INTRODUCTION

iagnosketch is a visual aid to explain med­ical diagnoses to patients at the bedside. It uses simplified images to illustrate compli­cated anatomy and concepts. The title, Diagnosketch, combines the term “diagnosis” with the term “sketch,” paralleling the way the book combines a medical di­agnosis with a simplified sketch.

Many American patients are unfamiliar with human anatomy and common medical diagnoses. Research from the US Department of Education estimates that only 12% of English-speaking adults in the United States have proficient health literacy skills.^[1] Studies in­dicate that almost 90% of adults have difficulty under­standing health information that is currently available.^[2] These patients are often unequipped to make important decisions about their own health care.

Diagnosketch improves health care literacy for the non-medical population. It simplifies human anatomy and pathophysiology into memorable, understand­able images. It relies on the concept of “picture supe­riority effect.” The picture superiority effect states that HEARING information will lead to 10% retention of the content, but HEARING and SEEING information leads to 65% retention of content. Diagnosketch not only explains difficult concepts to patients, but also helps patients remember them.

Diagnosketch serves as the visual guide that med­ical professionals use with every patient at the bedside. Excellent medical care involves diagnosing and treating disease, but just as importantly, communicating well with patients. Diagnosketch helps achieve this goal.

KEY COMPONENTS OF DIAGNOSKETCH

Simplicity

The images in the book intentionally simplify infor­mation to help educate a non-medical audience.

Practicality

The images in the book depict only the most common diagnoses seen in an acute care setting and only those that would benefit from an image. In busy settings, sometimes the health care encounter lasts just a few minutes. Diagnosketch presents a simple, clear image that improves understanding as quickly and efficiently as possible. In addition, the labels are minimal and are written in colloquial, non-medical language. This encourages the patient to listen to the explanation from the medical professional, rather than read and become confused by complicated medical terminology.

Inclusivity

The images in the book intentionally use various skin tones and physical features to represent the diver­sity seen across patients in various medical settings. Different diagnoses can affect any ethnicity. Aside from problems that affect a particular biological sex, diag­noses are depicted in the male or the female in a non­specific way.

to her other organs. You show her a gallstone and ex­plain how it blocked her biliary tract. You show her how this caused her pain and eventually her infection. She asks pertinent questions, and you give her immediate answers. You have a two-way dialogue. In just a few minutes, you have relieved her fears and increased her anatomical knowledge. You know that you communi­cated in a way that she understands.

how does Diagnosketch work?

how is Diagnosketch organized?

Diagnosketch consists of 100 images of medical illnesses commonly diagnosed in an acute care setting. It is meant to be used at the bedside to help communicate compli­cated concepts to a non-medical audience quickly. Most medical encounters between doctors and patients occur verbally. Although visual aids are sometimes used, they are not standard. This book changes this paradigm by incorporating a simplified, colorful graphic visual to assist patients to better understand their diagnoses in real time.

Imagine the following scenario:

A patient presents to the emergency room for se­vere abdominal pain. You run tests: blood, urine, ul­trasound. You diagnose cholecystitis. You verbally explain to your patient that her gallbladder is infected, and that she will need emergency surgery. Your pa­tient looks dumbfounded. She never expected this. She thought that she might have eaten something bad but is now on her way to surgery? She quietly pretends that she understands but does not really know where her gallbladder is located, let alone what it does. She does not even know what questions she should ask. You sense that she does not completely understand every­thing, so you quickly grab a paper towel and sketch a crude image of her anatomy. Although you'd like to stay longer, you feel the pressure of a waiting room full of patients, still waiting to be seen. You rush out, knowing that although you expertly diagnosed her condition and arranged for proper treatment, you could have communicated better.

Now imagine that same patient, but this time you use Diagnosketch. You return to the patient's room and explain her condition verbally AND visually. You show your patient where her gallbladder is in relation Diagnosketch is organized into seven different catego­ries by organ systems.

Different images are helpful at different stages of a patient encounter. There are three major categories of images: diagnosis images, procedure images, and con­cept images.

Diagnosis images: are used to explain basic diagnoses and basic anatomy (e.g. biliary colic, kidney stone, pulmonary embolism). Many of these simplified images have a “normal” side and an “abnormal” side so that the patient can easily compare what their body part is supposed to look like with what it looks like when affected. The images also may use the “1, 2, 3 approach” that show three common problems for a particular disease (e.g. diverticulosis, diverticulitis, diverticular abscess/perforation).

Procedure images: are used to explain a procedure to a patient before performing it (e.g. IV insertion, nasogastric tube insertion, drainage of paronychia).

Concept images: are used to explain a concept visually (e.g. how to alternate ibuprofen with acetaminophen for fever reduction; how diabetes mellitus actually causes high glucose; what “code status” means).

Obviously, the images can be used in whatever way is most helpful. Here are a few real-life examples of where Diagnosketch has been helpful in the acute care setting:

• A nurse showed the image of “Digestion” to explain to a reluctant 10-year-old why she had to drink a bottle of contrast for an abdominal CT scan to rule out appendicitis.

• A physician showed the image of “Back pain— side view” to explain the anatomy of the back to a disgruntled patient who felt that he needed an x-ray. After he understood his anatomy and why an x-ray was not indicated, he was happy to avoid unnecessary radiation exposure. This also saved the cost of an unnecessary test.

• A physician showed the image of “Urinary retention” to explain to an uncomfortable older gentleman how his enlarged prostate blocked his bladder, making it impossible to urinate. After he learned his anatomy, he felt comfortable with the insertion of the foley catheter and experienced much relief.

• A nurse showed the image of “Intravenous insertion” to her patient in the triage bay to explain how an IV works. She hoped to dispel the common misconception that an IV is a needle that stays in the arm when it is just a flexible piece of plastic.

• A physician showed the image of a “Heart attack” to the anxious male who presented with chest pain after smoking cocaine. After he visually saw how cocaine could cause his heart muscle to die, he vowed to never use it again. This potentially deterred future drug usage.

HOW DO PATIENTS FEEL AFTER seeing Diagnosketch?

Patients often ask for a copy of the Diagnosketch image to take home. Sometimes, they take a picture on their cell phone to explain to their family members later. Many patients have access to the internet at home and can extensively research their diagnosis. Yet, once they leave the hospital, they almost always do not. Instead, they rely on the simple, familiar images that the medical professional explained to them that they understand.

There are many beautiful anatomy books available with detailed pictures. There are hundreds of images on the internet about anatomy and diagnoses. There is helpful information on discharge paperwork from a hospital or clinic. Diagnosketch does not try to compete with these very useful resources. Instead, it serves as the first basic primer to understanding the medical diag­nosis. Once the medical encounter ends, the patient is now equipped with solid knowledge of basic anatomy and physiology and encouraged to further investigate more complicated medical information.

Diagnosketch is a quick, useful tool that greatly enhances the patient's experience. All images are in one place. All images are at a simplistic level of detail. And, all images are clinically useful and relevant to the med­ical problem at hand.