GRAPHIC MEDICINE: THE ART OF STORYTELLING WITH COMICS MICHAEL GREEN, MD, MS PENN STATE COLLEGE OF MEDICINE mjg15@psu.edu
What to Call These Things? • In the context of Graphic Medicine, the vocabulary is imperfect – Comics, graphic memoir, graphica, graphic narrative, illness narrative, graphic pathography, comic memoir • For every definition, there are counter examples and arguments
“What to call these things is one of the most nettlesome questions in the field. “Graphic” conjures for many the idea of sexually explicit; “novel” is usually a reference to fiction; ‘‘comic” suggests to some that these are supposed to be funny, or that they occupy the same terrain as “Batman.” Any of which could be true, but are not generally descriptive of the scope or ambition of these works.” Peter Dunlap-Shohl, 2018
Important Features of Comics • A form of literature that includes…. – Pictures – Words – In sequence – To tell a story – Words complement and enhance pictures to produce greater meaning than either alone
Graphic Medicine • Coined by Dr. Ian Williams • Speaks to interconnection between the medium of comics and the field of medicine • Not one thing; includes: – Stories by patients about illness experience – Stories by clinicians about being a health care provider – Materials to educate patients or clinicians – Tools aimed at changing health behavior – Scholarship about comics – It’s also about community
Storytelling • At it’s core, Graphic Medicine is about stories • The power of comics to show us something about health, illness and the medical context
Storytelling • In particular, stories that give voice to perspectives that are not often told • Comics have a long history of being a subversive medium
Underground Comics R. Crumb
Taboo Topics • Suicide • Mental illness • AIDS • Sex • Abortion • Death and Dying • Herpes
Monsters, by Ken Dahl 12
Giving Voice to Those at the Margins • Transgender • Cancer patients • People with eating disorders • Those with chronic illness • People with disabilities • Mutism
Dumb, by Georgia Webber 14
Offering Uncommon Perspectives • The inner thoughts of a doctor • The experience of being a front line nurse during the AIDS crisis • Being a family member of patient with cancer • Life as a medical student
Challenging the Status Quo • Myths about pregnancy Slightly Plural, by Marnie Galloway
Challenging the Status Quo • Doctors don’t bring personal feelings to work Tom Ferrier, Disrepute
20
Creation of “Missed It” Began as a narrative essay about a mistake I made during • my internal medicine residency Written as part of “Physician’s Writers Group” •
Creation of “Missed It” Evolved into a short and intense work of flash fiction Routine ER page. He says it’s a COPDer. This will be easy -- nebs, steroids, 0 2 . Home in a day. “What about the murmur?” I ask, “No worries, it’s innocent.” Just what I wanted to hear. Admit to floor; return to bed. 3 a.m. nurse is calling. Looks worse. “I can’t breathe.” Smell of fear. Lunge for my arm. Dead. Autopsy: pinpoint aortic stenosis. Fixable.
Creation of “Missed It” • Wanted to tell this story visually • Collaborated with Ray Reich, a talented illustrator • How to “show” rather than “tell” this story
JAMA 2015. Vol. 314, No. 22: 2345-2346
Zombie Themes • Fear of dehumanization • Isolation and loneliness • Mindless consumption • Being led by ruthless authority figures • Devaluing human beings • Erosion of empathy
Zombies serve as powerful metaphors for our deepest fears and preoccupations
Not About Zombies • Backdrops for stories about – Survivors – Relationships • Emerge in response to challenging times George Romero
Zombie Questions • How do people react to danger? – Band together, or is everyone out for self? – Help the least advantaged, or survival of the fittest? • How do survivors cope with stress? – Calmly or panicked? • How are power relationships negotiated? – Smartest and most egalitarian as leaders, or rule by strong & ruthless?
A Mixed-Methods Study Using “My Degeneration”
Study Team • Daniel George, M.S., Ph.D. • Mike Goldenberg, M.A., MSIII • Michael Green, M.D. • Erik Lehman, M.S. • Kimberly R. Myers, M.A., Ph.D. • Xuemei Huang, M.D., Ph.D. • L.J. Van Scoy, M.D.
Study Questions • Does reading My Degeneration help health care providers (HCPs) better understand the lived experience of patients with Parkinson’s Disease? • Specifically, does it: – ↑ confidence in understanding patients’ experience? – Change attitudes?
Mixed Methods Approach • Participants: o 12 health care providers who treat patients with Parkinson’s Disease § Mean age = 42 years § 83% female • All participants provided copy of the book • Pre/post intervention surveys • Qualitative assessment of small group discussion
Mean Self-Efficacy (n=12) 100 P=0.001 90 83 80 72 70 60 50 40 30 20 10 0 Self-Efficacy Pre Post scale 0-100; 0=low confidence, 100=high confidence
Comics Are . . . 1 2 3 4 5 6 7 Good Bad Worthless Valuable Juvenile Mature Passive Active Pre Post Simple Complex Unimaginative Innovative Dull Interesting Stupid Smart Semantic Differential Scale Mean score 4.8 à 5.3 (p=0.029)
Net Promoter Score 90 77 70 50 38 30 10 -10 Before Reading Book -30 After Reading Book -50 -50 After Discussion -100 = would not recommend book to family or friends +100 = would highly recommend book
No Change in Knowledge or Attitudes About PD Measure Pre Post P value Mean Mean Knowledge About PD (0-100) 85 86 0.56 Attitudes about Parkinson’s * 52 54 0.166 *scale 15-60; 60 = patients worry a great deal
Qualitative Results 1. “My Degeneration” provided a meaningful way for healthcare providers to learn about the lived experience of patients with PD 2. The comic form engaged the healthcare providers in ways that were different from other other mediums 3. The benefits of the book may extend past the healthcare team
Graphic Medicine is a dynamic new field with many potential applications: o For teaching o For research o For patient care o For public health
MICHAEL GREEN mjg15@psu.edu
Recommend
More recommend
