Drawing Pictures Helps Endocrinologist Engage Patients

To help your patients better understand what you’re telling them about their condition, draw a picture or just a scribble, artist and endocrinologist Michael B. Natter, MD, advises.

“That scribble can be very valuable, even if your patient can’t make out anything you’re drawing. The process is more important than the product. By establishing rapport, you help keep your patient part of the team,” said Natter, a clinical assistant professor of medicine in the Division of Endocrinology at the NYU Grossman School of Medicine in New York City.

When Natter meets with a new patient in the clinic, he often draws to teach them the pathophysiology of their disease state.

“You give life to the lines on the paper,” he said. “It’s always flattering and funny when my patient asks to take one of my scribbles home with them. It’s a tangible reminder of their visit, interaction, learning, and engagement,” he said.

“Our patients come from various backgrounds, and some may have educational, language, or other barriers,” he added. “Sitting down with someone and explaining their condition while drawing about it flattens those barriers to understanding. It also helps the patient see that you’re putting in time and effort to bond with them and that you empathize with what they’re experiencing.”

From Child With Type 1 Diabetes, to Art Student, to Endocrinologist

When Natter was diagnosed with lifelong, chronic, autoimmune type 1 diabetes, he was an active 9-year-old, so monitoring blood glucose, taking insulin, and watching his carbohydrate intake was challenging.

“While in the hospital with diabetic ketoacidosis, I became fascinated with how the body works,” Natter said. “But I was the creative ‘art kid’ and didn’t see myself being cut out for medicine.”

Art and medicine continued to intrigue him, though, so he followed both paths. He completed a Bachelor of Arts degree in neuropsychology and studio art at Skidmore College in Saratoga Springs, New York, then changed course and took postbaccalaureate premed courses at Columbia University in New York City.

“To my interviewers at Sidney Kimmel Medical College at Thomas Jefferson University, my experience as an artist made me a uniquely interesting applicant, so they accepted me,” he said.

After earning his MD in Philadelphia, Natter completed a residency in internal medicine and an endocrinology fellowship at the NYU Grossman School of Medicine.

“Imposter syndrome is pervasive in medicine and in art, and I’d joke with my art friends that I identify as a doctor and with my doctor friends that I identify as an artist,” he noted.

Art as a Superpower

“Medical physiology and chemistry are complex and difficult. Most of our brain is dedicated to visual memory, understanding, and spatial awareness. Imagining a concept visually, whether by creating simple characters or cartoons or by visualizing detailed receptors, hormones, and such, can make the concepts understandable, digestible, and retainable,” he explained.

If you can draw it, you can understand it, one of Natter’s art teachers told him.

“That’s very true. In medical school, art was my superpower. Art allowed me to actually learn medicine. Drawing structures and processes allowed me to translate difficult, complex medical topics into my own visual language,” he said. “I went from being not very academic to doing really well because it finally clicked that art was allowing me to learn in the way I was always meant to.”

In one art class, for example, Natter completed a difficult exercise that required him to perceive and paint very subtle gradations of specific colors from their darkest to their lightest. That skill served him well throughout medical school.

“The art teacher was showing me the exact way to detect exceedingly subtle findings on chest x-rays, which are gradations of black, gray, and white,” he said.

As a clinician and educator in an academic setting, Natter taught this perceptual skill to his medical students. In one experiment, he had them write their findings from a chest x-ray, then perform that art school exercise. When they looked at the x-ray again, they picked up additional and subtler findings.

“That was a very small sample study, not something I could publish, but anecdotally, these results suggest that methods of training artists can be applied to training doctors,” he noted.

Use Whatever Visual Aids Work, Even Printouts

“I think many of my colleagues who see my approach appreciate it and recognize its value. Pragmatically, I think printouts of drawings can save time, especially for clinicians who think they can’t draw well or don’t think drawing in real time is helpful,” Natter recommended.

“The onus is on us providers to educate our patients,” he added. “They see their doctor for 20 minutes or so every few months, but they live with their chronic conditions day in and day out. If you help your patients understand what is going on with them, you give them the autonomy and the agency to take better care of themselves.”