Comic Strips Carry Serious Messages for Medical Students

There is nothing funny about a "comic strip" when it illustrates a real-life situation in which a patient died because of an avoidable medical mistake. Drawing on his own experience, Michael Green, MD, professor of humanities and medicine at Penn State College of Medicine in Hershey, Pennsylvania, developed a so-called graphic narrative to teach medical students how to deal with such a difficult issue.

Illustrated by Ray Rieck, Dr. Green's 5-page example focuses on a fatal outcome after a missed aortic stenosis. It appears in a supplement to the March 5 issue of the Annals of Internal Medicine.

"This is a story that has haunted me for many years.... It meant a lot to me personally," Dr. Green told Medscape Medical News.

A panel from Dr. Green's graphic narrative.

Dr. Green describes the graphic narrative form as a story told using words and images that is often referred to as a comic. It can do more than words or pictures alone, communicating the emotional impact of a particular story by showing a patient's anguish, for example, or showing a conflict between a patient's words and expression or body language.

"It's a type of narrative medicine," he commented to Medscape Medical News. "Narrative medicine is concerned with the use of storytelling and stories in medicine...and comics are just another medium for doing this." Over recent years, comics have taken on new narratives, not only presenting superheroes righting wrongs but also presenting serious topics in society, history, religion, and more.

"There is great economy that takes place with the pictures," Dr. Green said. "You can communicate in a panel that is 2 inches by 2 inches in size something that might take 3 pages in some circumstances to describe by writing."

Among the important topics have been physician–patient communication, patient care, empathy, nonverbal communication, ethics, and the patient's experience with illness. Dr. Green said the visual aspect helps students become more careful observers, discerning hidden messages and nonverbal cues when interacting with patients. In addition to medical student education, he says comics are also good for patient education.

Dr. Green is now in his fifth year teaching a course in comics in medicine to medical students. "They love it," he said. "Usually the students when we start sort of don't quite know what to expect...but by the end of it they become sort of like me, really excited about the potential for comics, and they become advocates themselves."

He has organized conferences on comics in medicine, the next of which will be in July in Brighton, United Kingdom. When he has presented this medium at conferences, "I've never received any kind of negative feedback" about it not being serious enough to be included in the medical realm, he said.

The conferences bring together interdisciplinary constituencies, including graphic artists, scholars in narrative medicine and in English literature, physicians, students, and fans of comics.

At this point, Dr. Green said he does not have specific plans to do more comics but would welcome the opportunity and would encourage others to produce them. "I would love to see this sort of thing integrated into mainstream medical journals as a series," he said.

Dr. Green has disclosed no relevant financial relationships.

Ann Intern Med. Published online March 4, 2013.