Pictal Health
Published in

Pictal Health

How visual health histories can help military veterans

Last summer I had the opportunity to help ten local military veterans create visuals depicting their complex health histories and symptoms. This is what I do — my company, Pictal Health, helps people visualize their symptoms and health journey so they can communicate better with their doctors.

This project was funded through the Veteran Health Administration (VHA) Spark-Seed-Spread Innovation Investment Program, which helps employees “design and test Veteran-centric solutions in a space free of operational day-to-day restrictions.” I collaborated over the course of the project with two psychiatrists working at the local Burlington, Vermont VA clinic: Dr. James Rustad and Dr. Sam Kohrman.

Here’s how the project worked, once we got it kicked off (thanks to Dr. Kohrman’s behind the scenes work). Dr. Rustad recruited some of his patients who had memory problems plus complex health issues. We scheduled a time for me to have an in-depth conversation with the patient (and often a caregiver or family member) onsite at the VA offices. After this meeting, I would go back to my office and put together visuals to represent the veteran’s story. I dropped these off at the VA before the patient’s next appointment with Dr. Rustad, and after the appointment, the patient and doctor both filled out post-appointment surveys. Here is a visual of the process:

This was a more analog, in-person process than I was accustomed to; usually my clients are remote, and I work with them virtually using videoconferencing and other remote collaboration tools. Many of these veterans were not comfortable with newer technologies, so we kept things simple: paperwork was done on actual paper, meetings were in-person, and if I had questions I called them on the telephone.

The visualizations themselves were the same ones I’ve used with other patients: health history timelines help bring clarity to the veteran’s health journey, and symptom maps (on a body shape) help show the quality and distribution of their symptoms. As an example, here is one veteran’s timeline, with most words removed for privacy:

And here is a symptom map for a different person:

This was an exciting project, and I learned a lot. I’d love to share some insights I had along the way.

I loved this work!

I had never considered working with veterans before, but right from the beginning, I found them to be interesting, fun, respectful, and talented characters. I appreciated how freely they shared their life stories, struggles, and accomplishments with me, and I learned a lot about the sacrifices they’d made during their service.

The first person I met was an older man who always called me ‘ma’am’ and told me about a friendship he’d made years ago in Vietnam — this quote stuck in my mind: “he saved my bacon, and I saved his bacon.”

This process was especially helpful for those with complex health issues

All of the veterans rated the process highly, regardless of the severity of their health problems. (100% of post-appointment survey respondents said they would be ‘likely’ or ‘very likely’ to recommend this process to others). But, as with other, non-veteran clients I’ve worked with, people with more complex health issues and those still seeking answers for unsolved health problems seemed to find the process especially valuable. As one veteran with especially complex issues said:

“I don’t have to keep track of this in my head anymore.”

This work can help reduce the burden of information management that patients and their family members have to carry. Family caregivers (in this case, children and spouses) were often very appreciative, as they are frequently the ones who have to keep track of information and manage doctor appointments. I’ve even kept in touch with one person’s son.

The conversation is key

As I’ve found with other clients, the veterans rated the ‘conversation with Katie’ as the most important part of the process — even slightly higher than the visuals. In this work, the process is the product in many respects; the in-depth interview and the chance to tell their whole story was highly valuable to the veterans.

This confirms the importance of maintaining that human-to-human support as I move forward with Pictal Health.

Visual health histories can support those with PTSD

In part because of this project, I started researching the ways in which PTSD can manifest as physical symptoms over time. Multiple veterans in this project were struggling with ‘mysterious’ physical symptoms that seemed to be related to post-traumatic stress; things like fibromyalgia, and even a fainting disorder. I read a book called The Body Keeps the Score, which helped me realize the extent to which trauma contributes to physical symptoms, and I have even begun to hypothesize that visual health histories may hold some therapeutic benefit for those with PTSD.

In this work with veterans, this process did seem especially meaningful for those with PTSD, and it helped them better understand their personal story. As one veteran with PTSD said in his survey:

“[this] approach helped me to explore and connect impactful and meaningful events of my service, life and healthcare in ways that brought greater meaning and clarity to the breadth and depth of my complex chronic conditions and life events.”

And Dr. Rustad said, about this person:

“This visual health timeline was extraordinary. It really put in perspective all of the medical/psychosocial issues of patient and allowed me to fully appreciate how they intersect.”

Work history was often insightful

As I asked the veterans about their work responsibilities in the military and over the course of their post-military career, I was impressed by their unique skills. Many described themselves as ‘fix-it guys’ with a gift for building things and understanding machinery. I normally don’t map out work history with my clients, but I saw how work was central to each person’s identity and story, so I included it on all 10 timelines. Dr. Rustad observed that, in his conversations with the veterans, work history gave them a sense of pride. About one veteran with severe depression, he wrote:

“The timeline helped me learn more historical facts about patient which were helpful in understanding his illness. For example, he was awarded a high honor in the service which showed his intelligence.”

Work history was often tied to mental and physical health. I noticed many work-related chemical exposures in people who later had memory loss or other possibly-related health problems. Here is a small excerpt from one person’s timeline — after a career working on oil rigs around the world, he was experiencing seizures and memory and cognitive issues.

About another veteran’s timeline, Dr. Rustad said:

“I enjoyed the intersection of the social/work history, with the medical history (example: chemical exposure came together with migraines.)”

And a third:

“Patient confirms accuracy of complex medical history. Interesting to possibly tie-in Agent Orange and Lymphoma. Interesting to see his thoughts about guilt surviving the Vietnam experience. Helpful to see on timeline the connection between chemo and subsequent cognitive decline.”

Of course, it’s not always possible to directly link chemical exposure to current health problems; but for those seeking answers about why this was happening to them or their loved one, these exposures offered one possible explanation and helped bring some semblance of logic and order to their life story.

The type of work someone chose was sometimes an indicator of their state of mind; for example, one veteran chose to be a long-haul trucker so that he could isolate himself from other people, a symptom of his PTSD. This was a new insight for him to discuss with his doctor.

By mapping out work history, we also could more easily see gaps where the veteran may have been struggling with mental or physical health issues and been unable to work. The below person had a 3-year gap in work due to health issues:

Side note: as these skilled veterans shared their impressive backgrounds with me, it was difficult to see them struggling to contribute to society because of their memory and cognitive issues. I could see that many of them were experiencing a crisis of meaning and purpose, unable to do the work that had brought them joy and satisfaction in the past.

This work helped the doctor get to know patients better

Dr. Rustad mentioned many times that the social history (what I’ve been calling ‘life events’) helped him learn more about the veterans as people, and it brought up new topics of conversation to discuss in therapy sessions. Like the work history, he said the social history gave them a sense of pride. It also helped highlight how the veteran had fared with the military-to-civilian transition, which is a focus area for the VA. Here are a number of quotes from Dr. Rustad, each one about a different veteran:

“I learned a lot about the patient’s PTSD symptoms and his social history […] his life made more sense to me, how it relates to his health in the big picture.

“Job/social history extremely helpful in getting to know the patient better, which helps facilitate doctor-patient communication.”

“I felt that I understood patient better in terms of the interface between his pain and depressive symptoms and how it affected his functioning.”

“The visual timeline cued us into conversations about his interests for future careers. Also highlighted struggles he has financially, which triggered me to refer patient to social work with regard to social security disability application and other financial concerns. Timeline also highlighted that his relationship is quite supportive. I got a better feel for the breadth and scope of his chronic pain issues.”

Dr. Rustad mentioned that this project highlighted the limitations of standard medical histories; he and his fellow doctors tend to be more problem-focused when working with a new patient, working to troubleshoot immediate needs. The process we undertook during this project helped create a more holistic and complete picture of the patient’s past history, which helped support psychiatric treatment moving forward.

What did veterans say about the process?

Here are a few post-appointment survey quotes:

“Made appointment much more targeted to our concerns & easily referenced health history to illustrate the source of our concerns.” (02)

“We reviewed the visual health timeline and I could tell my provider learned a lot about me and was making effective connections, and I felt like, making effective treatment recommendations as a result.” (04)

“I was very appreciative of how the timeline visually made it easier for me to relate to different aspects of my life.” (06)

“More time efficient. Experience with Dr. Rustad and Katie [was] more gratifying appointment than with primary care.” (10)

What is the promise of health history visualization for veterans?

  • For those with PTSD, this work was especially meaningful and may even have a therapeutic benefit; a proper research study would help determine whether this is the case.
  • For veterans who have had past chemical exposures or trauma and who now are suffering from physical health or cognitive problems, these visualizations can help them form a cogent story and understand why their symptoms may be occurring.
  • For those who are experiencing a complex mix of physical and mental health symptoms, health timelines and symptom maps can help them better advocate for themselves and understand their personal stories.
  • Overlaying work and social history with health history can help healthcare providers understand the veteran’s military-to-civilian transition and bring to light issues with daily functioning, mental health, and social relationships.
  • It’s difficult to put a value on being ‘seen and heard,’ but many clients have told me that this is one of the key benefits of this process. This could be very powerful for veterans.

I am grateful to have had the opportunity to work with such interesting characters, and I’m honored that they trusted me with their stories.

Huge thanks to Dr. Sam Kohrman, who did an incredible amount of groundwork to help get this project started, and to Dr. James Rustad and Brian O’hare, who took on a lot of the daily administrative work while this project was in-process. Thanks also to Brynn Cole and the great people at the VHA Innovators Network.

--

--

Get the Medium app

A button that says 'Download on the App Store', and if clicked it will lead you to the iOS App store
A button that says 'Get it on, Google Play', and if clicked it will lead you to the Google Play store
Katie McCurdy

Katie McCurdy

Designer and researcher focusing on healthcare; founder of Pictal Health; autoimmune patient; chocolate-eater. katiemccurdy.com and pictalhealth.com