Graphic Medicine and the Doctor-Patient Relationship

Dr. Brian Callender is interested in clinical education, global health education, clinical ethics, the patient experience, and the use of graphic narrative in medicine. Dr. Matthew Sorrentino will lead a discussion with Dr. Callender on the role of graphic medicine and its impact on the doctor-patient relationship.

What is The Clinical Excellence Podcast?

The Clinical Excellent Podcast, sponsored by the Bucksbaum Institute for Clinical Excellence is a biweekly podcast hosted by Drs. Adam Cifu and Matthew Sorrentino. The podcast has three formats: discussions between doctors and patients, discussions with authors of research pertinent to improving clinical care and the doctor-patient relationship and discussions with physicians about challenges in the doctor-patient relationship or in the life of a physician.

[00:00:00] Dr. Sorrentino: On today's episode of The Clinical Excellence Podcast, we have Dr. Brian Callender who's going to talk to us about graphic medicine and the doctor-patient relationship.

[00:00:14] Dr. Callender: Patients don't understand a lot of what is said in one of those meetings. You know, they're high-stress, things go by quickly, and so the idea was that in giving them this tool, this comic, that they can take it home and they could sort of digest it at their own pace.

[00:00:30] Dr. Sorrentino: We are back with another episode of The Clinical Excellence Podcast sponsored by the Bucksbaum Institute. During this podcast, we discuss, dissect, and promote clinical excellence. We review research pertinent to clinical excellence. We invite experts to discuss topics that often challenge the physician-patient relationship, and we host conversations between patients and doctors.

I'm Dr. Matthew Sorrentino, and today I'm joined by Dr. Brian Callender. Dr. Brian Callender is an associate professor of medicine in the section of hospital medicine. He's interested in clinical and global health education, the patient experience, and the use of graphic medicine and graphic narrative in medicine. Brian, welcome to the program.

[00:01:15] Dr. Callender: It's a pleasure to be here. Thanks for having me.

[00:01:18] Dr. Sorrentino: Brian, when I think of graphic medicine, I'm reminded of the comic books I read and loved as a kid, growing up, how has graphic medicine kind of evolved from what we think of as comic books and what does it look like today?

[00:01:35] Dr. Callender: So when I talk about comics in medicine, it is not uncommon for individuals to bring up traditional comic books as a starting point for this discussion, often because that is their frame of reference for the term comics. They hear the term comics and they think comic books, superhero, superhero sort of genre of comic books. Um, but let me take a moment to sort of orient the listener to the terms graphic medicine and comics for those who may be unfamiliar. So a commonly used definition of graphic medicine is "the intersection of the medium of comics and the discourse of health."

So this is a broad definition, but it captures the breadth of interdisciplinary activities that define graphic medicine. And this includes creative practices and reflection, so the actual creation of comics, the creation of graphic memoirs.

[00:02:33] Dr. Sorrentino: Yeah.

[00:02:34] Dr. Callender: It includes sort of patient education, public health education using the medium of comics and also scholarly inquiry. You know, so looking at, you know, like what I do, sort of the doctor-patient relationship from a historical lens through the history of comics, which I'll talk a little bit more about today. And it really embraces these both historical and contemporary context.

[00:02:58] Dr. Sorrentino: So when you say historical, is this a brand new field or...? Because comics go back, I know, 50-60, 100 years, um, is this something brand new that graphics have come into medicine or is there an even longer history of it?

[00:03:13] Dr. Callender: The term graphic medicine is relatively new. Um, it was coined in, I believe, 2007 by a cartoonist and physician Ian Williams who practices in the United Kingdom and he was sort of struggling at the time, sort of thinking about his practice of medicine, how he practices medicine and how to sort of express that, and he was expressing that through comics. And from that, a small community developed and now it's been sort of building ever since then to what sort of contemporary graphic medicine is today. That includes a website, it includes sort of sibling websites across the world, in Japan, a new one in Italy, there's one in Spain, so there's sort of these groups around the world.

So it's an international community that, um, embraces this idea of how comics are used in medicine and what do they have to contribute to this discourse around medicine? And I'll just point something out, it's that even though the term medicine is in the sort of the title of the discipline, it's much more than just sort of the practice of medicine. It's thinking about health, it's thinking about illness, it's thinking about the patient experience, it's thinking about public health, it's thinking about climate change. It's thinking about a lot more than just sort of clinical practice or how we often just sort of think about the practice of medicine.

Now, even though the sort of term itself, graphic medicine is relatively new, when you do look at sort of the history of comics, it is not surprising that medicine, health emerged within those comics. If you think about how important health is to individuals.

[00:04:55] Dr. Sorrentino: Right, right. Yeah.

[00:04:56] Dr. Callender: And so, you know, one of the things that I became really interested in as I was exploring this sort of topic more starting with contemporary works, but sort of then asking myself, well, if we look back further in the history of comics, what are those depictions of healthcare, of clinical interactions? And so, when you do go back historically and you look at comics, old comics from the sort of mid-1800s where comics really started to emerge, um, both in sort of long-form narratives, but also very much so within satirical and political magazines, within sort of graphic journalism that you start to see critiques of medicine, you start to see sort of narratives around health-seeking behaviors and what the sort of healthcare marketplace looks like as individuals are navigating that space.

[00:05:54] Dr. Sorrentino: So I would assume those older comics though were, as you mentioned, more satirical or politically motivated and probably not putting medicine into a good picture. Uh, I assume that's shifting now towards something which is more patient-centered, more helpful.

[00:06:13] Dr. Callender: You bring up a really interesting point because as I sort of looked at this in its totality, sort of the history of comics with the history of sort of medicine layered on there and sort of what those depictions, that it tracks, interestingly, with that evolution of what medicine was doing and how comics sort of both sort of shaped attitudes around medicine, but also reflected them. I think one of the interesting things about comics as a medium, is that one of the sort of key aspects of it is how it's disseminated and how it's sort of widely disseminated, as opposed to something like fine art. That there are many, many copies of comics, when we think about how it's sort of disseminated when you think about comic books, that it tends to be a very social medium in terms of how it's consumed and how it's disseminated. Um, and so in that way it is very reflective of sort of social and cultural attitudes around healthcare.

And so if you look at the sort of long, sort of narrative of medical history, sort of as told through the history of comics, you do start out in sort of the mid to early 1800s where the take on medicine is very satirical. You have caricatures of doctors that are very... They paint the picture of physicians in a very sort of uncomfortable light.

Uh, the doctor-patient relationship is often very fraught with the intentions of the physician either for having profiteering motives, lustful motives or power motives. And so it's a very different picture of what the doctor-patient relationship is.

[00:08:04] Dr. Sorrentino: And even though at the time it probably was an over-the-top depiction, it probably also mirrored what a lot of people felt the doctor-patient relationship was at that time. So it's interesting looking through that history, it mirrors the history of medicine in a way, I suppose.

[00:08:24] Dr. Callender: Yes. And you know, at the beginning of the 1800s where there are not that many sort of therapeutics that were effective.

[00:08:32] Dr. Sorrentino: Sure.

[00:08:33] Dr. Callender: And so there was a lot of doctor shopping and this is sort of the era of what sort of is termed bedside medicine, right? That the patron or the patient had a lot of power in doctor shopping. Um, and there were ways in which the doctor had to really sell what sort of therapies and what sort of medications they were pushing. You know, this was the era of patent medicines and there was a lot of skepticism, uh, around clinicians and around the sort of therapies that they were pushing.

And so it's interesting to sort of see within some of the longer narratives that are around this time of what are those behaviors that had individuals seeking healthcare? Who were they seeking it from and what remedies were they receiving? And so it wasn't uncommon to see water therapy, milk therapy, fresh air therapy. So it gives us insight a little bit to what were some of those common therapies...

[00:09:28] Dr. Sorrentino: What was popular at that time.

[00:09:29] Dr. Callender: And what was popular at that time and why individuals were seeking those. But then as you moved later into the 1800s, as medicine became more scientific, the practice of medicine became more professionalized, you start to see a change in how that's depicted in some of these magazines and journalism. That you start to see, you know, the emergence of hospitals as institutions, medical education, sort of medical schools as an institution, and laboratories being depicted. And so I think that's one of the strengths of comics and just going back to sort of thinking about comics as a medium, is that there's that pictorial angle to them, right?

There's the textual angle and there's the pictorial angle, but the visuals allow us to sort of visit these spaces and see inside these different institutions that were part of this sort of new medicine, this new sort of scientific medicine.

[00:10:26] Dr. Sorrentino: It's fascinating that it's kind of that picture into how medicine has been over 150 years and you can have it all splayed out in front of you and see what it's like. That's probably a unique insight into what those practices were at that time.

[00:10:40] Dr. Callender: And even moving beyond the late 1800s, into sort of the comics that you are talking about, sort of like the 1930s, 40s, 50s, the golden era or the golden age of comics overlaps with sort of the golden age of medicine and you see reflected in those sort of medical genre of comic books is the sort of heroic clinician.

[00:11:02] Dr. Sorrentino: Yeah.

[00:11:02] Dr. Callender: So both the heroic doctor and the heroic nurse, and it's often the heroic doctor who through his sort of keen insight and intellect and sort of procedural skills is able to perform, you know, life-saving surgeries in a cabin or on the roadside.

[00:11:19] Dr. Sorrentino: Right.

[00:11:19] Dr. Callender: And then you have these sort of heroic nurses who are in some ways heroic when they push back against the hierarchy, but they're often fraught with sort of love interest either of patients or of like the physicians that they work with. So it's really interesting to look...

[00:11:34] Dr. Sorrentino: Had to get that audience in!

[00:11:35] Dr. Callender: Had to, and you know, this was too, there was overlap with sort of the romance genre of comics. Um, and so it's interesting to sort of see how that too developed that as sort of comics as sort of superhero sort of comics and heroic comics that physicians, nurses, were portrayed in these comics and they had their own sort of genre of comics, but also how it reflected that golden age of medicine where there was a really strict hierarchy, sort of male dominated and like you had your sort of different roles that were very sort of prescriptive.

[00:12:07] Dr. Sorrentino: Yep, yep. Well, let's move a little bit to the more modern era, to our day now, and I know that many illnesses are complex, they're hard to understand. It's difficult to teach patients about the complexity of both their illness and their treatments. How can graphic medicine help to, as a teaching tool, to teach patients about their illness? And can graphic medicine do this better than just having, you know, bedside discussion with their physician?

[00:12:37] Dr. Callender: So the short answer is yes, and I'll go into why a little bit, but there is a long history of the use of comics for health education. There is a fairly recent scoping review by Matthew Noe that's published online now that looked at the sort of long history of comics in health education and they identified 167 articles going back to the late 1950s that addressed the use of comics in health education.

And this was across a range of populations and a range of sort of students from kindergarten through 12th through, you know, medical students to graduates, undergraduates. You know, again, this is available online and not to take up too much time talking about it, but they sort of came away with, and they note towards the end that, they quote, "We find that there is more than sufficient evidence that comics are an appealing medium for presenting health information in educational settings, and recommend that future studies focus on proving their ability to impact knowledge transfer, empathy development, and behavioral change."

And so, you know, the question for me in terms of, well, why comics? What is it about comics that may work? And the way that I actually came to thinking about comics as sort of a medium to be used within healthcare was through a line of inquiry where I was really trying to better understand what the patient experience was, you know, what does it mean to be ill? What does it mean to be hospitalized? And through, you know, several years that included a lot of reading and teaching about the philosophy of medicine, about embodiment and sort of the phenomenology of illness or sort of the study, the philosophical study of the illness experience that some concepts emerged that sort of led me towards comics as the medium. And the two of those are sort of lived spatiality, right? So thinking about the spatial aspects of illness and then sort of lived temporality, thinking about the time aspects of illness. And in reading about sort of illness narratives or the illness experience, words alone didn't quite capture some of those aspects of sort of the lived experience of illness.

And through some serendipity, I ended up well comics is a medium that plays around with space and time and gives you the ability to expand time, compress time, think about space and think about the different levels or sort of scales of space allowed one to sort of manipulate those to tell that story of what is happening and so in ways that you just can't do through words alone. And so the visual aspect and the way that you can play around with a comics page and a layout and sort of the diagrams that can be embedded within a comic really allowed me to better understand that experience.

And so when I think about why that can be used in health education or patient education is that, you know, a patient doesn't sort of live their disease as we often talk about it in medicine. Right? They live the experience of having that disease which unfolds kind of as a story within the context of how they live their lives, the spaces they traverse, how time is affected by that...

[00:16:02] Dr. Sorrentino: Yeah.

[00:16:02] Dr. Callender: And so in being able to tell that story and think about how can you tell that story from an educational perspective, I think it will engage and there's data to sort of show that it is more engaging for patients and they understand, you know, oftentimes like a therapeutic narrative better when they actually see how it unfolds and they can place themselves within that narrative.

[00:16:30] Dr. Sorrentino: Well, I guess as humans we really are much more visual creatures sometimes than just hearing and it opens up a whole other sense, the visual sense, which clearly now with the way we approach the world and how so much is visual, I can see that adding a whole new dimension. And what I wonder also, is it easier to remember if you see something visually than just hearing it explained? I think back to when I was in medical school and I was trying to study for an exam, you know, if I wrote something down and looked at it, I was able to memorize it better than if I just heard it in a lecture. I had to write it down, I had to see it. I had to see it in front of me. So do you have a sense from, you know, using some of these graphic narratives that retention is better, that people see the story and remember the story better by seeing it instead of just hearing it?

[00:17:24] Dr. Callender: Yeah, no, there's a number of studies out there that do show, just one, there's sort of the engagement level, right? That if I hand you a patient education material that has pictures, tells a story, you're more likely to engage with that versus a patient education pamphlet that has a bunch of bullet points and some floating pictograms.

[00:17:45] Dr. Sorrentino: Yeah.

[00:17:45] Dr. Callender: Right? Because you'll engage with it as a story, and you may relate to it better. Like you said, we're also very visual.

[00:17:53] Dr. Sorrentino: Yeah.

[00:17:53] Dr. Callender: And so that's one of the strengths of sort of using comics because there's that visual aspect, but then there also is that textual aspect. And so, I'm not a neuroscientist, but from what I sort of layperson understand is that there's a sort of dual processing that happens between the textual and the visual that encodes information differently in terms of how one may sort of recall that and rethink that. And some of us just learn better visually.

[00:18:20] Dr. Sorrentino: Yep. I certainly did.

[00:18:22] Dr. Callender: Yeah. And so I'm one that does this too and that's in part why, you know, I've gravitated towards comics as well. Um, but I do think that going back, I mean, I could talk a little bit more about sort of, and use an example about why I think the use of comics in patient education has the potential to be really impactful if done well.

Dr. Dan Golden here at the University of Chicago, who's a radiation oncologist, worked with a team from the Institute of Design at the Illinois Institute of Technology to create a graphic narrative educational tool for radiation oncology for that, like, first visit and what to sort of expect...

[00:19:07] Dr. Sorrentino: Expect from the procedure the patient was getting then.

[00:19:10] Dr. Callender: From sort of what I call this sort of therapeutic narrative.

[00:19:13] Dr. Sorrentino: Got it.

[00:19:13] Dr. Callender: Right? So what is the sort of narrative of radiation oncology, right? You've already been diagnosed with cancer. You show up to the radiation oncologist, um, and it tells that story of what to expect and it breaks the chronology down into several different phases. Um, and within those phases, it sort of recreates in visual form some of those spaces that an individual is going to navigate, right?

The simulation room, the scanners, the personnel that you're going to see in those clinical spaces. You know, when you enter those spaces, they're somewhat known to you and they're less frightening or less anxiety provoking. But it tells the story all the way through the after-treatment, and it breaks it down into those phases, and so you're at that first visit, you see what that therapeutic narrative is going to look like. And you can get a sense of how that's going to unfold over time, um, and in what spaces it will unfold in. But it also, I think again, the visuals allow you to see some of the equipment. It allows you to see that that exists in these clinical spaces. It allows you to see the personnel. Um, it allows you to see some of the procedures that might happen, right? Like in the one that was produced, it showed in actual size what that sort of tattoo marking for alignment looks like. So you see, "Oh, I'm going to end up with that little mark." Um, and so it does a really good job of sort of navigating those spaces that are part of that therapeutic narrative.

[00:20:42] Dr. Sorrentino: I think we forget, as physicians, we're used to our spaces, you know, we work in these spaces all the time. I think about, you know, as a cardiologist, when I'm in the cath lab or in some of the different labs, I mean, I'm used to all that equipment. You know, it's what I see every day, but for a patient it's really foreign. It's really different and must generate a lot of anxiety and fear. And so, uh, I suspect that this can ease that, you know, that they can actually see it ahead of time. And so, "Oh yeah, I saw that in the graphic medicine. That's exactly what it looked like."

[00:21:12] Dr. Callender: And that's what sort of emerging data actually shows that so, you know, Dr. Golden and his team studied, you know, whether or not this has the potential to reduce anxiety. And that's what the data show. Uh, additionally, there's work out of Germany that looked at coronary angiography, so doing a cardiac catheterization. And they created a comic of that procedure to help with the informed consent process. And that too, the data from that study show that it improves comprehension, it shows that it reduces anxiety and that there's improved satisfaction about the procedure. And so that's some of the areas where I think the emerging use of graphic medicine is being seen is in sort of informed consent because you want to reduce anxiety, you want to improve comprehension of the procedure that you're going through. But like you said, one of the things that they showed was, you know, where the insertion sites are, what the rooms look like, what some of the images may look like. And so as a way of making, you know, the procedure less foreign, or less unfamiliar, that it allows people to sort of engage with what they're going to go through before they actually go through it and sort of place them within that process.

[00:22:32] Dr. Sorrentino: I remember hearing someone tell me once that when a patient comes in for a consultation and gets a new diagnosis, like a new diagnosis of cancer or heart disease, and they hear the explanation from their physician, they go home and remember only 10% of it. Usually it's that first word, you've got cancer and don't hear anything else, you know, after that first description of what's going on. In your work in this area of graphic medicine, how do you think having a graphic tool can help with that remembering of what was discussed? They can maybe bring it home and look at it again and understand it. Do you think it has the potential or is actually increasing a patient's awareness and knowledge and remembering what was said so that they're, you know, less concerned and fearful of it a day later when they say, "I don't remember anything that I was told."

[00:23:25] Dr. Callender: No, there is sort of a classic image within graphic medicine that sort of depicts exactly what you said.

It is a patient sitting across from a physician who's giving a cancer diagnosis and within that spoken word bubble is a bunch of scribble lines, cancer and a bunch of scribble lines.

[00:23:45] Dr. Sorrentino: Sure.

[00:23:45] Dr. Callender: And visually sort of it depicts exactly what you said, that they don't understand it. And that was actually sort of one of the premises behind this radiation oncology tool was that, just like you said, patients don't understand a lot of what is said in one of those meetings. You know, they're high-stress, things go by quickly, and so the idea was that in giving them this sort of tool, this sort of comic, that they can take it home and they could sort of digest it at their own pace.

And that is also sort of one of the sort of powers of comics as a medium is, you know, as opposed to sort of a video that sort of goes at its own pace, a comic allows a reader to sort of immerse themselves and move along, and engage with it at a pace that they're sort of more comfortable with, or that works for them, but it also allows them to go back into the narrative, right? That, "Oh, wait, wait, I got to a certain point, but let me go back and see on things." But also similarly to sort of how I mentioned sort of comics, how they're often disseminated, historically, I sort of look at this in the same way that they're given something, there's a physical thing that they can look at and that they can engage with...

[00:24:51] Dr. Sorrentino: Right, right.

[00:24:52] Dr. Callender: And that they could bring back, and in terms of thinking about, you know, giving a diagnosis, talking about a diagnosis, one of the things that is interesting to me as I read a lot of graphic memoirs is it was not uncommon for an anatomical diagram to show up within that graphic, within that graphic memoir, but it was also a very personalized anatomical diagram. So it was this sort of layering on of one's sort of personal experience with the anatomical diagram, either sort of describing how they feel within that diagram or mapping emotions onto that diagram.

[00:25:27] Dr. Sorrentino: Sure. Yeah.

[00:25:28] Dr. Callender: But again, coming back to sort of thinking about space within sort of the use of comics, I think about the body as a space in which disease plays out and in which we sort of practice medicine and thinking too about the scales at which we practice medicine, um, are often different than how a patient experiences their illness or that that disease, right? That we talk about, you know, we toggle between the whole body, organ systems, isolate an organ. Oh, you know, we do imaging, and we do slices, then we get a biopsy and we are looking at the cellular level, and we could even zoom in and look at the genomic, the sort of the gene level, and then we might zoom completely back out and talk about therapies that are going to affect them systemically.

[00:26:15] Dr. Sorrentino: Right. Yeah.

[00:26:15] Dr. Callender: And I think that can give patients whiplash a little bit. You know, like, "So wait, where are we?" And so again, the visuals and the ability to sort of diagram space becomes important in educational comics. I think it becomes important in sort of graphic memoirs and it becomes important in reflective exercise with patients. But the nice thing about comics is that it allows you to sort of display those scales simultaneously. So you can show all of what is happening on a single page, and that too is sort of part of that sort of diagnostic narrative or the diagnostic process. And so in many ways, it can sort of collapse a lot of what we do...

[00:26:55] Dr. Sorrentino: Into a simple visual.

[00:26:56] Dr. Callender: Into a simple visual. Exactly, exactly.

[00:26:59] Dr. Sorrentino: Now, I know you've been involved in teaching students and residents about graphic medicine. Can you discuss a little bit about your experiences with that and should this be really a part of our curriculum in medical schools?

[00:27:14] Dr. Callender: Sure. So I've had the good fortune of being able to teach a number of different graphic medicine courses, uh, primarily at the undergraduate level with a good friend and colleague of mine, MK Czerwiec, and we've taught several different ones. One that focused on sort of the life cycle, we taught one that focused on sort of comics as a form of knowledge formation, we've taught one that was on sort of death and dying, and then we taught one more recently on sort of the history of medicine as told through the history of comics. And these courses are primarily taught for undergrads with a lot of pre-meds, and I think, you know, some of the key takeaway points in teaching those courses, the students really appreciate, end up appreciating comics as a medium to talk about these topics because I think, and this is something I've run into in sort of talking about comics and medicine is that, well it is sort of a juvenile medium, right? That it has this reputation as being something that is not serious. And they're often very surprised to see that comics are used to write about cancer, talk about cancer, talk about one's cancer experience or death and dying. And so, but they also say that it made it more engaging and I was able to engage with it more. Also, all of our courses are not just sort of reading courses, but they're also creative courses. And so, you know, we very much believe that anybody can create a comic, right? You can write words and you can draw a stick figure.

If you can do that, you can make a comic and put them together. And so they also then end up appreciating how the textual components, how the visual components work together to tell a story, and use that in reflective practice. And it's not uncommon for us to hear about students towards the end is like, "Oh, this is great. I'm going to use this more often. It sort of re-sparked my artistic interest." And so I think just in terms of thinking about comics and the readings of them is what they can sort of offer individuals in terms of understanding the illness experience, but then I think there's very much that creative component that allows an individual to explore their experiences and so, so yeah.

[00:29:36] Dr. Sorrentino: So tell me what you see are the next steps in this world of graphic medicine. Where is it moving going forward?

[00:29:44] Dr. Callender: Yep. On a personal level, MK and I get to reteach the death panels course of the course on comics, and dying and death later in the spring quarter, and we're sort of really excited about that. I think in terms of the field itself, recently, this past summer was the annual graphic medicine conference that was held here on the University of Chicago campus, and it was the first time that sort of, we are back in person in three years. And it was really exciting to see the interdisciplinary collaborations that were happening, the type of activities that practitioners within the field are engaging with in terms of patient education, in terms of science communication, in terms of broadening the field to include topics like clinical ethics, public health, climate change, refugee health. And also thinking about how comics historically have been subversive in sort of tackling different aspects of what was going on in society. You know, going back to women's underground comics and abortion comics in the 70s, tracking with sort of the feminist movement to comics being created in the 1980s around the HIV/AIDS pandemic to thinking about how now comics are being used to address issues like social justice and health disparities, and access to reproductive health and abortion.

And so it's really exciting to see how comics are being used to tell these stories, to communicate about what's happening, but also for advocacy, and really sort of thinking about how we can use the medium of comics to do all of this work. And so it's really exciting to sort of see how expansive it is.

And it's really exciting to sort of see how more and more, you know, healthcare professionals are using comics within the practice of medicine and trying to study that more. I mean, one of the challenges really is sort of, you know, with a lot of sort of health humanities disciplines is...

[00:32:00] Dr. Sorrentino: How do you study it.

[00:32:01] Dr. Callender: How do you study it and what the impact is. And this sort of comes back to the previous question a little bit about whether or not it should be in sort of curricula. And, you know, I would of course, say yes, but I also recognize that sort of it's challenging because not everyone will be, or can be engaged by comics. You know, for some people it is reading, for some people it is movies, and so I think that's one of both the sort of benefits and drawbacks of the health humanities, that it's so broad and it can engage an individual across a number of different sort of genres or disciplines, but at the same time, it's not for everyone.

[00:32:34] Dr. Sorrentino: Well, it's good to have alternatives.

[00:32:36] Dr. Callender: Exactly.

[00:32:36] Dr. Sorrentino: You know, because as you pointed out, not everybody learns the same way. Some people are more visual, some can read and pick up the information. I think having these alternatives, especially in a field like medicine, which is so complicated, it seems that this might be a way of making it understandable to everybody.

[00:32:54] Dr. Callender: Yeah. And that's what the sort of limited studies out there that work with trainees show is that, you know, they do appreciate this as an outlet, and it does improve various skills, observational skills, communication skills, empathy, but it also gives them an outlet to express what that experience is. And you know, one example is just somebody, a colleague up at the Medical College of Wisconsin who's looked at, you know, over I think, 200 and something comics that were created by medical students and residents, and the sort of main takeaway was feelings of being overwhelmed, frustrated, feeling inadequate, and useless, I think was one of...

And so it's a way for I think, you know, trainees to express what they're going through, but I think as individuals within academia is to help us understand what that experience is and what they are going through. And then just as I think it's important that we read these memoirs, graphic memoirs to understand what our patients are going through.

[00:34:00] Dr. Sorrentino: Right, right. Well, Brian, this has been fantastic. Thanks so much for joining us on the podcast today.

[00:34:07] Dr. Callender: It's been a pleasure. Thank you so much.

[00:34:09] Dr. Sorrentino: Thanks for joining us for this episode of The Clinical Excellence Podcast. We are sponsored by the Bucksbaum Institute for clinical excellence at the University of Chicago.

Please feel free to reach out to us with your thoughts and ideas on the Bucksbaum Institute Twitter page. The music for The Clinical Excellence Podcast is courtesy of Dr. Maylyn Martinez.