Wednesday, May 13, 2015

"The Bad Doctor," a Graphic Medicine Prescription for Patients and Doctors

What is graphic medicine? It's the broad term for those works (this blog, for instance) that take on issues associated with illness, treatment, wellness, the health care system, and their place in community and the wider world, through the visual language of comics. The idea is that comics can be a powerful medium to open beneficial lines of communication between patients and medical service providers. They may also help clarify our thinking about tough subjects such as end-of-life care, or fairness in the distribution of care and resources. Comics can be potent in their ability to distill and pass on complex ideas and intense emotions. If you don't believe me, you haven't read "Maus," by Art Spiegelman.

Penn State Press is undertaking an effort to publish a series of books both about, and of the Graphic Medicine genre, on the theory that it "articulates a complex and powerful analysis of illness, medicine,  and disability and a rethinking of the of the boundaries of "health'" (Full disclosure, the Penn State publications will include my book "My Degeneration" about dealing with young-onset Parkinson's Disease.)

The first two books in the Penn State series have just been published. They are "Graphic Medicine Manifesto" written by editors of the series, and "The Bad Doctor" a graphic novel about a middle aged doctor who practices in the British countryside. It was written by Dr. Ian Williams, one of the editors of the series. I've read "The Bad Doctor," and can answer the question of whether it makes the case for the merits of this genre with a clear "yes."

One advantage of comics is the form's ability to compress information. In just over 200 pages "The Bad Doctor" lets us look over the shoulder of its central character, Dr Iwan James, as he encounters an assortment of patients ranging far and wide on the spectrum of "normal."  We also get close-ups of number of James' colleagues, who emerge as people remarkably like the rest of us. They struggle with romantic problems. They have personality flaws and philosophical conflicts about how to run their practice. They have moments of strength and weakness, idealism and avarice.

Nobody embodies these conflicts more than Dr. James. While on duty with patients, He exhibits a calm and caring competence. Underneath there is tension. He is attracted to one of his partners, and at odds with another one, who is opportunistic and lazy. Not that Dr. James is above researching bicycles on the internet when he should be attending to clinic business. Furthermore, we learn from a series of dreamily-rendered flashbacks, he still is still troubled by the intrusions of a case of obsessive-compulsive complex. We see Dr. James'  baseless fear that he may harm one of his patients subtly reflected in the fear of an obsessive-compulsive man he treats who is tormented by thoughts he will damage his beloved nephews.

Dr. James is no Dr. Kildare, able to pull miracles from his pocket. James' pocket is more likely to produce lint.

So what is the lesson here?

When I first began to attend support group meetings for people with Parkinson's Disease, I was surprised at the amount of time the group spent airing anger at the doctors who were supposed to be our allies in our efforts to cope with the disease. Often these feelings were based on callous remarks or moments of utter cluelessness that these Doctors inflicted on their patients. These moments of casual destructiveness were made all the worse by our expectations of doctors, that they are demigods, learned, deft healers, immaculately trained and disciplined, yet wise and caring.

Well, bang goes that illusion. And really, good riddance. Thanks to "The Bad Doctor" we may see doctors as limited like the rest of us. Once we no longer imagine them as high priests of healing endowed with holy infallibility, two things happen. First we can see our doctors as human, struggling to do the best they can with the tools at hand. This will enable a more realistic expectation of what is possible, and a gentler sense of disappointment when these (mostly) good people fall short of the perfection we sometimes count on.

Second, with the recognition of doctor's limits, it becomes all the more important that the patient accept more responsibility for managing their care. Patients need to learn what they can about their affliction, and to be alert to factors or phenomena that their doctor may have overlooked or not been aware of. The new paradigm is for partnership between doctor and patient to treat disease.

"The Bad Doctor" acts like a vaccine against the notion that we can delegate responsibility for our health to anyone else. We must find the best-trained, most capable medical care we can, and then to work with them to achieve the most satisfactory result. We must be realistic about what doctors can do. That's not a bad thing. It's a recognition of reality.

There certainly are miraculous things accomplished today by the people who wield the tools of modern medicine. None is more miraculous than the important fact at the core of "The Bad Doctor": these mighty feats are performed by people not so different from you or me.

No comments: