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Comics: A step toward the future of medicine and medical education?

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June 14, 2016
by Michael D. Goldenberg, MA

Within the past decade or so, interest in comics as an educational tool and more than just cheap entertainment has increased substantially. The integration of comics and medicine (dubbed graphic medicine) has also emerged as a legitimate academic discussion, despite the fact that “the general public has traditionally been profoundly unaware of the potential range of the comics medium, and has continued to see it essentially as entertainment for children.”1 Green and Myers state that those who believe in the utility of graphic medicine must “contest doctors' and patients' biases against graphic stories-including the misperception that they are juvenile, simplistic, or frivolous.”2 Graphic medicine ultimately helps provide knowledge to those laypeople who otherwise would not have access to the expertise held by medical professionals.

Comics, also known as graphic novels, have been used in both general and medical education as well as in patient care, and they have been found beneficial in various respects: educating medical students,2 mediating the difficult emotional state after diagnostic mistakes,3 showing examples of good and bad medicine and how to avoid/rectify mistakes,4 and allowing children to understand their participation in medical research,5 among others. Popular and award-winning titles such as Tangles: A Story About Alzheimer's, My Mother, and Me; Cancer Vixen: A True Story; Mom's Cancer, and Stitches: A Memoir emerge regularly to wide acclaim. Tangles won numerous awards in Canada; Cancer Vixen was one of Time's top 10 graphic novels of the year; Mom's Cancer won the Eisner Award for Best Digital Comic in 2005; and Stitches was a New York Times bestseller and National Book Award Finalist.

“Traditional” comics (featuring superheroes or other nonmedical topics) that contain medical themes can be used to mediate the effects of illness for those who require an emotional outlet.6 Instructional comics have even been used by The Centers for Disease Control and Prevention in the education of young adults about human immunodeficiency virus and other sexually transmitted infections for which they may be at risk yet about which they have little information.7 Moreover, comics are effective not only in teaching health messages, but also in making them stick. A study published in the Journal of Nutrition Education and Behavior showed that children who read comics about healthy food are more likely to make better snack choices in the long run.8

One of the benefits of using comics instead of traditional text-only print material is that images touch us differently emotionally, “bypassing all the guard towers…. You often go to the movies and see people with tears streaming down their cheeks, but you don't often see this reaction in libraries.”9

With comics, the reader must pay attention to two forms of information simultaneously-visual and textual. Moreover, the illusion of “motion” created in a comic is performed entirely in the mind of the reader, which connects two static images as the eyes pass through the gutter (the area in between two comics panels).10 This requires the reader's participation on two levels; thus, engagement with the information is increased, allowing a flow of emotional and intellectual attachment not achieved as easily with text-only media.11

The emotional connection is enhanced by exploiting “the icon”-any image used to represent a person, place, thing, or idea. The icon conveys information as well as emotion because, by simplifying, it provokes identification in the reader.”12 For instance, a smiley face resonates with nearly every human, irrespective of skin color, ethnicity, sex, etc., by the very virtue of its simplified form. A detailed photograph of a human face might not resonate the same way with people of different backgrounds.10

Now that the preliminary work has been done, wider acceptance of graphic medicine by the medical community is inevitable and will surely improve patient education and care. Otolaryngologists should be among the leaders in developing this tool. Graphic medicine has obvious potential value, not only to the many pediatric patients treated by otolaryngologists, but also to head and neck cancer patients, geriatric patients, and others. For example, see David Small's Stitches, which deals specifically with a misdiagnosed thyroid cancer and its aftermath.13

Healthcare professionals can improve their understanding of the patient's inner condition by emotionally resonating with the graphic tales of the sick and injured in the ways mentioned above, while the patient also can find support through others' stories and through traditional physician/nurse approaches.

Patients, too, have begun to find some graphic pathographies (graphic novels that discuss illness) on their own and have reported how much these have helped them come to terms with their illness14 and/or become more open to discussing it with their physician.15 Thus, any health professional should be encouraged to attempt using graphic novels in patient care, recommending them especially to patients who may be having trouble understanding their illness or are not forthcoming in discussing their condition. Taking time to read some of these comics may give the medical provider a different insight into the patient's emotional state and, in turn, provide more thorough and empathetic care. Physicians may also find it rewarding to become involved in writing new graphic healthcare materials.



References

  1. Smith ST. Who gets to speak? The making of comics scholarship.In: Czerwiec MK, Williams I, Squier SM ,et al. Graphic Medicine Manifesto. 1st ed. University Park, Pa:Penn State University Press; 2015:21 - 40.
  2. Green MJ, Myers KR. Graphic medicine: Use of comics in medical education and patient care. BMJ 2010; 340:574-7.
  3. Keller DM. Comic strips carry serious messages for medical students. Medscape 2013.www.medscape.com/viewarticle/780235. Accessed March 31, 2016.
  4. Genes M. Medicine in the comics: Inverse metabolism and mutating viruses. Medscape 2006. http://www.medscape.com/viewarticle/530706. Accessed March 31, 2016.
  5. Grootens-Wiegers P, de Vries MC, van Beusekom MM ,et al. Comic strips help children understand medical research. Patient Educ Couns 2015; 98 (4): 518-24.
  6. Goldenberg MD. A picture is worth a thousand hurts: Representing illness through the fantastic in comics [master's thesis]. University Park, Pa.:The Pennsylvania State University; 2015.
  7. Wahowiak L. Health workers, artists partner to deliver messages via comics: Tools can influence health behavior. The Nation's Health 2014; 44 (7): 1-16.
  8. Leung MM, Tripicchio G, Agaronov A, Hou N. Manga comic influences snack selection in Black and Hispanic New York City youth. J Nutr Educ Behav 2013; 46 (2): 142-7.
  9. Small D. David Small on Stitches. Amazon Exclusive: Interview by Amazon.com. www.amazon.com/Stitches-A-Memoir-David-Small/dp/0393338967. Accessed March 31, 2016.
  10. McCloud S. Understanding Comics: The Invisible Art. 5th ed. New York, NY:HarperPerennial; 1994.
  11. Schneider EF. Quantifying and visualizing the history of public health comics.In: iConference 2014 Proceedings 2014:995 - 7.
  12. Squier SM. Future tense: Making it graphic. Lit Med 2008; 27 (2): 124-52.
  13. Small D. Stitches: A Memoir. 6th ed. New York:WW Norton & Co.; 2009.
  14. Szabo L. Laughing in the face of cancer. USA TODAY Health and Behavior section.May 22, 2006.
  15. Packer S. Comics and medicine: A conference…or a movement? The Psychiatric Times 2014; 31 (8): 44.
Division of Otolaryngology-Head and Neck Surgery, Penn State Hershey Medical Center, Hershey, Pennsylvania
Ear Nose Throat J. 2016 June;95(6):204-205