Top 8 Keys to Visual Communication
An essential guide to create effective visuals for bedside use
Over the years, I’ve learned a lot from drawing simplified illustrations for my patients. I started to realize what works and what doesn’t. When I went to medical school 20+ years ago, I remember countless lectures on the Krebs cycle, the the biochemical process that turns oxygen into energy. But I don’t remember a single one on how to actually communicate with patients, something I do on a day-to-day basis. So I started keeping notes and over time, created a list of the ‘Top 8 Keys to Visual Communication.’ It’s my ongoing guide to make sure my illustrations are clear and effective.
1. People like active learning.
Do you remember those fun educational games we played as a child? My family subscribed to ‘Highlights’ magazine and I still remember the excitement of opening the mailbox to find the latest issue. My favorite game was, ‘Can you spot the difference?’ This game was so fun so I began to wonder, can’t we make all learning this fun, especially learning about health?
So, I started using this concept in my illustrations. For example, when I explain ‘Hiatal Hernia” (page 44 of my Diagnosketch book), I show two pictures and ask patients, ‘Can you spot the difference?” They usually get it in seconds.
Now a general hernia (the type that bulges out on your body) can be difficult to explain to patients, but a hiatal hernia can be even more difficult because it doesn’t bulge out on your body. It’s when the upper part of the stomach bulges through the diaphragm, into the chest and disrupts the sphincter that normally keeps acid in your stomach. Acid travels up into your esophagus and causes a burning sensation in your chest.
There is a method of patient communication called the ‘Teach Back’ method. It’s when you explain something to a patient and then ask them to ‘teach’ it back to you. I’ve tried to use this method, but it just doesn’t feel right. It feels like I am putting a patient on the spot and quizzing them. So, instead, I use this method and ask patients to see the difference. It’s more fun and engaging and, it involves pictures, which is always a plus (yay!).
I even used this method for a project at Children’s Health in Texas, where I created side-by-side visuals to teach kids about enlarged adenoids. Can you spot the difference?
2. It’s hard to Remember Complicated Verbal Explanations
Do you remember playing the ‘telephone’ game as a kid? One person whispers a phrase to the next and by the time it reaches the last person, the laugh at how distorted a phrase would get. The more complicated the phrase, the more the distortion. In medicine, I see this game being played all the time. Family members call me all the time after they visit their doctor and try to explain what was said. Sometimes, it makes sense. Often, it doesn’t. I realize that I’m in the midst of the game of ‘telephone,’ with complicated information being retold and, unfortunately, becoming distorted.
During COVID, I saw this happen constantly. Only one visitor could be with a patient, so that person became the messenger. No matter how carefully I explained things, I knew details could get mixed up. One night, I treated a patient with an aortic dissection, a tear in the wall of the aorta that can be life-threathening. Instead of giving a long verbal explanation, I showed a simple illustration (page 34 of my Diagnosketch book). The patient’s daughter took a photo to share with her family. She told me, “ Now I can actually explain this in a way my family will understand.” That’s when I realized how pictures stop the ‘telephone game’ distortion.
Now, I encourage patients to take photos of my drawings. A single, clear image is easier to remember, share, and understand than pages of text-heavy discharge papers. My goal is to fit everything a patient needs to know on one simple, visual page.
3. Think about where the illustration will be used. Does it pass the Billboard test?’
Take a look at the following billboards. On the left is an example of a very effective billboard. In just a few seconds, you understand what it is: an ad for a gym that costs $10 per month. And if you join, you’ll look just like that photo. On the right is an example of an ineffective billboard. There’s just too much information. Maybe it would work if you were stuck in traffic and had time to read and process the information. But, most of the time, when you whizzing on by, it just doesn’t work.
When I create an illustration to use at the bedside, I always think: Does it pass the billboard test? Is the image for when you are driving by on a highway (i.e., at the bedside)? Or is it for when you are stuck in traffic (i.e., discharge or post-care paperwork)?
Some visuals, like the beautifully detailed ones from JAMA Patient Education, are perfect for sitting down and studying. They are “stuck-in-traffic” images. But at the bedside, when you only have a few minutes, you need something clear, fast, and memorable.
I started incorporating the ‘billboard test’ with my illustrations since I use them mainly for bedside education. Here’s one I use often (page 65 from my Diagnosketch book). When a patients comes in early in pregnancy with pain or bleeding, we order an Ultrasound and but sometimes, it’s inconclusive. There are usually three possibilities: 1) It’s just too early to see anything yet 2) It may be a miscarriage 3) It could be an ectopic pregnancy. My illustration shows all these three possibilities on one image and makes it helpful to explain what might be happening.
I know medical professionals strive to spend as much time with patients as possible, and I don’t mean to imply that we do a quick ‘drive-by’ to care for them. But sometimes, there are constraints that are beyond our control, and we need efficient methods to share vital information.
4. Embrace New Ways People Learn
Remember when learning meant lugging around heavy textbooks and spending hours with a highlighter? But now, times have changed. Attention spans are shorter, and newer formats like visuals are changing they way people learn. I’d argue that people are learning information differently now, so we need to communicate it differently. If people are turning to social media for health information, maybe that’s exactly where we should meet them.
Last year, I started a project called, “What Patients Ask.” I created simple illustrations to answer common patient questions. I thought hat if one person had a question, others also might have that same question. I shared them online, and the response was incredible. People appreciated clear, bite-sized explanations they could actually remember, Some people told me, “I’ve always wondered that but never wanted to ask.”
Could this be a way to educate the general public on health-related issues? Could this be a way to improve health literacy?
These days, I carry a small notebook in my pocket to quickly jot down questions that patients ask to see if I should illustrate them later.
5. Pictures are for Everyone, Not Just Kids
One night during my ER shift, a man wearing a business suit came in with severe abdominal pain. I only work the night shift so this attire at 3 AM was quite unusual. He was convinced that something was very wrong. We ran blood tests, a urine test, an EKG, and even did an abdominal CT scan. After a full work-up, we had to tell him that the source of his pain was constipation. I knew he felt embarrassed. I hesitated to show him my simple and cartoony illustration. Would he be offended? But, I went ahead and showed these images of the digestive tract and how stool moves through the colon. (Pages 38 and 51 from my Diagnosketch book).
To my surprise, he was so appreciative. He had a ton of questions and felt comfortable asking them all. Seeing these simplified pictures diffused the situations. We often think pictures are only for kids, but I came to the conclusion that they are for everyone.
Pictures can be helpful to discuss difficult-to-talk-about things like end-of-life care, especially in a hurried situation. They may hear works like ‘intubation’ and ‘ventilation’ without knowing exactly what they mean. Sometimes a simple picture helps explain concepts that words cannot do alone.
6. It doesn’t have to be beautiful to be effective
When I first started drawing for my patients, everyone seemed to have questions about hemorrhoids. So, I knew I had to create a picture of them. I spent hours on it; the shading and colors made me so proud. I was sure I had nailed it, that this was the picture that would teach the world about hemorrhoids.
But when I tested it with patients, they had no idea where on the body it was. One patient even asked, “My underwear has red blood stains—why is the blood blue in this picture?” That’s when I realized that what makes sense to a doctor doesn’t always make sense to a patient. I thought, What’s the point of making a beautiful picture if the patient doesn’t understand it?
In medicine, we often make sketches on scrap paper to explain things to patients. These drawings aren’t pretty, but they can be effective because they help patients understand complicated medical stuff quickly. A quick sketch a medical colleague shared with me about a hernia. Does it make sense to you? And here’s another one that was actually drawn on a patient’s bedsheet to explain this medical emergency.
I learned the same lesson when a a nurse asked me to illustrate kidney failure for a trip to Nicaragua on a medical trip. She was leaving in a week, so I didn’t have much time. Honestly, I was a little embarrassed about the picture I created because it was so basic and not pretty. When she returned, she told me the quick sketch was so useful. Because it was so simple, even the Spanish translator could explain it to the patients without the doctor or nurse. She even left that picture at the clinic to continue educating patients when she returned. She also told me using a visual was helpful because of the language barrier.
So, remember that not every image has to be pretty, as long as it conveys information in a way the patient understands. Many times, I look at one of my drawings and cringe because it looks too basic or too simple. That experience reinforced an important lesson: an image doesn’t have to be beautiful. As long as it helps patients understand, it’s doing its job.
7. The more you say, the less they will remember.
Several years ago, a family friend, Rama, became sick with pancreatic cancer asked me to come to her appointment with a liver surgeon. Her doctor was very kind and thorough. She sat down, held Rama’s hand and explained the cancer using words like metastases and hepatic lobe infiltration. She pulled up a CT scan and scrolled through it. She pointed out how extensively her cancer had spread. She was being very complete—giving her every single bit of information about the cancer.
But Rama was completely lost. Like most people without medical training, she didn’t know where her pancreas was or what it did. The words and scans meant nothing to her.
As doctors, we often think more information is better. I am guilty of it. At the beginning of my career, I also would pull up a scan and scroll through it. But after this experience, I stopped doing this. I realized that it took over 8 years (4 years medical school and 4 years residency) to really understand this picture. I realized that all Rama needed was a simple picture.
That day, when I brought her home from her doctor’s appointment, I drew a simple picture of her anatomy. I showed her her pancreas, her liver, her gallbladder. Where her cancer had spread. I used words like ‘cut this part out’ and ‘zap that.’ In just a few minutes, Rama understood her disease completely.
So remember, the more you say, the less they will remember. If you really want to drive home the point, say the smallest amount of information possible but repeat it over and over again. And use a simple picture.
8. There is Medical Speak and Patient Speak
When I first started creating visuals, I often used medical images I found online. One beautiful stroke diagram caught my eye. But, when I used it, I realized that people have no idea what these words mean. On this one page itself, there are 5 highly technical words. Totally overwhelming.
That’s when I realized that in the medical world, we have two different languages: medical speak and normal speak. Medical speak is what you use to talk to other doctors/consultants, and what we use to document medical information. Patient speak is what you use to talk to patients. You would never think about going into another country and expect people to understand your language, yet we do that with patients all the time.
So, I came up with a simpler picture for stroke that can be used at the bedside. I simplified the concept into the absolute basics for what a patient needs to know initially. There are two major types of stroke, one caused by bleeding and the other caused by clots. I used simple words.
When talking with patients, plain language makes all the difference. Use words like “hot” or “angry” instead of inflamed. Use words like clot instead of thrombosis. The goal isn’t to simplify medicine, it’s to make it more understandable.
That’s my list. I continue to add to it as I make more images. Every time I create an illustration, I go through this checklist to make sure the image is understandable and effective.
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