Graphic Medicine: Comics for Collaborative Healthcare Communication

[00:00:00]now it is my great pleasure to turn the um turn the zoom stage over to MK surck who is also known as the comic nurse MK is going to do a um is going to do an interactive workshop and we're going to ask you all to participate actively in the chat um MK is a nurse a cartoonist and an educator and a co-founder of the field of graphic medicine and she said that um as she said I'm a nurse who uses Comics to reflect on the complexities of illness and caregiving and this this um presentation is entitled graphic medicine drawing our way to collaborative Care thank you MK and welcome thank you very much um it's such a thrill and an honor to be here and I've so enjoyed uh this uh this uh Consortium thus far and thank you for inviting me to be here um I am going to share my screen um and I work in a visual medium so I've got a lot of visuals here um but I'd like to invite you before we start um to be very involved in the chat drop any comments and questions and one of the um advantages of being in this format is that we can have access to our thinking as you're thinking it and I've been really enjoying watching the chat and the feedback uh as this entire conern tions going on um right so this is my uh my elevator pitch first I thought you'd tell you kind of who I am and what I do so that you get a feel for kind of where I'm coming from I'm a nurse who uses Comics to contemplate the complexities of illness and caregiving and the word uses there is doing a lot of work it kind of refers to the fact that I read Comics um I'm reading graphic novels by people living with illness and caregiving and disability I teach with them so I teach medical students and nursing students and basically every aspect of that you can imagine of all of us who come to give and receive care um and I um I make comics I'm a cartoonist myself so um uh yeah sorry slide your up this is kind of my my mission statement my work attempts to use the medium of comics to help make challenging situations somewhat easier for patients and families and as a nurse you know we see things wrong that don't necessarily need to go wrong we've heard a lot of examples of that this morning and I think that a lot of times the issue is a communication gap and I think that the medium I work in actually has some wonderful tools for filling those gaps um but I want to start at the absolute Basics because you're thinking like wait a minute we've been talking about really serious things why are we using Comics I want to really kind of dispel uh preconceived notions about Comics this is my definition of a comic a comic is sequential art that conveys a narrative and often incorporating text so basically it's a series of images that may have a few words in them and our brains interestingly work very hard to assemble images next to one another into a story and a little Insider fun thing about Comics is that the empty space between the panels in a comic between the images is actually called The Gap or the gutter I'm sorry The Gutter and the gutter implies time so you start with the static image a single thing and as soon as you put one next to it that sort of maybe mirrors it or seems to pair with it we want to assemble a story and even just looking at those little four simple panels there you probably are assembling a story about what's going on um you'll notice that when I mentioned what this whole this whole slide I said nothing about superheroes I said nothing about kids this is a medium a creative medium that I think and I've come to learn over the last 15 years I've been doing this has incredible possibility in this Arena exactly the things we've been talking about today and I hope by the end of spending time together you will agree with me and sort of start thinking about potential for this in the work and the the experiences that you're living and having I thought I'd start with my Comics origin story because I think it demonstrates in some ways how one example of how this can work so my original clinical experience as a nurse was during the height of the AIDS crisis in Chicago and I was a new nurse out of school and I was really struggling how much um how to deal with the human side for me as a caregiver of everything that we were witnessing at that time and I'm sure there were a lot of Echoes of this during covid with caregivers but you know I I went to a very good nursing school but they didn't teach us this right they they talk something about take care of yourself and it's never really clear what that means um and so I was really struggling to turn to the humanities to figure out there must be something in the Arts and the humanities to help me kind of get through this difficult time and one day believe it or not is a straight line from doing this that one day to me being with you here today that I just drew this picture of myself and I wrote some words above it just because that's where I was at and then because I had these words and image separate I put a box around it I didn't know anything really about Comics at that moment I was not the kid who grew up reading them very much I'd read a little bit of underground Comics like Linda Barry and cartoonists that I'd liked in kind of daily newspapers but I was not a Comics kid I also want to point out I was not the kid at school who could draw I was told to put my crayons away and my markers away and to use your words and I was okay with words so I left the drawing behind and that's a piece I think is very unfortunate I won't get on that Soap Box about how we all actually can draw uh hopefully you'll just get it by uh intuition here um so since I had an image and a and some words I just put another thing next to it and I kept going with this about what had happened the before in hopes that I would then be able to be present to my patients that evening on my shift and not carry with me all of this grief I was carrying and rather than take you through the nine panels that this comic sort of developed into I want to take this to the abstract and show you what happened for me that day I started here and as I moved an image and text through these panels just writing a little drawing a little drawing a little writing a little kind of like call and response I found myself here and that kind of blew my mind and I was like oh wow well this works and it was the best coping um kind of plan I found for what I was dealing with and so I just kept making comics and I don't expect you to read these but these are some real early Comics I made about reflect they weren't made for anyone else to read them they were made for me to just use this as a medium and an experience and a way to get through what I was going through um you could see the first one there was about um again I don't want you to read it but it was about a situation where I wasn't sure i' made the right decision with the patient the other two were about bridging kind of life on the unit where everything was really challenging and off the unit where it wasn't but I still wanted to reflect on what did I learn in that place and in that time that helped me kind of carry through the rest of my life I've made comics about my own struggles with health issues certainly about caregiving my elderly family members um I even made some Comics during covid about you know things that we hope don't come back uh after Co um but just it's clearly has been a way to navigate the world and I think that you know at anything I hope you take something away from this but but mostly that combining image and text because different things are happening in our brains when we draw even if we use stick figures even if we feel like we don't aren't good at drawing or can't draw it's still actually doing important work and so the field I work in is called graphic medicine and this has exploded in the last 10 years when a number of people kind of came together and put a stake in the ground and said we think Comics actually can do serious work in healthcare and this is my colleague Ian Williams he's in England he's a cartoonist and a physician and he coined this term graphic medicine to refer to the interface between the medium of comics and the discourse of health illness disability and caregiving and of course the the sort of on a theoretical side of course the graphic medicine movement is very kind of rooted and echoed in The Narrative medicine movement which you might be familiar with which really focuses on the role of stories in healthcare we absolutely are doing that same thing but we're just bringing this medium of comics to that service and the use of images so this is a book that came out in I think 2006 really rocked my world and changed the possibility of what I thought those little Comics I was making at home could do in healthcare this is what made me take it seriously um and I want to show you a little bit just a a small passage from inside this book to help you sort of see what I was getting from it so this is how this whole book started the guy who created it uh Brian Feast had gone with his mom to chemo and he was a science writer and he brought some work with him and when he finished he you know he was also an artist he sat and he just sort of sketched his mom and now this is a more sophisticated version of that sketch but he just sort of sketched his mom in the chair with her consent and got you know just sort of like annotated it and he sort of realized in doing this the balance between um science and culture science and the things that are important to her science and her family her Society all these things were all balanced in the experience of being um his mom with cancer and so this prompted him to do this book with his family's involvement started as a online web comic that got a huge following and then was published as a book and I want to show you a section from this book this is a section from the book called The Usual unusual and Brian says at every visit the docs always say call immediately if you notice anything unusual this simple order turns out to be surprisingly hard to follow this is Mom the patient I have a headache yeah don't worry about it oh okay on a visit I had a deep cough what you should have called it once oh again I feel weird Stingers in my head that's normal with a brain tumor oh okay in the office I a leg cramp that could be a deadly blood clot why didn't you call sorry Mom calls again I can't breathe so you have lung cancer what did you expect right she's wrong when she's complaining and she's wrong when she doesn't either way she feels stupid how am I supposed to know after a while she stops trying the reason I showed you this excerpt from Mom's cancer is that I think it really is a perfect encapsulation of the power of this kind of work to share the window into care that we may not really put together we might not have that perspective right and I had this Insight of wait a minute if I could use this to share it with doctors and medical students and nursing students and people who can't get this these many windows of perspective into the situation maybe no one caregiver in that path meant to be doing harm but what we see from the son's perspective is that put it all together this is the patient and Family's experience and and maybe we could be more careful about these kind of things right so I just thought this is a great example of one of the ways these works and I also wanted you to see the way in which these are not kids books these are books by adults for adults living with those experiences Brian said about creating this book Comics were the right medium for the story I wanted to tell they meld words and pictures to convey an idea with more economy and Grace than either could alone a comic takes reality and pairs away everything that's unnecessary until you get to the heart of that experience and that's really true and that's really powerful and important in the kind of in the environment that we're speaking of right and I just want to stress so this is one of the books that some colleagues that I that came together uh created called graphic medicine Manifesto and uh I want to use a panel from that book to show you why I advocate for graphic medicine mostly is because I truly believe that those best positioned to represent illness in caregiving are those living with it and that's in Latin there the S um the slogan of the disability rights movement nothing about us without us and as a family member of someone who with chronic Strokes um elderly parents who've just uh you know been on on all sides of the uh clinical encounter as the caregiver and as the family member this is critically important um and unfortunately though the history of healthc care is not really oriented this way right um and one of the things I love about mpaf is that that's exactly where this this work is coming from um the history of medicine is that doctors tell us what a disease is and nurses tell us what to do about it and that's just not that's a patriarchal system that's not really good for anyone that that really the patients and families are the authorities on what's best for their life and their body and their community and their family and all of those things and we should be listening to the voices of of these patients and families and the cool thing about these graphic Memoirs they're actually called graphic pathographies and I'm going to share more with you is that this is a great opportunity for us to sort of listen to that voice and Elevate the those voices so here's an example from a book called cancer Vixen um and uh what the Creator uh Marcela aella marchetto is able to do here is sort of show the notion of this idea of this metaphor that cancer is growing around me um even though and it's in the air around me it's now a part of my life this image is representing the day she was given her diagnosis even though you know life goes on right we have to order dinner let's just like move on but of course this is kind of this part of her life and she's able to use this medium to do this interesting work to sort of communicate what that's like another example this is a book by uh Peter Dunlap schol uh called my degeneration and this image represents the day he was diagnosed with Parkinson's for him it's a wonderful book about um his experience living with Parkinson's and um again this is him telling us what this was really like for him as a patient um and this is the the cover of that wonderful book and again as I mentioned these these books that are by people living with illness and caregiving for adults by adults um are have been given this term graphic pathographies it's just a fancy way to give them a term for people to take them more seriously but the reality is they're Comics right and so this field has exploded here are eight examples just about reproduction trying to get pregnant being pregnant inability to get pregnant perinatal loss um postpartum depression things like that um this field has exploded and I'd like to stress here before I go further not just in English um there's a uh so we have a website graphic medicine.org which I'll share that link later um there's also medicina Graphica which is a Spanish language version there's a Japan graphic medicine Association it's an Italian this has become crazy enough in the last 10 years a worldwide phenomena of realizing the power of comics in this Arena but moving along these are four books about uh people living with Alzheimer's by their caregivers again all non-fiction here are more about cancer there are quite number of them about different kinds of cancer um these are about mental health issues struggling with things like bipolar disorder anxiety PTSD again just very few examples of what's out there there are also things in the graphic medicine uh consider in this umbrella things not just that in the clinic or the hospitals but of course things that happen in society anything that impacts physical and mental health and of course structural racism police brutality bullying uh War um migration things that impact of of course physical and mental health and even things like climate change there's lots of work that represent all of those areas before I go any further I want us to sort of stop in light of what I've just talked about and sort of think about this in a personal way and so I would like us to gather a few supplies even if you just have a pen or pencil that's a wonderful thing about this field there's a very low bar of Entry uh which I find really exciting for it to do the work that might be of benefit to you whether or not you choose to share this with family and friends is irrelevant what matters is the work that it's doing for you and so I thought we could start with something a little bit fun um so this is a graphic Memoir I did called taking turns stories from HIV AIDS Care Unit 371 which was where I worked as a nurse um and uh to do this book and to do it in comic form I had to create sort of what we call an avatar of myself and I decided I would make mine somewhat representational some human shaped right but that's the kind of fun thing about Comics is that we transcend all registers we can transcend time we can transcend space reality all of that so you could actually have an avatar that is a rock this rock could have incredible Adventures um you would read potentially an interesting graphic novel about this rock also a flower tree truck anything can be an avatar for how you want to work in your comic stick figures work wonderfully as you see from this example stick figures can actually be pretty expressive um there's a cartoonist name Ivan brunetti and this is uh another cartoonist using his style says that basic geometric shapes work pretty well um Linda Barry says that uh you know you can't do that much as a stick figure you probably could do a little more if you just added some fun to it so what I sort of want to put out to you to think about as we continue um as I continue talking and as we continue thinking and working together is what would be your comic Avatar if you were going to make a story about how you your average day using this as a tool how would you draw yourself and you're not limited to one there could be a million different ones but uh feel free to drop in the chat some ideas but also I'd love to have you take pen and pencil or crayon I love using crayons my chapter in the um the graphic medicine Manifesto is called the crayon Revolution because I think if we all went back to using crayons we could do some important wonderful work together and you'll see examples of that so I've created um since we're such a large group and I we can't individually uh kind of share these wonderful ideas together I've created something on a website called padlet and I'm going to share the link in the chat and I'll share it uh now and later and there's also I'll share in a minute a QR code um if you are good with doing those but it's a padlet and basically if you see in the bottom corner there that little plus sign you can this is a private uh just to uh the people who have the link that you'll have it's not public facing um but if you want to share uh your drawing of your avatar you just press this little button and upload an image upload the photo phot you also can upload links and after this talk I will be uploading some more Links of anything you ask about in the questions that you want links to or um anything that I think might be relevant for you to have this as a resource so this will live out in the world after we're done and this is the QR code that I mentioned um if you want to take a quick snap of that I'll bring this back later so don't worry if you don't have your phone nearby and again we'll have the link in the chat um which it already is all right the link is in the chat fabulous thank you so in talking more about um we're going to have one more interactive uh exercise in a minute but in talking about graphic medicine in this field I wanted to throw out enough stuff that I think resonates with some of the things that have been talked about already today that hopefully you will pick up and figure out ways to again make use of in your work um and in your way of kind of giving and receiving care and so I wanted to talk about four ways that I see Comics being used in healthcare today and this is a quick overview I could give a full lecture on each of these four areas because as I said this field is exploding and it's very exciting but the four areas are education reflection research and activism so let's take a look at education and Comics first of all which probably doesn't come as a surprise there's a long history of comics being used in public health particularly in crisis such as war or uh pandemic um and Comics are actually great teachers especially when there is a high density of information a high level of importance to that information and the learner is in a high stress situation so if you think about yeah getting a diagnosis or even just having to learn you know a lot of stuff in a school program right there's a lot to learn it's really important that you understand it because you're going to have to make decisions based on what you're learning but you're also stressed out and we know that people under stress have a difficulty um absorbing new information right and so Comics are actually great medium to to do this work um and the classic example that you'll see of course is this right when you're on an airplane this is a comic right it shows over time what needs to be done the learner is very stressed it's important that you need what to know what to do and there's a lot to learn right so that makes sense that this would be what we would use and also potentially Comics can transcend language barriers and literacy challenges and they add this visual attraction and appeal to receiving information right and of course the other reason Comics are frequently learn used in public health is I've come to understand it they're lowc cost and low Tech you know I did a lot of research around the age crisis and Comics that were used during the Age crisis and what I was told by the National Library of Medicine is we don't even archive all of this because that probably every Health Department used and had made a comic to help teach how not to transmit AIDS how to deal with if you know whatever how to deal with any of the side effects or whatever all the information that needed to go on during that time and I this happened again during covid and we archived a lot of it on the graphic medicine website it's lowc cost low Tech and immediate especially now on the day of the internet so one example this is a a great Doc in the Chicago land area named Alex Thomas and he's a pediatric Al allergist when he was a kid he had asthma and he couldn't figure out which was his immediate relief inhaler and which was his long-term care inhaler that he's supposed to be using once a day and versus in an emergency and in an emergency you need to know quickly which one's which right and there wasn't really any uniform packaging or uniform labeling like literally right on the um the inhaler thing and so he created characters that he has a little kid Drew for himself and he put them and taped them to his inhalers as an adult it turns out he's actually a great cartoonist as well he grew up and he created this whole educational series called Iggy and the inhalers and you can see there in the front the little cowboy character is Bronco the Bronco dilator and up in the front there is um uh colron the controller and then these are sort of the triggers of asthma um and this actually is incredibly uh surprising this is aimed at kids uh surprisingly effective way of teaching kids um some pretty sophisticated understanding of the pharmacokinetics of their medication through using these wonderful Comic characters and the metaphors that they are using there um but you know I said Comics are not just for kids um through his company booster shop media he and his partner Gary ashwal who's a specialist in health education have actually made some pretty sophisticated adult comics about um informed consent decision-making and cancer therapy and you can go on their website Brer shot Comics to learn more about their wonderful work um but that's just one example of the way Comics are being used in healthcare there are a lot of pilot projects and of course our healthc care is is uh research-based and so it's not just fun to be enthusiastic about this we want to make sure we're doing research to make sure that these are being used in the best way possible and develop our best practices and make sure done well and involving the patient population that perhaps is depicted all that good important ethical stuff around uh research and making these uh educational interventions but there's a lot going on out there so that's just one example the next area that he Comics are being used in healthcare I want to talk about is reflection so this is a book by a colleague of mine named Andrea caner witz and she's a she's a a painter and um educational she has a PhD in education and she's very convinced that drawing is a way of thinking and she says here drawing is a way of constructing ideas and observations as much as it is a means of expressing them when we are not ready or able to put our thoughts into words we can sometimes put them down in Arrangements of lines and marks and I think that's a big part of why even from that first comic I made drawing is important to me in conjunction with text right and so if you think about it in this Arena maybe we're struggling with a decision we're struggling with our options and some sometimes drawing around that can actually take us to places than just talking out loud with our family and friends or writing text alone could take us so here's an example of how I try to use utilize the power of drawing in mostly crayons is that when I teach so this is teaching first year medical students who are really struggling with um having to sort of impersonate doctors in the clinics when they know they're not really doctors um but going in and taking a history and so I asked them in their health Humanities elective that I teach draw a clinical encounter and I say that very vaguely right I don't tell them like in which this happened or whatever I say this vague prompt for a couple of reasons because sometimes what comes up for them is they actually draw a clinical situation they were in with families so they're not the provider they're actually on the other side of the stethoscope and they're the family member or the patient but a lot of times they are the provider or this new kind of role they're trying to take on and we have really powerful conversations around what comes up with them just drawing these with crayons so this is she's chosen the sort of cinematic perspective of letting us see through her eyes as she sort of draws this idea of walking into a room and meeting a patient being feeling pressured by time and the exam which is the little box in the corner knowing she has to do a full physical exam and what is going on what you know just full of questions right and so this is the perspective this person chose and um the way in which she chose to do it another example is a little hard to see um and this kind of image comes up a lot the patient feels very large and the provider feels very small and they feel like they want to be able to be there for their patients but their knowledge is is so limited right another example uh from a student medical student is how the things that are happening outside of their encounter you can see what they're trying to draw there is the partnership between them and the patient those hands coming together and in the center is the encounter um the things outside of the clinical encounter that are so impacting the um this time that the two people spend alone in that room and we talked about some of this earlier today another thing that comes up a lot is the idea of speaking on different registers so you have the provider there thinking with all of their abbreviations and the information that that medical student is sent into that room and charge to get and the uh person there with the head injury is talking about in and sort of in this Dynamic way not even using words just describing this image of falling on the stairs and that's how they got their head injury so I find it really interesting that this comes up a lot this miscommunication here's another example of the doctor the the wouldbe doctor saying like I feel like I'm talking in XYZ the patient is telling me ABC and there's this disconnect and so these communication barriers come up frequently um in these these young people who want to do best for their patients um and so just in just doing these simple drawings and crayons we can have these wonderful conversations about what this is like and then taking it one more step so I then have them take that single panel and I'm telling you this because I think this is a fun way to approach thinking about something that you might be struggling with or or want to explore using this little crazy tool I'm talking about and I want you to draw from there what came before and interestingly when I have my students do this they draw what came before often they draw what they were struggling with maybe you know 25 beeper calls and 300 demands by their attending physician but sometimes they switch roles and they draw that the patient had been sitting in that room for for 45 minutes before they came in and perhaps that's why they felt like the encounter didn't go well and so in drawing what came before we start understanding the context of the situation that we were struggling with and they were drawing about and then I have them draw what came after that initial drawing and often again they'll switch registers and maybe they'll draw that patient going home and trying to explain to their spouse what the doctor told them and realize that maybe they weren't very clear and the person maybe didn't even they didn't really communicate what they wanted to or they draw themselves coming out of it and asking all these questions did I do this right did I do that right because what drawing what came after actually gives you insight into the consequences of that initial moment right so this is just a just by switching time registers like this is another really interesting thing that Comics can do I want to throw this out and I'll put a screenshot of this so don't worry about writing all this down when I'm done but here's a wonderful way that I like to use Comics to think about just about any issue but particular to this situation um we T talk one of the narrators in the video talked about like um feeling like you got out of the visit and you didn't even know you didn't even get the questions answer that you wanted right and so I think it would be interesting to use a a method like this like at that doctor visit tomorrow I want to ask about and then maybe draw some images of things that respon correspond to that and this is important because when I leave a doctor visit I hope to know because then and again you can see the way that the work of the gutter is moving things forward with just contemplating this whole idea of a doctor visit and again I'll put a screenshot of this on our our joint padlet so you'll have it if you're interested but I thought um an interactive thing for us to do and this is where I'm going to have you use the chat um we're going to use this Cascade of responses in the chat and so this is um a six panel sequence Actually it's seven panels there um from uh a book by the infinite weight uh by this cartoonist named Julia wz and it's basically I use it an example of someone at having an encounter with a physician and what I want us to do is to take a look at this and I'm going to ask you you'll see that I've taken out the original text from this visit um I'm going to ask you to in the chat drop in a few things that might be in the speech bubbles okay so starting with this first one here we have a physician walking in to a patient who's been waiting and says something and don't do it just yet because we'll zoom in on each panel then the physician says something else and the patient responds then the physician says a lot of something a lot of something again and is handing if you look at their hands here you'll see this closeup later he's handing the patient a bottle of pills the patient says something about that thinks something about that patient takes a second or the doctor takes a second sort of thinks about that and says something in response okay so let's take this panel by panel what I'd love for you to do in the chat is drop into the chat what you think perhaps a physician might be saying when they walk into a room with a patient based on think about the visual look at the body language of the patient look at the facial expression look at the facial expressions of the of the doctor what kind of things you think a doctor could say when they walk into a room like this nice sorry to keep you waiting so long thank you Sarah that's great yes absolutely that's a very nice and sensitive thing to say yeah excellent yeah what brings you here today yeah yeah what brings you in good good so an opening Salo how you feeling today so asking about their well-being good tell me what brought you in today yeah yeah so usually that's kind of an opening ah I like that just kind of cut into the Chase from Wanda hi Jane your test results came back positive let's talk nice how are you today again inquiring never AG greeting though never a greeting that's interesting I see here you are experiencing yeah so having reviewed the chart I've already looked at this jump to the chase I see you're experiencing XYZ thank you Tracy good good okay so that kind of covers I think some of the things there let's move on to the next panel so the doctor continues talking based on those things you said the first time what might the doctor be saying next and Tracy yours still applies there I see your experiencing XYZ what else and so it seems like that the patient responds again look at the that facial expression right um there's so many interesting things you can do with facial expressions in this very simple medium um but the patient will respond to whatever the the doctor says there what do you think the doctor might be saying there I want to order test in these medicines for you let's figure out what's been bothering you good thank you what's going on anything since your last visit good good good I received your test results good I have concerns yes can you tell me more about how you're feeling good so IED your test results yeah yeah so kind of cut into the chase there again how long has it been going on good I see a prior diagnosis of good your nabs were negative for xyv yeah great great and then in that context then what do you think the patient is saying back feel free to use I don't know yeah but I'm still experiencing I am still I don't know but I'm still experiencing symptoms I've not been feeling well I'm worried what are my options here good I don't I still don't understand or you still don't understand I love it that's great yeah bringing in some of that stuff we talked about earlier I've not been feel can you explain the labs in detail very good very good no one seems answers I'm over it I'm really concerned I've not felt this way before am I contagious yeah good good good the meds make me feel worse yeah I love that thank you good what does that mean for me yeah so you've given me information what does that mean for my daily life excellent excellent excellent all right let's move on to the next panel next panel we have the doctor then a pretty I'm beginning to worry that no one understands on that last one thank you Vanessa um a pretty looks like like lengthy says a lot in response now feel free to respond to the thing that you put in the chat or any of it so the doctor responds oh this I think this is to the previous one where the patient says can you please give me a simple explanation as to what me going on with me good thank you Lisa thank you okay so then all that's been said or asked by the patient the phys the clinician is responding I shouldn't say physician necessarily it could be a nurse practitioner of course we can start by doing this and then try that there are several medications you can try if you taken this antibiotic before good good oh you're anticipating that next panel there Wanda thank you remember that gives a list of different options yeah I'm sorry expresses empathy I'm sorry this is frustrating I'm sorry you have to deal with this experiencing this yes we've tried this and that which is the usual treatment maybe we could try something else very good thank you Tracy that's great that's great let's explore our options ah I understand you live in a food desert area meaning that you do not have easy access to healthy food and you also lack sidewalks and appears your A1C at a level we should talk about your options your preferences so really tuning into important things thank you I understand this has been a worry for you but let's see what your options are we'll go at a pace that you understand and makes you feel comfortable excellent excellent excellent all this is very exciting um so that we've got that panel one of you anticipated it handing off a med may I have you may have something in writing to read as a patient saying that that's great that's wonderful these Labs mean blah blah blah I suggest you take these options but you're in control it's your choice I want to ensure you know everything in detail before making a decision excellent there are a lot of viruses going on I'm not too concerned probably some antibiotics can help great great great so yeah handing off that medicine excellent there's a lot of responses here that really are showing that you reflecting a lot of what we talked about this morning with asking questions and things like that so now now the patients is responding patient is responding either verbally or and in their thoughts right so this is really interesting um your TSH is low gives you this The Physician again nice here's it might a prescription it might be able to address it good good I think it's really interesting that in um Comics we have access both to what people say which is a speech bubble and what they're thinking and I think in healthcare you can imagine all kinds of interesting things that happen in that difference right um people say like okay thank you but really they're thinking I don't even know if I can afford these I don't know if I can take these I don't know if these are going to make me sick right so what are some of the things that maybe I what I'd love to show here is the conflict that sometimes comes up patient thinks why do I need yet one more pill good yeah thinking how do I take this how often thinking how much will this cost what would it really do to me great great great I wonder if these meds will make me sicker I'm so so tired of feeling like an experiment how long will I need to take this before I can feel better right okay thanks I don't know if I want to take this are there any other options excellent will this medicine bother interact with anything I'm taking excellent why what are my alternative to meds oh no another pill yeah excellent excellent exactly and some of those things yeah exactly might be things that you'd say just thank you or thank you very much or and you're thinking oh no as Lisa says here not another pill I'm pregnant will this impact my unborn child right and then uh moving along we have this sort of beat where the physician sort of takes in whatever the person just said nothing else is said and then the physician says a closing statement ah I like that going on the last one there Elizabeth patient says thank you this is great and patient thinks do I really need this what is the side effects will this conflict with my other meds excellent yes excellent so closing the encounter we have the last panel here okay then see you soon yeah I like that Sarah after the doctor's Blank Stare exactly okay then see you soon if you don't feel better we can follow up and go from there good good good good great great well it's interesting thank you very much uh I'm so cynical today sorry that's great take two of these and call me in the morning that's wonderful this can be inexpensive and trial medication and you or we can check and see how much your cost will be let me know if there's side effects so actually attending to some of those concerns that came off you great if you are my mother I would insist you follow these recommendations can I bring my daughter with me to help me understand good good thank you wonderful wonderful great so what I love is that in responding to this I think that um uh be oh sorry last one the doctor says being that we've tried other things I think you should at least try this and keep me posted if they're not working then we could try try something else very good so kind of leaving those lines of communication open remember it's your choice and we're here for you but feel free to use your portal to contact us as soon as possible excellent so yeah even gesturing towards follow-up care excellent so what's interesting is as I looked to this I I you know I think that what's wonderful is that I I wanted to ask two questions and I think that that in your responses you really reflected both of these like you really reflected maybe what was less than optimal in this visit but you also in your responses from what we even justen listening to what we listened to this morning talked about how this could go well how this can go better how this can go better than sometimes how we often in encounter these kinds of things and so this is another exercise that we use in graphic medicine to sort of look at and think about um like you know how do these encounters go and how can we can use these just these visuals uh minus even the text and what we also do is sometimes when we use this um this with medical students for example if someone fills out this entire page um and then we look at the entire Pages all together we can see how widely variant these conversations can be right um and so that's another interesting way to use these kinds of texts so I'm going to move up uh move along and try to wrap up pretty pretty um ah I there's still some comments coming that's great great great great so I want to wrap up and and show you a few more things that hopefully you'll find some relevance in and um try to wrap up on time so this is a workbook that um some colleagues of mine uh particularly Michael J green who is a doctor at Penn State um in Hershey and he's been very active in the graphic medicine movement as one of the co-founders with myself and some other colleagues um and they worked with a group called project talk and they created a workbook kind of a Zen if you know what Zen are but basically like simple paper folded in a workbook um that uses drawing and illustration but leaves room for people to use this as a reflective tool and so this was done in in conjunction with social workers and other care providers to help people prepare for conversations with families in the IU um so these are basically prep conversation prep books for family meetings in the ICU and so people get these in advance and they're allowed to sort of have some time to really sort of use this as a reflective tool I'm only going to show you a few of the pages from within this that I think are most relevant and interesting so they're actually given a piece of paper that asks them to write down a few things that as the either the um family member or the patient that they understand about the current medical situation um and so again this kind of opens up this space Not Just necessarily even just in the moment of that meeting but kind of like giving people some prompts for preparing for that so they can then turn to it if maybe in the meeting they get really nervous or they forget you know i' I've gone into doctor's uh appointments with lists of things and then the conversation is so variant I've really lost track of it and so these are fun ways to keep uh uh to have these things another example that I think is really helpful in these ICU moments of course is what is worrying you the most and again the hope is that in the meeting they that people share these things and even just writing these things down I think is helpful for the person using this to reflect um to help them kind of bring to the four and make them realize oh wow you know this whole time what I've really been worried about is X and I've talked more about why right um they even ask in in one of the pages here for a chance to give feedback to how the medical team is doing right so is is this like is the care you're getting the best is it somewhere in the middle or is it just really just horrible are you upset and then gives them a chance to say more and then gets to this question around that I think we we talk about a lot in in icus but not just even it's it's so incredible important as we make any kind of decision to make good decision it can be helpful to think about your values what is most important to your family member or friend this is for family members of people who are in the ICU again kind of focusing on the areas and that really zero in on what our values and understanding our values of course is a step towards really understanding how to make decisions and what our choices are and then they ask about decision- making process right let's talk about how you and your family make decisions how do you usually make difficult decisions right thinking again reflecting on this gives us an opportunity to kind of get closer to um kind of how to help make a decision and then I want to talk about two more registers and I'm going to wrap up is is that um so that's the reflection piece I wanted to share that research and activism these are going to be quick so Comics are being used in research to um this was a comic that I made for uh a University of Chicago Clinic where the patients were saying that they felt that the computer was really in interfering with the clinical encounter and so they um were given this flyer in the waiting room and let them know by the way you know you have the right to ask to see the the screen you can become involved right so the patient is saying hey I don't take that medicine anymore and the doctor says okay let's fix that record and that they also have the right to say can we step away from the computer and so the family members and patients were given these little uh cards that had this comic printed out in the waiting room and then a few weeks later they were called to ask if they remembered any of that and this research that was published in the um uh in this journal said that they did and actually three out of five people could read remember one of those three things and they actually felt the comic did Empower them to uh be more active in their care so that's one of the ways I mentioned earlier that Comics can be used as an intervention but we need to make sure these are actually effective and done well and then the last piece I just want to talk about is activism there I think that it's really powerful because Comics can bring the personal narrative and the research can bring data and when you bring those things together and you realize that what we think of as maybe an individual's problem is actually a systemic issue and we've talked about a lot of systemic issues today you can use this Medium as a way to communicate that and do some powerful activist work so here's a great comic uh by a cartoonist named Aubrey Hirsch called medicine's women problem and she starts with this struggle of herself in high school or in college rather Lo losing weight going to see doctor after doctor this is just a a simple snapshot of the first panels and in the course of this she comes to realize that actually this is a systemic issue she brings in data she's got footnotes it's inedible and this is another cartoonist named Whit Taylor who was pregnant and she's also a health professional I'm sorry um a public health professional and a cartoonist and so she made a wonderful comic that I can put a link on the um on the padlet to this comic about uh the obviously the the issue that of Health the specific issue of um M maternal um mortality um in the African-American community and so um this is a wonderful comic that again pairs her personal concerns with data around this and then she uses the story story of Serena Williams as you see here so I think that Comics are a great tool for that and I think I can get close to wrapping up to summarize I want to say that reading and drawing Comics can be powerful tools for caring for our health the medium is also useful for teaching and learning thinking and planning and researching and advocating and for more information and ideas you can go to graphic medicine.org which is our website my website is Comic nurse.com and you can contact me directly there and I have made our Workshop padlet there is our QR code if you want to get that but the link is also in the chat thank you very much and I welcome back Gwen Daren thank you MK that was just fantastic and um I uh the last thing shared about the work that you did with uh Lolita Al caresi was work that um was work that she and I presented on in a in a in a presentation and it was so so exciting to see what happened and how it really increased people's feelings about comfort and access and taking taking ownership over their healthare and I Think Through The Years um people have felt that computers were distancing but you showed how they could be empowering and that kind of interaction could be empowering and so the whole notion of drawing and we we've done a couple workshops with MK they've been fantastic but the whole notion about drawing and thinking and expressing uh as a way to empower and um and really articulate your choices your values your desires um is is a really powerful is a really powerful way of communicating and I hope that people will take the opportunity to um collaborate on the padlet um and that padlet will be up for a while