “the internet” – that is an international construct – lists “US” at the top of the list and then every other country alphabetically? I’ve had similar reactions to those quoted by Holly when I suggested that sites with a clear and large proportion of users coming from countries outside the US (admittedly the most represented country in cyberspace) consider reworking their defaults to more accurately reflect their participants’ countries of origin, maybe listing the top four or five countries at the top instead of just the US.
    The kind of vitriol from others in both examples seems very OTT – and in the case of countries can’t be linked to Teh Eeevil Plot To Destroy English Language. I can understand peoples’ investment in the status quo as a place of mental safety, but I do have trouble understanding the extreme reactions caused by even a minor challenge to that setup – it seems so strange that people react so very violently to having the status quo challenged in such a small forum – maybe proof that even little ‘c’ conservatives recognise the power of small things?

    As a note to the original point:
    Consider the original Sims game, which has been documented as one of the highest selling games of all time – and the only game that can claim to have over 50% of its dedicated fans identifying as female (excepting the sequel). In the original the default Sim, when you went to create a new character, was ALWAYS a caucasian male.
    They got wise in the sequel and installed a randomiser.

  42. I agree that SOME default is generally handy, because it’s a couple of keystrokes fewer. perhaps there’s some accuracy tradeoff, but I think defaults are still useful.

    I suspect that there exists a way to change the default, either through IT or the company who wrote the program. Similarly, i expect that the reason YOU can’t change it is that users are often assumed to be idiots.

  43. Ok, so I get that “married” might imply there’s another insurer, etc…but beyond that, why is widowed, divorced or single anyone’s business?

    And when does a divorced person become “single” again? I tossed my exhusband out 16 years ago. My doctor was a bit miffed when I put *single* as my marital status recently. “I know you were married once, your son is a patient here too.”

    I’ve been unmarried again for more than 3 times longer than I was married, for heaven’s sake.

  44. I’m using SOAPware, which is a relatively inexpensive program that’s designed for primary care.

    Marital status is a standard part of medical history-taking. Time was when we believed that it told us something about risks of sexually transmitted diseases. I find it a useful starting point to learn about someone’s family system, although I usually ask “who lives at home with you?” rather than “are you married?”. My office uses a standard data-collection form which just asks for “marital status”, but I don’t rely on that.

  45. You have checkboxes for male or female on each chart, and that’s it? What do you do if you have a transgender patient, or a patient with a sex chromosome-related condition? I mean, you probably couldn’t have checkboxes for all possible situations, but wouldn’t you want one that says “Other – See Chart” or somesuch?

    I actually work for an EMR company and I’ve wondered about this question since I started there. Our software is made such that you could add the extra category if you wanted, but is this something organizations do?

  46. And when does a divorced person become “single” again?

    Never. Never ever. You must live with your failure for the rest of your natural life. You must wear your failure like a badge of shame. You evil harlot, you.

    🙂

  47. I used to be surprised when I’d see men actually get almost abusively angry over books (roleplaying games, usually) that found ways to alternate masculine and feminine pronoun usage rather than use masculine all the time. Sure, they’d talk about how the masculine = default (feminine = other) was the Way Things Are and Should Never Change. And this was ground that had to be defended violently and loudly and never an inch given, because using feminine pronouns for indeterminate people was eroding the English language away to nothing.

    That stuff about language really, really bothered me when I was a little kid– I remember obsessing about it as a five year old, trying to figure out how the world worked. I am pretty sure that the word “default” was not in my vocabulary but the default=male pronoun issue bothered me a LOT. (and why was the female pronoun LONGER than the male one? Why was woman a longer word than man? Just like those words like lioness where you had to add a bit on to make it female, as if a woman is a special kind of man and a she is a special kind of he. Why is being male the normal thing?The thing that you are, until someone tells you you’re not?) It worried the hell out of me,and I didn’t know who to ask, or how to ask it. I saw the default=male thing EVERYWHERE (it was particularly annoying in religion class) and there was one token woman in the Catholic pantheon and all the cartoons; it was like all women were somehow the same because being female was enough to define who you should be.

    and it was a real relief fifteen years later to see that some people had actually written about all those lunatic thoughts I had had and then tried to dismiss when I was five.

    Just proferring my memories as evidence that this stuff is far from petty and does affect us deeply. For some reason I was conscious of the process, which seems to be unusual (yes, I was a weird child), but I bet that hundreds of millions more children are going through the same thought processes unconsciously all the time– the threatened men referred to above certainly did.

    The programming choice in the post is exactly the kind of thing I would have noticed, worried about, quietly resented and eventually, depressively accepted as inevitable when I was a small child– if I’d had the opportunity to play with a medical records database at age 5 which wouldn’t have been likely, but you all know what I mean!

  48. Similarly, i expect that the reason YOU can’t change it is that users are often assumed to be idiots.

    Standard cover-your-ass policy used by nearly all computer hardware/software merchants. By assuming the end-user is an idiot, they hope to minimize any perceived liability from having to incur blame/having to fix a problem that was caused by the end-user’s mistake. As a freelance IT tech, 90% of the problems I encounter on client machines was due to end-user mistakes such as downloading virus-laden porn files without checking them in an anti-virus scanner first.

    Moreover, as someone who worked in a corporate IT related department, I have lost count of how many times we were blamed for mistakes that were later found to be caused by the end-user. As such end-users tended to be MBA upper-management types….the blame naturally got shifted to us.

  50. Standard cover-your-ass policy used by nearly all computer hardware/software merchants… …I have lost count of how many times we were blamed for mistakes that were later found to be caused by the end-user.

    Exactly.
    The dreaded PEBKaC or ID:Ten-T errors.

    Every time there’s a problem, it’s your fault. It doesn’t matter that the user thinks you have to install a web-based system, or that they don’t even know how to bookmark a page. It doesn’t matter if they’ve repeatedly tried to submit a page despite the pop-up telling them that they haven’t filled in all of the data required with the missing information conveniently highlighted so they can fix that- they want to go to the next page, damnit! Why can’t they do that?!
    Ugh.

  51. That whole single thing pisses me off. Cause in about 2 years, I will no longer be “single” (though I’m not sure if living with the person I have been dating for well over 2 years should be considered single) but I will still have to mark the single box!

    Also, the default male thing is the perfect representation of our culture, it’s kind of sick. Default = White Male, Everyone else = OTHER.

  52. I agree with those who either call for no default option…or that it should be easily adjustable by the end-user.

    Ideal would be adjustable defaults. If that’s not possible, no defaults to minimize inconvenience and faulty data.

    Every time there’s a problem, it’s your fault. It doesn’t matter that the user thinks you have to install a web-based system, or that they don’t even know how to bookmark a page. It doesn’t matter if they’ve repeatedly tried to submit a page despite the pop-up telling them that they haven’t filled in all of the data required with the missing information conveniently highlighted so they can fix that- they want to go to the next page, damnit! Why can’t they do that?!
    Ugh.

    And this problem seems to quite common among those with MBAs in upper-management positions…or anyone with a high degree of power over others who is not technically inclined. The Dilbert principle at work.

  54. As for the original program, while I agree that the proper default should be “blank” (i.e. requiring input), it may be that the programmers didn’t do so because they were restricted by their programming environment. I’ve used environments (VB 1.0, if you must know) where any option group you created was required to have one of the buttons be true at all times, even when the form was first displayed – the “none selected” scenario was either impossible or required some serious fighting against the framework to achieve.

    Of course, that’s speculation; they may very well have put in defaults for all the categorical inputs simply to make it faster to fill out a complete form for their own testing. We (programmers) are a lazy lot sometimes. I’d file a bug that the default should be “blank” citing the importance in medical entry of never having incorrect data sitting on the form unless the user actually entered that incorrect data.

    As for why the default option is “Male”, that’s just flat-out male privilege of the standard “a fish doesn’t think about the water” kind. (That is, we – especially us men – are so surrounded by male privilege that we often don’t realize it’s there) That’s an explanation, not an excuse.

  55. Jay says:

    I just created a new chart and realized that the drop-down menu has the marital status options listed in alphabetical order: divorced, married, separated, single, widowed. But the one that shows in the box before you pull the menu down is “single”. Sigh.

    This one actually doesn’t bother me so much, because everyone starts out single (at least as a child, right?). It’s universally chronologically first, and then maybe later you pass through one or more of the other labels. To me, that makes it make sense as a default, especially when the other options are alphabetical, which implies no value ranking.

  56. Ok, so I get that “married” might imply there’s another insurer, etc…but beyond that, why is widowed, divorced or single anyone’s business?

    Well, a few reasons. There are correlations regarding health related to one’s marital status. Married men, for instance, tend to be healthier, live longer, etc. Social arrangements do have a genuine impact on how we live, and being widowed, for example, especially if the widowing is recent, puts a man at risk with respect to his health. But as well as the other things people have mentioned, I just want to note issues of visitation and decision-making that come into play in the medical field. If medical decisions need to be made for you, marital status matters legally.

  57. Longtime reader, first time commenter.

    I’m a transcriptionist and we occasionally have to create temporary demographic information before transcribing the visit note, op note, etc. In the program our company uses, all the demographic defaults are blank – no dropdowns, you type numbers and letters for gender, age, etc. You could make a patient a “B” or “Q” for gender if you wanted, which allows for error, but it also allows for flexibility as far as gender assignment goes. I don’t know how it uploads or whether anything but “M” or “F” is put in a dump file. I do wonder, though, if the company who developed the software has a lot more female/unmale people on staff or what. Obviously someone put some thought into the design of the demographics interface.

  58. Jay – I read your post on designated patient status for women and loved it. I have long been interested in the ways that our culture pathologizes and paternalizes women. Can you suggest scholarly articles on this idea?

    Also, marital status is none of their business, just as your social security number is none of their business. I do not fill out that information for medical practitioners. I skip anything that does not connect to the visit that day.

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