WHY I CREATED DIAGNOSKETCH

Several years ago, a non-medical friend, Rama, was diagnosed with pancreatic cancer. She asked me to come to her doctor’s appointment as a friend, but more importantly, as her medical translator.

Rama’s doctor was very compassionate. Yet, she used complicated words like metastases and hepatic lobe infiltration. The doctor scrolled through a CT scan on the computer screen. She showed Rama how extensively the cancer had spread. To Rama, it was overwhelming.

You see, Rama knows her body like the rest of the non-medical population–at a second-grade level. She did not know where her pancreas was, let alone what it does. How could she possibly understand the complicated CT scan?

I felt bad. When I brought her home, I took out a pencil and paper. First, I drew her anatomy. Then, I drew her cancer. Finally, I drew her treatment plan. Empowered with this basic knowledge, Rama told me that she felt strong enough to think about fighting her disease.

I had always drawn little sketches for my patients on the backs of paper towels or in the corner of the whiteboard in a patient’s room.  However, after I saw the utility of a visual aid to explain a concept with Rama, I began to draw even more. I made a point to try to draw an image for each patient. After a while, I realized I was drawing the same image over and over again. I then decided to make one master image that could be used multiple times. Photo: Drawing some of my first hand-drawn images in 2016.

 I also drew simple pictures of procedures before I performed them. Before inserting a scary nasogastric tube into a patient’s nose, I drew an image of what was going to happen. Before placing a foley catheter in a patient’s bladder, I drew a picture of where it was going. Before draining a paronychia on a child’s finger, I drew a picture of what I was going to do. The patients all seemed to tolerate the procedure better when they understood what was going to happen to them.

Once I started using my images regularly, I began to notice something. People started asking questions. Intelligent questions. Logical questions. People began to understand what was going on inside their bodies. They began to understand how their body worked. With a simple sketch, they actually began to understand and take ownership of their medical disease.

As I continued to use images, I began to think about different ways to explain things. I initially used several existing medical illustrations. But, I felt that they were too detailed and used confusing medical jargon. I wanted something that could be used at the bedside, quickly and simply. Over the years, I tried many different iterations. I experimented with super “cartoony’ images and more realistic images. I incorporated real-time patient feedback until I found the perfect style of illustration. This style worked best because it relayed accurate information in a simple, colorful, and non-threatening way. It gets the point across without being too cartoony or “dumbed down.”

 In January 2021, I compiled the 70+ images that I had created over the years into a prototype. I distributed it to local emergency departments, urgent care facilities, and to my network of physicians and nurses across the US and abroad. The prototype quickly became a useful visual guide that was used to facilitate patient understanding. Collectively, these initial prototype images were used to assist hundreds of patients in the US. In addition, colleagues used these images internationally, on medical trips to Nicaragua and to rural Nepal.

 Some emergency departments stored the prototype in a prominent location for easy use for all staff members. Here is an image of it being used in a busy urban emergency department in Charlotte, NC.

The images are also useful internationally because they have very little text and the pictures are universal. Here is an image of the book being used at a busy rural Nepali hospital. The physician is explaining the digestive tract to the patient.

Here is another image of the book being used at a clinic in Nicaragua. The nurse uses an image of kidney failure to explain what happens when a patient leaves his high blood pressure untreated.

Diagnosketch is also useful during medical visits. Here, a colleague brings her copy of Diagnosketch when she takes her elderly parents to their doctor’s visits. She says that it is much easier to explain things to her parents with a picture.

I now use Diagnosketch with the majority of my patients. They often ask for a copy of the image to take home or ask to take a photo of the image. These patients have access to the internet at home and can probably do extensive research about their diagnosis. Yet, once they leave the hospital, they almost always do not. Instead, they rely on the simple, familiar images that were explained to them at the bedside and that they fully understand.