I'm enamored with the potential presented in our cover story, a piece by Hugh Dubberly, Rajiv Mehta, Shelley Evenson, and Paul Pangaro. The authors investigate healthcare, and start—and end—by analyzing the nature of the framing words used to describe the system. It is in this observation of framing, and the role of the facilitation language we use in system design, that I find the most insight and the most opportunity.

The authors note: "Professionals care for patients—by observing symptoms, diagnosing diseases, and proposing therapies. Their proposals are not just suggestions; they are prescriptions or literally physician orders. Patients who don't take their medicine are not in compliance." The language frames the system, and the system frames the language, and both directions end in the same place: a designed system that acts with the end user in mind only when is most necessary. It seems to function not for but in spite of the needs of the people involved.

I remember years ago working with a major pharmaceutical company that had come to the conclusion that "compliance and persistence was a billion-dollar-a-year problem." That they quantified the problem in revenue is probably good business, but the sheer mechanistic nature of their language indicated that people were a necessary evil in a system intended to "order compliance." More recently, I've found in similar consulting situations that the language companies use to present their views is an enormous tell. I hear clients talking about how much they value their customers, but they use phrases like "own the customer's search experience" (See http://gigaom.com/2007/10/18/who-will-own-the-search-experience/ to find out who, exactly, will own your search experience. Note that "you" is not a choice) and describe their "customer segments" as if people could be reduced to interchangeable widgets. Some companies even disseminate this language internally, as "nearly every bulletin board in every office has a sign that reads 'The Customer Experience: Own It.'" (See http://www.fastcompany.com/magazine/nc01/012.html to learn more about who owns your experiences.)

I realize this is marketing speak, one of the absurd facets of large companies that seems to be self-perpetuating and a way of life for many who work in these organizations. But while it's "just words," these words have a way of catching on—and the shorthand of "own the customer experience," which no doubt originated as a thought like "let's support and help provide the best experiences we can," has a way of injecting a truly bizarre sense of control and authoritarianism in corporate life.

I'm worried that the way companies refer to paying customers internally actually begins to manifest itself in the products, systems, and services that the company produces. And it gives me pause that a group of people—all well intentioned—are likely sitting around a conference-room table discussing how they can own my experiences or order me to be compliant. This is the same concern shared by Steve Portigal in his January 2008 interactions article, as he described the misuse of personas in design and marketing. "Personas are misused to maintain a 'safe' distance from the people we design for, manifesting contempt over understanding, and creating the facade of user-centeredness while merely reinforcing who we want to be designing for and selling to."

The cover story on health and healthcare reform concludes with: "For designers who have spent years perfecting their craft and who delight in making beautiful form, the notion of user as designer and designer as facilitator can seem frighteningly foreign." I wholeheartedly agree, and a way for us to better embrace this shift is to begin with the words we use to describe our work. It's not "just language," and the more we carefully select our words, the more comfortable we'll be in making the wholesale shift toward the emerging role of design in healthcare—and in other arenas where social responsibility is growing, and designers are able to value the whole person.