Helen Osborne: Welcome to Health Literacy Out Loud. I’m Helen Osborne, President of Health Literacy Consulting, founder of Health Literacy Month and author of the book Health Literacy from A to Z. I also produce and host this podcast series, Health Literacy Out Loud.

Health Literacy is about communicating in whatever ways might help patients better understand. This often goes beyond just the written or spoken word. Good communication sometimes also includes art.

Dr. Maria Baimas-George knows a lot about this topic. She not only is a transplant surgeon, but also the author and illustrator of The Strength of My Scars, a series of children’s books about a wide range of medical and surgical conditions.

Maria is passionate about the value of intertwining art and surgery to improve patient understanding, to increase satisfaction and to help reduce apprehension.        

Welcome to Health Literacy Out Loud.

Dr. Maria Baimas-George: Thank you, Helen. I am super excited to be here and be talking to you about this topic.

Helen Osborne: I saw some of your books and I am wowed. I can’t wait to hear more about how you intertwine art and surgery. But let’s put this into context for all our listeners. How are art and surgery intertwined?

Dr. Maria Baimas-George: I feel like surgery is just entirely filled with different artistic pieces. There’s so much beauty within the human body, I think, within the operating room and within the profession. For me, I see art. It’s almost ubiquitous to me in surgery. They very much parallel each other.

Helen Osborne: I get goosebumps when I hear you talk about that. I just think of the artfulness like, “How well can someone do the stitches after an operation?”

I, of course, have no sense what goes on inside the human body. I took some classes in it, but you see it every day, what happens inside the body. Can you describe for us a little bit what you mean about the artfulness and the beauty of the human body?

Dr. Maria Baimas-George: When you’re doing an operation, there are just so many different pieces, the anatomy and what you’re doing, that are really beautiful in and of itself.

Then when you’re doing the operation, I view it as a technical craft. How you’re operating, there’s beauty in that.

Surgeons often will say, “What beautiful planes.” Those are the different tissue planes in the human body. Or, “What a beautiful dissection.” There’s this graceful artistic approach that I think a lot of surgeons often see. For me, I look for that every time I operate.

Helen Osborne: Boy, if I need surgery, I want you. I want someone who sees what’s happening inside me, what makes me me, and sees the beauty of that.

Dr. Maria Baimas-George: It’s really cool.

Helen Osborne: There’s another side of you, too. Aside from the surgeon part, you’re also an author and illustrator. Can you tell us more about that?

Dr. Maria Baimas-George: I like to call myself more of an amateur artist/illustrator. I view it as my side hustle.

Helen Osborne: Like you needed one. You’re a surgeon.

Dr. Maria Baimas-George: I know. That’s what my mom says, too.

When I was first starting residency, I really noted the lack of great communication that often happens when you’re telling patients about something that’s scary, like a new diagnosis or needing surgery.

That is multiplied when there are poor health literacy levels, which a lot of people in the United States and the world have what we consider poor health literacy.

When you’re trying to explain something in a state of fear on top of that, how is someone supposed to understand, retain that information and then go forward with actual consent?

Helen Osborne: To understand, go ahead and then consent?

Dr. Maria Baimas-George: Yes, exactly. To give surgical consent, for instance, or medical consent is that people need to understand the full risks and benefits of X to be able to really say, “Yes, I want to go forward with that,” or, “No, I don’t.”

I think it’s actually really difficult to get real consent because of that kind of anxiety, fear and maybe not entirely understanding of the medical terminology, anatomy or pathophysiology.

That’s when I thought of this way to attempt to make it better, and that’s how I dove into the children’s books.

Helen Osborne: I can certainly put myself in that patient situation, which I have been at times. I so much appreciate your sensitivity to the fact that people can have trouble understanding. They can have trouble for so many reasons, but on top of all that is the fear, anxiety, new news and all the other issues that are going on.

Tell us, what do you do to improve understanding?

Dr. Maria Baimas-George: I’m super visual. The way I learn is by seeing, so I thought a lot about, “What would make me understand something better and what would I want?”

I like things very simplified and visual, so I decided to create these books where I use analogies that most people would understand to explain more complex pathophysiology.

Helen Osborne: I’m going to stop you right there. I just want an example. How do you help someone understand pathophysiology?

Dr. Maria Baimas-George: Absolutely. One I’m actually just working on is a book on hemodialysis. Hemodialysis is when you take blood out of a patient whose kidneys aren’t working, you clean it and then return it to their bodies. It’s a bridge often to transplant, or some patients are on it indefinitely.

The analogy I used for hemodialysis is I did a story about an aquarium. Similar to human bodies, aquariums with fish create trash. There’s fish poop and extra fish food just swimming around all of that, and it builds up in the water. When it builds up, it makes the fish feel sick.

Helen Osborne: I didn’t even imagine you were going there in that metaphor or analogy. Now I can picture this aquarium and little fish poop at the bottom. How do you bridge from that to hemodialysis?

Dr. Maria Baimas-George: Fish are feeling sick, so aquariums need water filters. They pull out the junk in the water, filter it out and put back in good new water. That process is exactly what hemodialysis is, essentially.

When we eat food, it makes different things within our bodies. We also make toxins and byproducts that aren’t good for us. We usually flush a lot of those out in our urine, or our kidney filters them out and puts them in our urine. If our kidneys aren’t working well, we can’t flush them out of our body in our urine.

The hemodialysis is like a water filter. You take your blood out that way, it filters it out and puts it back in.

Helen Osborne: I am fascinated with this, but I’ve got a question about it. This would work if the person goes to the aquarium or has some fish at home. If that person looks just as perplexed when you talk about fish tanks as you do about their blood, can you switch and quickly come up with a different metaphor that might fit in their life?

Let’s say they’re a musician or something. Are you prepared to do that? I know you said you’re very visual and you like things simple.

Dr. Maria Baimas-George: The way I do these books and analogies is I draw them out, so if you’re not necessarily familiar with the concept that I’m describing, it’s really portrayed easily so you can still follow. They’re written for a fifth or sixth grade reading and literacy level.

But that’s something that’s a really good point. Not every book or analogy is going to work for everyone. I think every doctor or surgeon has to tailor their approach to the individual.

You can take that book and say, “I sort of understand this, but can we talk about this in a different way?” Absolutely. Then you build on that.

The analogies, I would never be able to think of one that quickly off the top of my head right this second. They take me a decent amount of time. I think of a book I want to do and it’ll often take me months to think of the analogy I want.

But there are a lot of different ways to describe a disease or medical process and draw upon it and build upon it. I think everyone has to be tailored to, because everyone is different and everyone’s understanding is going to be different.

Helen Osborne: I’m thinking of maybe a car mechanic or something with your computer. There must be other analogies. I’m not that familiar with that one. But the fact is that you are spending a lot of time thinking about this.

I want to ask you now, and it will be on your Health Literacy Out Loud web page, too. Please tell us all about your book series. It is phenomenal. That’s how I heard about you, was through this children’s book series.

Just tell the world and we’ll have the link also. Then I have some more questions I want to ask you.

Dr. Maria Baimas-George: The book series started in residency. I started them just because I wanted to, again, create a resource for my patients. Then I started to build upon them and decided to study them.

I started with just a couple books. I did one on appendicitis, pyloric stenosis, some neonatal conditions.

Then I sought to see if they did what I actually wanted them to do, so I applied for a research grant and was lucky enough to get it and did a randomized controlled trial at the Children’s Hospital in Charlotte.

What that means is that half the patients got a book and half of the patients didn’t get a book. They were randomized to either arm. Then I looked to see if the books improved their understanding and their satisfaction and decreased their anxiety. Those are the three parameters.

I was really happy to find that they did. Our results, I’ve presented them at a couple national meetings, and we just got published in one of our big surgery journals.

That spurred me on. Now I’m at about 25 books. Gosh, I have a list of at least 40 others I want to do.

Helen Osborne: All of these are under the umbrella title of The Strength of My Scars?

Dr. Maria Baimas-George: Yes. I thought of that name when I was first starting out, and I liked that because the first instance that made me think to do this was a specific scenario in the hospital. There was a little baby that was born and he had gastroschisis. That’s a really long word for basically his abdominal wall didn’t form and his intestines were outside of his belly.

The mom was so scared about that. She didn’t want to see her baby until after he’d had surgery. She was so fearful.

For us, gastroschisis is actually a really simple thing to fix, unless it’s a more complex type, but that’s rare. We just put the intestines back in the belly and close the belly. But you’ll never have a belly button. We try to create one, but you don’t ever really have a belly button.

I was thinking about it from these two perspectives of, one, I wish I had a resource that I could show the mom that this is going to be okay, and, two, when that kid grows up and looks at his belly compared to other people’s bellies and says, “Why do I have a funny scar? What is that from?” I would love for them to have a book that they can see they should be proud of those scars.

They went through something and it’s something to be proud of. There’s strength in your scars.

Helen Osborne: Thank you for sharing that story. That’s going to stay with me. My respect for you has grown and grown, not only your ability as a surgeon that I’m sure is phenomenal, but your sensitivity, art and caring.

The URL for the whole books is what?

Dr. Maria Baimas-George: It is https://strengthofmyscars.com

Helen Osborne: That’ll be on your web page. I encourage everyone to take a look. That’s why I was so impressed and wanted to interview you.

Dr. Maria Baimas-George: Thank you.

Helen Osborne: But let’s get back to everybody else now. Beyond being your cheering section, what can listeners be doing?

I want to describe the podcast listeners. We may be clinicians or in public health. We might be working in community organizations. We might just care about communicating clearly. We could be anywhere in the whole world.

What lessons learned or tips would you like to pass on to all of us to be able to somehow interplay the arts and healthcare or medicine?

Dr. Maria Baimas-George: I think the big thing that I’ve seen in my practice and that I think holds true most of the time is incorporating some sort of visual understanding when you’re talking to patients or family members about something. The use of something visual really helps.

There’s a lot of research behind that. There’s this theory of dual coding, the Dual Coding Theory of Cognition, and it describes the human mind as being comprised of two functionally independent systems, where visual and verbal information are processed and then stored along different channels. This allows an additive effect when verbal and visual information are both utilized.

Helen Osborne: I want to stop you right there. To incorporate a visual. You’re talking about a really complex surgery. You also said it takes you a while to do these books. What about if you’re just meeting with that terrified parent or patient at the moment? What do you do in the moment?

You can’t just pick your book out of the bookshelf. What would you do for something that’s kind of complicated right then and there?

Dr. Maria Baimas-George: I like to draw things out. Even if I can’t necessarily draw out the whole surgery, draw out some of the anatomy or even draw out the pathway that we’re going to go down, like, “Day 1, we’re going to get these tests. Day 2, we’re going to go to the operating room. Day 3, XYZ.”

I think there are a lot of different ways for a lot of different levels of artistic talent to incorporate something where your patients can be seeing what you’re saying.

There’s actually a really funny study that I saw. It came from a surgery department in Scotland. They cited that “even then, relatively crude sketches of surgeons were highly valued by the patients.”

Helen Osborne: You’re a good artist. You said you’re an amateur. But you don’t have to be a great artist to be able to do this.

Dr. Maria Baimas-George: No, not at all. When you’re talking about it and drawing it at the same time, the patients can follow even if it looks like a triangle and not a liver.

Also, when you’re drawing or writing as you’re speaking, your pace of explanation is rate-controlled by the speed of your drawing. It allows for you to gradually build in detail in both words and imaging.

I think that makes that complex information easier to process than a sudden presentation of X, and you’re constructing it in real time, so you can tailor it to everyone’s need and understanding.

Helen Osborne: That is fascinating. Do you keep art supplies at your desk, or do you use something digital? What do you use to do this?

Dr. Maria Baimas-George: I honestly usually use the back of my patient list or chart and sketch out stuff with a pen when I’m at the hospital, just because when I’m in surgery and whatnot I’m always running around with minimal things. But I’ll sketch stuff out on the back of my piece of paper.

If there’s something I think that would be really useful to show someone something maybe more detailed or complex beyond a simple ink drawing, I’ll pull stuff up on my phone.

But I think if you’re a provider who could have resources on you or you’re in office hours versus in a hospital and have different resources of things that you like to use, having those nearby or having sheets printed out that you can give to patients and not just show patients, I think, is really important.

The piece that also I think is really important is that a lot of studies show that 80%, if not higher, of material is forgotten by the time a patient gets home.

Even if they had perfect understanding in your office of what a gallbladder surgery would be, by the time they get home, they see that 80% or more of that information is forgotten.

Helen Osborne: That’s really interesting. You’re reminding me of a story experience I had. I had a mole on my toe. I’m going to see the doctor. She’s going to take off this mole.

Then I go back for the follow-up and I can tell by her tone of voice my mole isn’t so great. I’m already tuning out. I’m terrified of what she’s going to tell me in that next sentence that hasn’t yet come.

But what she does is she takes a pen or whatever she had . . . Do you know that paper stuff that’s on that table that patients sit and lie on?

Dr. Maria Baimas-George: Yes.

Helen Osborne: She just drew my mole, my foot and the different layers of stuff.

Dr. Maria Baimas-George: I love that.

Helen Osborne: She showed me that it was not right on the surface but not so deep, and it really wasn’t so bad. Because she did that, I could relax and listen. But I still remember, and this was long ago.

I sure wish she had done one more step. It was a very crude drawing, but I wish she had ripped off that piece of paper and given it to me. I don’t have it. She just threw it away. For her, it was just a scribble. For me, it really made a difference in my understanding.

Dr. Maria Baimas-George: That piece is so important. It’s not just that piece about the understanding, but it provokes or brings back the memories and feelings of being in that experience, and feeling maybe that you felt comfortable, understood, satisfied and safe.

Again, this is why the children’s books, people have talked to me about putting them digital. I’m not exactly sure about that yet, but I love that you can have something where it’s like a health memory, if that makes sense.

Helen Osborne: I love all that you were doing. We don’t have time to go through all the many things you’ve learned, but I hope that listeners are getting a taste of this, and also a sense that not only is it great when you do it, and to go look at your books, but they can do it, and I can do it. We all are capable of building in this.

Dr. Maria Baimas-George: Yes, anyone.

Helen Osborne: Just to recap, you talked about the role of metaphors and using that to bridge to something that’s unfamiliar.

You talked about the importance of talking while you’re drawing and doing it in real time. You can do it with almost any implement. You can do it with sheets that are preprinted. It probably would help if you’d sketch on there somehow. Maybe give it away.

Really, you’re not only explaining what it is that’s about to happen or just happened, but you’re also engaging the patient on that.

Dr. Maria Baimas-George: Yes, exactly.

Helen Osborne: Maria, you’re fantastic. I don’t want to take more time because you have to go do all this wonderfulness with patients and then operate on them.

Thank you so much for being a guest on Health Literacy Out Loud and sharing all this great information with our listeners. Thank you, thank you, thank you.

Dr. Maria Baimas-George: Thank you, Helen. I’ve enjoyed this so much. It’s incredibly easy to talk to you and I had a wonderful time.

Helen Osborne: As we just heard from Dr. Maria Baimas-George, it’s important to communicate in all the ways that help people understand, and that often can include art. But it isn’t always easy to find the just-right ways to communicate difficult concepts.

For help clearly communicating your health message, take a look at my book, Health Literacy from A to Z. Feel free to also explore my website, www.HealthLiteracy.com, or contact me directly at helen@healthliteracy.com.

New Health Literacy Out Loud interviews come out the first of every month. Get them all for free by subscribing at www.HealthLiteracyOutLoud.com, or wherever you get your podcasts.

Please help spread the word about Health Literacy Out Loud. Together, let’s tell the whole world why health literacy matters.

Until next time, I’m Helen Osborne.

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