For children, curiosity is fundamental. It’s how they learn and understand, become creative and develop. Does that also go for adults in the workplace? Yes, it does, according to current research: curiosity is an important asset that needs to be cultivated.

If we think about working in clinics and surgeries, the top priorities are quality and safety. One important guarantor for stable processes are Standard Operating Procedures (SOPs) – as they are defined in many areas of work. What they all have in common is that SOPs are based on experience, often written down in painstaking, small-scale detail and on the basis of trial and error and are intended as working instructions for future staff.

But are they making us too complacent? If, out of a sense of caution, all staff members stop trying things out and stop asking questions, it can get in the way of innovation. So caution is good, but it isn’t the be-all and end-all. We can describe it with an image. Caution is like a brake pedal. If you keep pressing it, you get down the mountain safely, but it takes a long time. Innovations generally owe their existence more to the accelerator pedal: you get down the mountain quickly, although not without a certain amount of risk.

In other words, caution is the hope of knowing more before the event than after; curiosity, by contrast, is the desire to know more after the event than before.1 And isn’t that the aim? Curiosity and its significance in the work process have only relatively recently become the subject of scientific research. At the moment we can look back on a mere twenty years of research, more or less. What are the results so far?

Explanation is everything

Medical explanations are intended to support patients in deciding for themselves whether or not to undergo a treatment or procedure. The informed consent discussion conveys precisely how an examination or operation will proceed. The medical benefits and potential risks are discussed. Patients often don’t fully understand what’s being said, can’t take it all in properly at that time and feel overwhelmed. They’re unable to process the facts and data in the time provided. This can lead to patients misunderstanding the benefits of a procedure, refusing it or approaching it with fear.

 

Study proves the value of comics

Two cardiologists at Charité Hospital in Berlin recently faced this challenge. They wanted to optimise informed consent discussions for patients requiring heart catheterisation. As in the case of many examinations and operations, patients were very often overwhelmed in the informed consent discussion by the complexity of the content. 

Professor Verena Stangl and Dr Anna Brand of Charité Hospital therefore investigated2 the value of using an informative comic, in addition to the conventional discussion, with 121 patients prior to heart catheterisation. The 15-page comic was designed and created at Charité. Some patients received the standard informed consent discussion, while others received the informed consent discussion plus the comic. The patients were asked, both before and after the discussion, how severe their anxiety was, how well they understood the procedure and whether they were satisfied with the explanation.

The comic turned out to be a success in all respects: patients who received the illustrated brochure in addition to the informed consent discussion were able to answer an average of almost twelve out of 13 questions correctly about the procedure, its risks and important behavioural rules to be followed after the procedure. After the standard informed consent discussion alone, the number of correct answers was just nine out of 13. In addition, after reading the comic, the participants stated that they were less anxious than before the informed consent discussion.

72% of participants were satisfied with the explanation in the comic and felt they were well pre-pared for the heart catheterisation. After the standard informed consent discussion, only 41% of the patients were satisfied with the explanation.

 

More time to understand

The investigators concluded that comics make it possible to grasp complex content both verbally and visually, which improves understanding for different types of learners. Another advantage of this form of explanation is that, unlike a discussion or a video, comics allow the individual reader to take as much time as necessary to absorb the content.  

Despite these findings, comics have not yet seen much use in informed consent explanations, although international studies are now being conducted on the value of comics for patients with breast cancer3, infertility4 and anorexia nervosa5. The use of visual explanation does seem to be much more widespread in the Anglosphere than, for example, in German-speaking countries. Comics can be useful not only for complex examinations, operations and therapies but also, in particular, for topics that are emotionally difficult. Stories in pictorial form can help link feelings, worries and fears to facts and information much better than a discussion can.

Recommended to try

Might this also be a good idea for your clinical practice? Give it a try by working with a good graphic designer to develop a concept for hard-to-understand medical examinations or operations. 

Similes can also assist with the transfer of knowledge. To help you, we’ve put together a checklist of «Practical tips for formulating a “graphic narrative“».

Download

Practical tips for formulating a «graphic narrative».

Check-list

Read more

German

Prof. Dr. Stangl

Verena Kardiologische Comics.

Charité, 2021

German

ComAn 1

Timos Bunter Traum – Comic für Kinder zur Narkose [Timo’s Colourful Dream – Comic for kids on anaesthesia].

Thieme Verlag, 2019

English

Barry, Linda

Making Comics.

Drawn & Quarterly, 2019

English

Haines, Steve

Pain Is Really Strange.

Singing Dragon, 2015

Sources

  1. Hüther G. Wir denken sehr gerne in Bildern. Whitepaper Storytelling 05. news aktuell 2017; 9–10.

  2. Brand A, Gao L, Hamann A, et al. Medical Graphics Narratives to Improve Patient Comprehension and Periprocedural Anxiety Before Coronary Angiography and Percutaneous Coronary Intervention: A Randomized Trial. Ann Intern Med 2019;170(8):579–581. 

  3. Lee TI, Sheu SJ, Chang HC, et al. Developing a Web-Based Comic for Newly Diagnosed Women With Breast Cancer: An Action Re-search Approach. J Med Internet Res. 2019;21(2): doi: 10.2196/10716.

  4. Venkatesan S, Murali C. Infertility Comics and Graphic Medicine. Perspect Biol Med 2018;61(4):609–621.

  5. Venkatesan S., Peter AM. Feminine famishment: Graphic medicine and anorexia nervosa. Health 2020;24(5):518–534.

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