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Reducing fear is the killer app


The high-pitched screech of the drill. The sickly smell of antiseptic and fear. The long nervous wait for the attendant to call your name and take you... back there. We assume that people are afraid of the dentist, but we don't usually think of software as scary. Maybe we should rethink that. Our users might be more afraid of us and our products than we think. And those who can reduce or eliminate that fear have a huge advantage. Not to mention a passionately loyal following.

Something extraordinary happened to me yesterday, but before I tell that story I want you to look at these pictures:

One, a drab but typical medical office. The other, a warm, inviting, spa-like environment. The spa-like place is actually my dentist's office. And I would drive 100 miles to go there, because the people there work their a** off to reduce my fear. And the pictures don't do it justice because you're missing the smell (freshly ground coffee beans and warm cookies) and the sounds (jazz, not drills).

Here's another picture, of the Boulder Community Foothills Hospital, the first hospital in the US to earn the LEED certification for being "green."


It doesn't look like a hospital. It doesn't feel like a hospital. And it doesn't smell like a hospital. I'm not sure how they do it, but no matter when you go, it smells like fresh popped popcorn. Think about that... almost nobody has a bad association with the smell of popcorn. I instantly think movies and theme parks. (And the live piano music reminds me of shopping in Nordstrom's.)

In a medical scenario, reducing fear means a lot. But think about all the ways our users (or potential users) might be afraid. Not in mortal terror, but afraid nonetheless. The fear of not being smart enough to learn a new product, programming language, or procedure. The fear of being taken advantage of by an unscrupulous company and/or sales person. The fear of making the wrong purchasing decision. The fear of looking stupid or slow in front of our co-workers.

I've often said that reducing guilt is the killer app, but now I'd put reducing fear way up there too. He who reduces fear better than the competition can, potentially, stop competing on price, convenience, or just about anything else. Reduce my fear, and I'll be grateful forever.

So here's my story:

Y'all have probably seen a lot of pink lately, inspired by the fight against breast cancer. Yesterday, I went to the Boulder Foothills Hospital (in the picture) where I was scheduled for a mammogram. I was terrified. I'm not exaggerating. As many of you know, my mother was diagnosed with breast cancer at a young age, younger than I am now. She did not survive. The most tragic part was that she probably would have, if it had been detected earlier. But she was too afraid to have the exam... afraid of hearing the results she ultimately got.

Cancer has been on my mind a lot this year. Less than a year ago both myself and my daughter were diagnosed with a form of cancer that had not yet become invasive, but that could have killed both of us had we not been tested.

But worst of all, I have--quite irrationally--not had a mammogram in 10 years. A monumentally stupid choice, given that I'm at very high risk for breast cancer. But... I am more terrified of that test than anything I've ever done, and I've spent the last few years convinced that it was already too late. Thinking about it sends me straight to the childhood moment when I learned the results of my mother's mammogram (and the awful period that followed). It was selfish of me, as a mother myself, to not do everything I can to stay healthy and alive, but fear does bizarre, irrational things to the brain. Finally, though, all the pink-awareness and a visit to this extraordinary hospital convinced me.

When I arrived, I told the technician my story, and literally begged her to rush the results. "7-10 days is how long it takes for the doctor to review it and get the results to your doctor," she said. "There's nothing I can do to speed that up." I could barely breathe or walk, but I managed to get through the exam. But now the worst part begins... The Wait. The first wait is for the ten minutes it takes for the tech to review the film to make sure the pictures aren't too dark, light, or blurred. Once they've checked the film, they either walk you back to repeat the test, or send you home to start The Wait. So there I sat, waiting for the tech.

Five minutes passed. Ten minutes. 20 minutes I sat in that little room. Finally she walked in and said, "The film is fine, you're free to go." And then something happened that I'll remember for the rest of my life. She sat down next to me and said, "Oh, so how would you like to enjoy your weekend?" I was confused. "I convinced the doctor to break protocol. He said everything's perfect and we'll see you in a year." We both cried.


Reducing fear doesn't have to be about life or death or pain to be meaningful and powerful. If you can help your users feel more confident and less stressed, you've given them a wonderful gift. Whether it's a policy change, better documentation and support, or more user-friendly design, anything you do to genuinely reduce my fear improves my life. Why not ask customers about their needs before you agree to sell them something? (And be willing to "downsell" rather than trying to convince them to buy something more expensive than they need.) Why not keep Consumer Report magazines in your dealership, or give potential customers a quote from your competitors, even if it means you lose that sale? Why not work harder to make sure new users (or students) realize that they really ARE going to be able to "get" this, and that you'll be there every step of the way?

Reduce my fear and I'll love you forever. : )

Posted by Kathy on October 14, 2006 | Permalink


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» Customer Service is Everywhere from Ben's Brain
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Apropos our ongoing flirtation with this idea of Google Data Privacy, I noticed Kathy Sierra just wrote this wonderful, stunning post called Reducing Fear is the Killer App: The high-pitched screech of the drill. The sickly smell of antiseptic and... [Read More]

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Outstanding post, Kathy. I'm very glad you received the good news fast. Even if you had found a lump, about eighty percent of those are benign. But don't delay next time. We enjoy reading your blog too much and don't want anything to happen to you.

But for those of you who may have questions, the American Cancer Society has a toll-free contact center @800-ACS-2345 that's open right now. Or, go to www.cancer.org/



Posted by: Glenn | Oct 14, 2006 7:55:07 PM

Kathy, that was a moving combination of personal storytelling and bigger world insight. Thanks for another great post.

Posted by: Tom Guarriello | Oct 14, 2006 7:59:59 PM

Of all the great posts you've written, this is the first one that's brought tears to my eyes.

Posted by: Bill Kinnon | Oct 14, 2006 9:01:12 PM

what a wonderful post. a very close friend of mine is going through stage 4 breast cancer right now, so this is personally significant to me. what you say about customer service is very insightful. and, btw, when i started my practice, i had very similar thoughts in mind, not only for my physical practice but also for my web site. a lot of therapist's web sites look a little like dentists' waiting rooms, and i tried to get a different look, too.

Posted by: isabella mori | Oct 14, 2006 10:20:15 PM

As an uninsured mother of three, living below the poverty line, I can't quite see the value of getting a mammogram. If I am diagnosed with cancer, I can't afford to treat it, so what's the point?

Posted by: Jude | Oct 14, 2006 11:21:20 PM

Wow. You never cease to amaze Kathy! So I am sending this out to my staff and I am sure it will move them as much as it did me. But I am also sending this out to my techno-phobic family to show them the crown jewel of the blogosphere! I mean really, you're starting to really hone in on universal themes with your writing. I can seriously see the day when you put out a Head First Creating Passionate Users book filled with material drawn from your blog. It would sell to technologists and business students alike.

Keep up the good work and thanks for sharing! Enjoy the rest of your wonderful weekend!

Posted by: Greg | Oct 15, 2006 12:33:50 AM

In these fast world of technology we live our days, we often forget about truly and important things in our life. I'm glad for you that everything went well. You now have the opportunity and as you wrote responsability for being here for your daughter and you should seize that with all your strengths.

You have got to love this blog...

Posted by: Pedro Custódio | Oct 15, 2006 3:27:50 AM

I'm not sure how they do it, but no matter when you go, it smells like fresh popped popcorn.

The answer is in recent issue of Time magazine.


As always, thanks for wonderful (and helpful) blog posts.


Posted by: Rahul Jain | Oct 15, 2006 8:00:07 AM

Congratulations on the positive results. Please, go again next year.
On the subject of reducing fear, and a tie in to the "Books I wish everyone would read" post.
There is a book called "Crucial Conversations". One of the first rules for having a difficult conversation is to reduce the fear. Fear that you will be yelled at or can not share your ideas. It should be read by every manager and most husbands.
The authors web site

For an idea of the quality of the book and writing, ask for a copy of the email newsletter about "Grandpa's hat".
They have a copy at the Longmont Library if you are in our neighborhood

Posted by: Doug Withau | Oct 15, 2006 8:11:31 AM

This is a very inspiring story, Kathy. Thank you for sharing.

And the next time you're there, as incentive and explanation for the smell, if you go to the pharmacy on the first floor, they have a real, honest-to-goodness popcorn machine. Almost every time I go there, I stop to get my small free bag.

Posted by: Ted | Oct 15, 2006 10:14:00 AM

Personally, I hate the smell of popcorn. I makes me think of theme parks, which I loathe, and of cinemas full of people stuffing food in their mouths and not watching the movie! I do take the point though.

Posted by: L. | Oct 15, 2006 10:59:42 AM

The last time I bought a new car I explicitly went out of my way to give the sale to a salesman I'd spent only 3 minutes talking to.

I walked into his dealership, told him what I wanted and asked him for the best price. He flat out told me it, and said the only way they go lower is for rental companies.

Hours and hours of dickering with other salesmen at other dealerships only to get them down to the same price this guy quoted me on walking in off the street.

He was honest with me and didn't waste my time. Even though I wasted my own time talking to other people I felt he deserved to be rewarded for his behaviour.

Posted by: engtech | Oct 15, 2006 2:24:32 PM

Ms. Sierra,

Please do take care of your health. Not only for yourself and your daughter; but, for us readers. This story is quite moving and I hate to think you and your wisdom might be taken from us all far too soon.

Here is a post I made on a Land Surveyors message board that relates to your post. Hope you dont mind.


Enjoy the weekend.

Larry P

Posted by: Larry P | Oct 15, 2006 3:20:45 PM

It is so important to understand your customers/clients/patients and how to make them feel safe, secure and smart. 'Make the user smart' is a usability tenet, but it applies to anything you do.

I'm one of those people who doesn't feel safe during medical procedures unless I know exactly what is going on. By telling my dentist this, he kept a running commentary going as he worked and the root canal I had earlier this year was much less stressful and actually kinda cool to observe (who knew those roots went so far down into your jaw?)

It made me feel calmer, more in control and helped me to manage the pain better.

Remember, we are always dealing with human beings. They are afraid of so many things: looking stupid, feeling out of control, making bad decisions. Deal with the person behind the issue, understand their fears, make them feel safe, secure and smart. Don't hide behind protocol and procedure.

This was an amazing (and sobering) example, Kathy. Thanks for sharing.

Posted by: Theresa Cunnington | Oct 15, 2006 8:06:21 PM

I cannot tell you how glad I am that you are OK, Kathy. Your evocation of the experience brought tears to my eyes.

This is the most fun, inspiring and thought-provoking blog on the web (well for my money it is...

Posted by: anne marie | Oct 16, 2006 12:27:36 AM

I wonder, next time you go to a movie won't it smell like at your dentist office?

Could it be that you get a movie-fobia because your dentist use popcorn smell for his office?

Posted by: Vilmantas | Oct 16, 2006 5:49:17 AM

Another loyal reader inspired and moved to tears... I'm glad you're okay.

Posted by: Verdi | Oct 16, 2006 7:52:15 AM

I get my mammograms done at a clinic here in Seattle where the Doctor reads the films right there and tells you the results. You walk into the darkroom and he has your current plus several old films. He gives you the results immediately and then shows you how he read the films. If he finds something you go downstairs for the ultrasound to followup immediately [my sister had to have one once, fortunately it was a cyst].

I can't imagine having to wait over a week for results.

Posted by: Julie | Oct 16, 2006 9:48:27 AM

Thanks for beautifully articulating the feelings that surface related to surviving cancer (yours, your daughter's *and* your mother's) and anticipating our fate will follow that of our parents.

Fear is the greatest inhibitor of creativity and insight. Now that you've endured and survived one of your biggest fears, we'll expect even more amazing things from you.

Posted by: B-Labber | Oct 16, 2006 10:03:17 AM

I love this post and the whole concept of pushing people to see the possibilities with boundaries. As a therapist who started blogging to throw it all out there (caution, mainly) I see constraints as boundaries that can protect us but unnecessarily stifle creativity if taken too seriously.

If I have to introduce every story I tell with the words, "Of course I've disguised the a) identity, b) gender, c) biological sex, d) context of everything and everyone in this annecdote, then FINE, I WILL.

Just don't tell me not to blog.

Thanks for the creative look into other arts, Linda

Posted by: Therapy Doc | Oct 16, 2006 9:51:18 PM

You've created one of the most moving posts I've ever read. Stunning insight as usual and you've spurred me on to see my doctor as it's probably been 10 years myself.

Posted by: Brett Nordquist | Oct 16, 2006 10:26:11 PM

Wow... It's a nasty time, when you think there's a possibility you might have something awful like that. Been there myself & had painful biopsies which in the end proved it was all OK, and I've been there with a friend.

Jude: At the very least, it'd give you time to deal with it mentally & go round saying goodbye to everyone or go do something you always wanted to do but were too afraid to try before - I mean, what the heck, if you know you're dying, it may be a great time to take up speedway motorcycling, rap-jumping, etc, or tell your best friend you always fancied them, or go eat Fugu in a sushi restaurant. Nothing ventured, right? Once you become symptomatic with cancer, by which I mean, once it gets painful & you collapse or lose the use of an organ etc, it's pretty much too late for anything. Without treatment it'll usually be pretty fast. Testing at least gives you the breathing space you need to put things in order. Or the sure and certain knowledge that you're okay.

Posted by: Matt Moran | Oct 17, 2006 7:33:14 AM

On a more practical note, one usually doesn't think to test children for cancer, so I was wondering what prompted her testing? Was it some symptoms, or more of a family history thing? What do people need to look for in their own children?

Posted by: Richard Cook | Oct 17, 2006 8:35:07 AM

Wow. I teared up, too. Very glad your test turned out as it did. Powerful blog, Kathy.

Posted by: Jeff the Poustman | Oct 18, 2006 10:32:57 AM

Wonderfully written.

When my grandma went through heart surgery, my parents became completly terrified because of a wrong indication in the surgery information board.

The poor indication made it unclear that the surgery ended well and my parents had about 10 minutes of worrying sick before we found a doctor and clarified the situation..

More on my post on the surgery board:

Posted by: stupidapp | Oct 18, 2006 3:17:33 PM

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