Imagery in Medicine

Information can be conveyed via many different methods and the brain has a great ability to store this information in a meaningful context. The predominate form of knowledge exchange since the arrival of the Gutenberg press has been textual. While words have been doing a great job at exchanging information sometimes a simple picture can say a thousand words.

Imagery in medicine is not something new, but has generally been underutilised. As seen in a recent BMJ article on Graphic Medicine, there are benefits to the patient, to the medical student and to the medical professional.

Graphic Medicine for medical students and professionals

Lifelong learning is facet of medicine that medical students sign-on for when they begin their medical education. As a consequence of the current technological advances and this facet of medicine, students and professionals alike are posed with the threat of information overload. Graphic medicine provides one avenue for reducing this load by providing information in a variety of contexts. The combination of pictures and text has been shown to enhance understanding via activating different regions of the brain (i.e. The inferotemporal cortex- visual perception, storing memories of visual patterns; The prefrontal cortex- memory for the temporal order of events, working memory). Essentially pictures and text can increase the efficiency at which you absorb and retain information.

Investigating the world

When making clinical decisions, the current practice is to use evidence-based medicine (EBM), which often involves scouring through clinical trials attempting to find relevant information. Using well thought out imagery however, the big picture can become clear. A great example is the work done by the folks at Information is Beautiful. They have transformed their review data on the effectiveness of certain vitamin supplements, into a succinct, interactive and visually appealing image. The image shown below takes into account;

  • A substance and an associated use (represented by a bubble)
  • Level of Evidence (location: higher up equates to more solid evidence)
  • Popularity measured by Google Hits (size of the bubble)
Snakeoil Supplements

'The Snakeoil Balloon Race' - click on the image to go to the interactive version at 'Information is Beautiful'.

In just one image, it is possible to get a succinct overview, when otherwise you would of have to have read over 100 journal articles.

Understanding the World

As a species we are heavily reliant on using our eyes to understand the world around us. Therefore, it’s not surprising that images can also help us understand concepts. Images in medicine have been used to illustrate biochemical pathways, display anatomy, the interaction of concepts at large via mind maps and much more. As the authors of Graphic Medicine noted, images have an untapped potential to be used in areas of medical education such as illness pathology. They coined this idea as graphic pathographies— illness narratives in graphic form – which can be written by both patients and educators alike.

Patient graphic pathographies offer an insight into how a patient copes with the condition and their concerns which may be overlooked. Patient graphic pathographies provide an outlet for patients to share their feelings when they might of otherwise feel uncomfortable. This can assist in fostering empathy in fledging medical students and remind medical professionals of the humanistic side of medicine. Michael Green and Kimberly Myers postulated the following benefits of graphic medicine for medical students.

“During preclinical years, such stories remind students thatthe vast body of scientific knowledge they are trying to masterwill one day help real people. During clinical and residencyyears, graphic pathographies can reinforce that healing a patiententails more than treating a body. ”

Michael J Green & Kimberly R Myers in Graphic Medicine, BMJ 2010;340:c863

An additional benefit seems to be that it aids in refining diagnostic skills; seeing what is being said, what is being shown, and filling in the gaps.

Empowering the patient

“Patient‐Centred Care: Health care that is closely congruent with and responsive to patients’ wants, needs, and preferences”

Laine & Davidoff 1996

Some days words fail to truly convey the desired message. Leaving the patient, unsure and consequently anxious of what is happening to them. Graphics can be used to promote public awareness andenhance patient care for various problems including:

  • Substanceabuse
  • HIV
  • Diabetes
  • mental illness and so on

Words can especially be made redundant when dealing with a Culturally & Linguistically Diverse (CALD) Patient. Images bridge this gap in a sense by being more universally understandable. By providing information in a more accessible and easily understood form, patients are more likely to feel comfortable dealing with the same health professional again in the future. Even more importantly comply with the treatment recommendations of the health professional. This empowerment of the patient will hopefully lead to better health outcomes in the long term.

Tools for visualising your world

There are a number of websites that display medical information in graphic form. Here are some suggestions.

Feel like spicing up your own data points?  Then give the following a try:

  • Tableau Public a free windows application that allows you to create beautiful visualizations from your data.
  • Swivel: Brings your numbers to life with interactive graphs.
  • Xtimeline: Allows you to create web based timelines incorporating videos and images

Finally it is always important to ask yourself what an image is trying to convey.  Does it tell a tale of a thousand words?

References

  • Craig JC, Irwig LM, Stockler MR. Evidence-based medicine: useful tools for decision making.  Medical Journal of Australia, vol 174, p 248-253 (2001) PMID: 11280698
  • Green MJ, Myers KR. Graphic medicine: use of comics in medical education andpatient care. BMJ. 2010 Mar 3;340:c863. doi: 10.1136/bmj.c863.  PMID: 20200064
  • Mayer RE, Sims VK. For whom is a picture worth a thousand words? Extensions of a dual-coding theory of multimedia learning. J Educ Psychol 1994;86:389-401 [abstract]
  • Pinel, JPJ. Biopsychology. Boston, Mass.: Pearson/Allyn and Bacon, c2009.  7th ed.

Editorial comment:
The Life in the Fast Lane team warmly welcomes this guest contribution from Aaron Sparshott of Project IV Line – cheers mate!

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Comments

  1. says

    Great segue into image-based reporting which will be covered during Thursday's breakfast seminar at PathWest (The Hard Cell: a casebook of cellular microbiology). http://micrognome.priobe.net/2010/03/hard-cell-cl

    This also takes us back to stuff we did in Singapore in 1994, using the computer game Myst to introduce med students to diagnostic decision-making. Hey, we had some fun, and maybe did a bit of learning.

  2. says

    Totally agree with you Clinton, using visual aids with patients can be great for explaining medical concepts. I think it would be also highly beneficial as the authors of Graphic medicine suggested to show what other's have gone through with an illness. I guess, demystify the illness, the treatment options and showing them that they're not alone. That others have had similar fears and concerns.

    Thank you to Tim, Ravi, Clinton and Chris for sharing opinions and insight.

  3. says

    I was the art director of MidwestHeart. In designing the award-winning publication we believed that images, particularly on the cover, would immediately engage the reader and generate interest in reading about the subject. Graphics were used to help explain complex information, increasing comprehension.

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