Meet the physician who educates patients with cartoons [PODCAST]

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Listen to psychiatrist Emily Watters’ work with the homeless population and how she got her start writing cartoons, educating patients using out-of-the-box communication strategies.

Emily Watters is a psychiatrist and can be reached at The Cartoon Shrink.

She shares her story and discusses her KevinMD articles, “Blood clots and the Johnson & Johnson vaccine: a comic explanation” and “If the COVID vaccines don’t make you sick, why do some people feel sick?”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Here on the show, we’re talking to Emily Watters. She’s a psychiatrist, and she wrote a few KevinMD articles, and they’re a little bit different because they’re cartoons. For those watching on the video, I am going to show them right now.

And you can see here a lot of the cartoons. They are involved with patient education, and specifically with the vaccines. So here we have “Blood clots and the Johnson & Johnson vaccine: a comic explanation,” and another, “If the COVID vaccines don’t make you sick, why do some people feel sick?” And today we’re here to talk with Emily about that intersection between patient education and cartooning. Emily, welcome to the show.

Emily Watters: Thank you.

Kevin Pho: All right. So we’ll get into those topics in a little bit, but first off, can you just share your story and journey to where you are today?

Emily Watters: I’m a community psychiatrist, and I trained at Wayne State in Detroit and then did residency at Northwestern in Chicago. I’ve been in the Bay Area for 11 years now, and for the last four years, I’ve focused almost exclusively on working with people who are homeless. And so some of the work that’s involved has been, you know, I’m based in the county shelters for half my week, and then I’m in a clinic half the week. I originally was just in the shelters, trying to see people short term and link them into the county clinics, and that was not working at all.

And I think the part I started to see over time is that people who are homeless have extensive histories of trauma that date back to early childhood in many cases, and that it was really asking a lot to ask this person to meet strangers in a clinic when so much of their experience with mental health has been very, very negative and involves psych emergency or jails. What I found is when I moved some of my time into the clinic, and they could see me in the clinic and not have to start all over and lose that connection, it wasn’t a big ask anymore, and it opened this door that just hadn’t been there for them before.

Kevin Pho: Tell me, how common is it for a psychiatrist to go to homeless shelters and deal specifically with the homeless population?

Emily Watters: Well, not as common as it should be. In the Bay Area, each county has some sort of team that does homeless outreach, and there might be one psychiatrist on the team. Occasionally there’s more than that. But people who are homeless represent a huge part of community psychiatry, and I think that there’s a lot of frustration with this population of, “Ah, this person’s not showing up on time,” and this kind of feeling that this person isn’t trying hard enough, when, having learned more about this group of people, early childhood trauma affects executive function, about half of people who are homeless have had a TBI, and methamphetamine use affects executive function. And with all that in mind, I mean, asking someone to adhere to a traditional clinic schedule just isn’t going to work.

And I think that many psychiatrists would find it tremendously satisfying to work in a shelter and keep a more flexible schedule, where it’s kind of like, if you show up somewhere on the same day as your appointment, then that’s a success, and I will see you.

Kevin Pho: Now, you mentioned this earlier, but I was wondering if you could certainly go into more detail. So I’m a primary care internal medicine physician, and I see patients, obviously, in a clinic. If someone who is homeless comes to my clinic, from a behavioral health standpoint, what are some things that I need to be looking out for? What are some questions that I need to be asking?

Emily Watters: I think a really valuable thing to screen for is PTSD, and there’s a way I’ve learned to screen for it that I think is really useful, which is starting with talking about how that person does in crowds, and if they notice feeling on edge or irritable or fearful when either someone’s in their personal space, they’re in a crowd, or there are loud noises. And if it’s a yes to that, then expanding into nightmares.

If asking specifically about traumatic memories, I always frame it with that person: “You know, I’m going to ask this really focusing on now, and there’s no need for you to have to go into background about trauma.” Because I think the second that person senses this conversation is going toward trauma, it’s very common they’ll just close off. But PTSD is extremely, extremely common in the homeless population, and treating it can really be a game changer for that person.

Kevin Pho: All right. So let’s transition now into some of the KevinMD articles that you wrote. As I said before, they’re not really articles. They are cartoons, and they deal with patient education, specifically with COVID and the COVID vaccine. So tell me about how you got started with cartooning.

Emily Watters: I think that in medical school especially, that was the way I would retain information, by making cartoons for myself, and also a way I would just keep myself engaged with the material.

And then in 2016, there was the election, and it was another time I felt very compelled to make something that I felt the public could understand. So I made a comic about understanding narcissistic behavior and antisocial behavior. It took me a while to make it, but it was so satisfying because I felt there were things that I could say in the comic, or through the illustration, that really take a lot of words to convey the same thing.

And then around that time, I also started doing some lectures with comics. Shortly after that, I started working at the shelters, so I did one on de-escalation techniques and using trauma-informed care when working with people in the shelter. And that was another one that just really lent itself to comics. And I think pictures are, even though I’m not a particularly talented artist, pictures are so satisfying for me to make. In some ways, I think I’m not burdened with having tremendous artistic talent, and it helps me distill things into something I think simpler.

Kevin Pho: And I think that is very helpful, especially in the age of COVID, because COVID itself is changing almost on a daily basis. And of course, as the vaccines become more widespread, that’s also changing on a daily basis in terms of what we’re discovering about the vaccines and in terms of potential side effects and short- and mid-term complications. Now, the cartoons that you wrote on KevinMD have to deal with the COVID vaccine. So tell me about some of the misconceptions that you’re trying to help clear up.

Emily Watters: I think when the vaccines first came out, I was reading a lot about them, and I kept running into, really with any article I was reading, there was like a gap. And the feeling I had is that the person writing it decided, “You know, the public isn’t going to understand this part, so I’m just going to glaze over this part.” And what I have in mind, and this is informed partly through working at the shelters, is that people are really scared. And when people are scared and they see gaps in the information being delivered to them, people fill in the gaps, sometimes with fear-based ideas.

And so I was seeing that the way people were filling in those gaps were things like, you know, more traditional things that we would see with vaccines, like, “I heard the vaccine could give you COVID.” And I think that was one I really wanted to clear up with the first comic, which was about the mRNA vaccines. And I also think I approached it from a perspective that I want to leave as few gaps as possible, and try and make it inviting and not scary to look at, because I think that’s another way misconceptions happened, is that people felt afraid. Many of my patients really stopped reading about COVID, you know, maybe a month or two into the pandemic, and so it was kind of ripe for misconceptions anyway, because there are so many already about COVID.

Other misconceptions I wanted to clear up up front were the ones that were about the vaccine impacting DNA. And I think what I hadn’t anticipated is that this was just the tip of the iceberg for vaccine misinformation. Vaccine misinformation has extended so far beyond those earlier ones that it feels a little impossible to catch all of them, but at least that basic framework is a place to start, I think.

Kevin Pho: And I completely agree with everything that you say. I think that presenting what could be complicated medical information in an easy-to-understand pictorial format is tremendously helpful to patients, especially when it’s something new like an mRNA vaccine. Now, what do you say to those other physicians who may push back and say, “This is not serious medical literature. These are comics, and how can you present medical information as a cartoon?” So what do you say to some physicians who kind of push back on this approach?

Emily Watters: Strangely, it hasn’t come up. It probably comes up privately and just isn’t stated to me. But to me, I think our role is to present information that people are willing to read, and when it becomes more about our own needs to appear professional or serious, we lose the audience. And we’re kind of living in a time of people with extremely short attention spans, so I think anything that can keep attention, that’s honest material, is worth doing.

Kevin Pho: We were talking to Emily Watters. She’s a psychiatrist, and she wrote a series of cartoons explaining the COVID vaccines and their potential side effects on KevinMD. So, Emily, take me through just a basic workflow of how you distill something that could be a complicated concept into a cartoon.

Emily Watters: Sure. So I usually start with spending a couple of days reading as many articles as possible. For the first comic, I also just bought a more recent immunology book than what I have left over from med school, and it’s a great read. It’s the book How the Immune System Works. It’s just a delightful, engaging read. So I read that book and then reread many chapters over and over before I felt like I could start to see more of a story.

And then I usually have a really kind of messy series of photos, and I do it a little bit like making a storyboard, more or less. I used to make videos in medical school, and I did a little bit in residency, and with those I would storyboard. So I just storyboard for these, but no video, and do it in a way so I can move the panels around.

Kevin Pho: And for those other physicians who may want to present patient information pictorially or as a cartoon, or really distill what are complicated medical concepts into the simplest essence, what kind of tips can you offer them?

Emily Watters: I think it’s great to get as much feedback as possible. So I have an eight-year-old daughter. She is one of my first readers, and she really gives great feedback. But I usually start with people close to me for feedback, and then, you know, for these comics, I brought them to online groups, even like vaccine interest groups, and just heard from people for a little bit before I made my final draft.

And I think when getting feedback, strangers especially can sometimes be fairly harsh. What I always have in mind is that there’s often a kernel of truth in even really harsh feedback, and I try and take it seriously, and I also don’t take it personally. If someone feels compelled to make something really harsh, it generally doesn’t really have much to do with me. And I think that’s an approach to take when navigating those things, and especially when you delve into the world of social media and online forums, it’s best not to take things personally.

Kevin Pho: So give an example. What’s an example of some criticisms that you receive when you put your work out there?

Emily Watters: The first one especially, you know, it was, “People aren’t going to understand this,” and “It should be funnier,” which, you know, sometimes is hard to make use of. But I took the part about “people aren’t going to understand this” really seriously. And then I decided the best way for me to see if people are going to understand it or not is to start presenting it to people and seeing, not what someone thinks other people will think, but whether the person reading it understood it. And so the feedback I took most seriously was like, “When I read it, I wasn’t sure about this part.”

Kevin Pho: And my final question: What’s your take-home message that you want to leave with the KevinMD audience?

Emily Watters: To me, I think we’re in a really critical period where the people who were super excited about the vaccines have already, for the most part, gotten their vaccines, but there are a lot of people who are on the fence. And I think individual conversations really matter. And I think something that I try, a way I try and approach those conversations, is really through the lens of trauma, where I think people have been really afraid for a very long time, and some of the fear about the virus gets mixed up with fear of the vaccine.

And when it’s possible, the more we can slow down, it helps the other person slow down and be able to take in information. And I think when there’s like a conversational approach to it, then minds become more open to hearing what we have to say, you know. And so, as much as I love making these comics, I also don’t want them to take the place of individual conversations. And so I would say they’re like an accompanying piece to those individual talks.

Kevin Pho: Emily, thank you so much for sharing your time and insight, and thanks again for being on the show.

Emily Watters: Yeah, thank you so much.

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