Medical Visualizations for Law

Designed and illustrated medical legal visualization panels for the courtroom within a co-design team. 

Medical Legal Visualization
medical legal visualization
Panel3.jpg

Overview

These panel visualizations were created in collaboration with Avesta Rastan and Nitai Steinberg for the Canadian courtroom as visual aids in a defendant physician's medical malpractice lawsuit. See below to read a case summary.

Note: names have been changed.

Date: Winter 2018​

Format: Print / Digital

Skills: Research, content development, medical legal

Tools: Procreate, Adobe Photoshop, Adobe Illustrator

 
 

Design Challenge

Create visual aids supporting a medical legal case, teach the a lay audience (judge and jury) about complex medical information, and use demonstrative evidence within the Canadian courtroom.

Background & Problem:

 

Summary of the legal case: The case begins when the infant plaintiff is born with a congenital defect known as Transposition of the Great Arteries, and has to undergo a major heart surgery known as Arterial Switch Repair. Thirteen days after a successful surgery, the infant is found to have a hemorrhagic spinal infarct that results in permanent paraplegia of the lower limbs.

The plaintiff's family pursues a legal case against the operating surgeon; their arguments include: [1] the surgery caused the spinal infarct and [2] the surgeon should have waited longer before operating.

The defendant argues that [1] the surgery was successful and did not cause the spinal infarct; they propose that the infarct was caused by an umbilical catheter inserted into the aorta, a common practice in the neonatal intensive units. Additionally, [2] the surgery was emergent and necessary; waiting would have meant increased risk of patient death.

 

Medical legal cases often involve telling a compelling scientific story; however, the judge and jury seldom have any background in science and medicine. Thus, it can be a great challenge for both plaintiff and defense to communicate their legal arguments accurately without losing audiences in technical medical terminology. Thus, my co-design team and I were tasked with creating a series of visual aids that teaches lay audiences about complex medical information in this patient’s medical case, and supports the defense’s legal arguments.

Co-Design Plan

My team and I created co-design plans that included delegating responsibilities and creating a stylesheet for visual consistency between panels (below). Although we held primary responsibility in certain tasks, we worked closely together throughout and solicited feedback constantly.

Layouts courtesy of Avesta Rastan

 

Design Strategy

This project’s biggest challenge was the complexity of medical material involved. We needed to teach lay audiences about complex infant heart anatomy while also explaining the defendant's conceptualization of events.

With this goal in mind, we came up with several design guidelines for this project:

  • Teach the jury, and scaffold knowledge such that we can present complex medical information without confusing audiences.

  • Depict the patient's complex medical events with clarity and accuracy.

  • Visually support and emphasize the defence’s line of argument in our medical illustrations.

We first outlined how we thought the medical information should be presented in court; in other words, we wrote a “scientific story” that would help guide the defence’s line of reasoning. This is depicted in our initial sketches:

The expert medical witness should first spend some time teaching the audience about relevant infant heart anatomy and direct attention to important areas (Panel 1; left). This will serve as foundational knowledge that will scaffold the audience’s learning. Then, according to the timeline of events, the expert medical witness can explain the patient’s condition and need for life-saving heart surgery (Panel 2; top right). Finally, using the largest panel (Panel 3; bottom right), the medical witness will tell the defence’s conceptualization of events and explain how the infarct could have happened.

Comprehensive Sketch

Our final comprehensive sketch is shown below:

 

We intentionally separated panels 2 & 3 to create “psychological space” between the surgery (panel 2) and the infarct (panel 3). We experimented with various methods of depicting blood-flow (arrows, gradients, etc). We purposefully blended more graphical representation with more highly-rendered representations in order to balance simplicity and realism/accuracy. Overall, this layout provided a clear and accurate account of events that supported the defence’s legal arguments.

 

Final Panel Design

After some feedback from Dr. Lax and final adjustments, we submitted our final panel designs below:

References: [1] Agur, Anne M. R., and Arthur F. Dalley. 2017. Grant’s Atlas of Anatomy. 14th Edit. Philadelphia: Wolters Kluwer (Pages: 15,238, 246, 250, 369, Figure numbers: 1.12, 3.43, 3.48, 3.52, 4.80). [2] Boston Children’s Hospital. n.d. “Transposition of the Great Arteries (TGA).” http://www.childrenshospital.org/conditions-and-treatments/conditions/t/transposition- of-the-great-arteries (Figure: “Transposition of the Great Arteries”). [3] Castaneda, Aldo R., William I. Norwood, Richard A. Jonas, Steve D. Colon, Stephen P. Sanders, and Peter Lang. 1984. “Transposition of the Great Arteries and Intact Ventricular Septum: Anatomical Repair in the Neonate.” Annals of Thoracic Surgery 38 (5): 438–43. doi:10.1016/S0003-4975(10)64181-1. (Pages: 438-443, Figure numbers: 1, 2, 3). [4] Fenichel, Gerald M. 2007. Neonatal Neurology. Neonatal Neurology. 4th Edit. Elsevier. doi:10.1016/B978-0-443-06724-2.X5001-2. (Chapter 5, pages: 99-100). [5] Lemke, Robert P., Nnanake Idiong, Saad Al-Saedi, Niels G. Giddins, Cameron Ward, Andrew Hamilton, Lois Hawkins, Betty J. Hancock, and Jonah N.K. Odim. 1996. “Spinal Cord Infarct after Arterial Switch Associated with an Umbilical Artery Catheter.” Annals of Thoracic Surgery 62 (5): 1532–34. doi:10.1016/0003- 4975(96)00778-3. (Pages: 1532-1534, Figure numbers: 1). [6] Mavroudis, Constantine, and Carl L. Backer. 2012. Pediatric Cardiac Surgery. Edited by Constantine Mavroudis, Carl Backer, and Richid F. Idriss. Forth Edit. Oxford, UK: Blackwell Publishing Ltd. doi:10.1002/9781118320754. (Chapter 26, pages: 492-529, Figure numbers: 26.9, 26.10, 26.12, 26.18). [7] Rosenquist, Glenn C., and Lauren J. Sweeney. 1982. “Anomalous Semilunar Valve Relationships in Transposition of the Great Arteries.” Pediatric Cardiology 2 (3): 195– 202. doi:10.1007/BF02332110. (Pages: 195-197, Figure numbers: 3). [8] Schuenke, Michael, Erik Schulte, and Udo Schumacher. 2010. Head and Neuroanatomy (Thieme Atlas of Anatomy). Stuttgart, New York: Thieme Medical Publishers. (Pages: 282-283, 286-287, Figure numbers: 9.9, 9.11). [9] Schünke, Michael, Erik Schulte, and Udo Schumacher. 2010. Neck and Internal Organs (Thieme Atlas of Anatomy). Stuttgart, New York: Thieme Medical Publishers.(Pages: 94-95, 100, 112-113, Figure numbers: 2.13, 2.16, 2.22). [10] SickKids. 2016. “Arterial Switch Procedure.” https://www.aboutkidshealth.ca/Article?contentid=1656&language=English# (Figure: “Arterial switch procedure”). [11] Sim, Eugene K.W., Jacques A.M. van Son, William D. Edwards, Paul R. Julsrud, and Francisco J. Puga. 1994. “Coronary Artery Anatomy in Complete Transposition of the Great Arteries.” The Annals of Thoracic Surgery 57 (4): 890–94. doi:10.1016/0003- 4975(94)90196-1.[12] Talwar, Sachin, and SupreetP Marathe. 2015. “Surgery for Transposition of Great Arteries: A Historical Perspective.” Annals of Pediatric Cardiology 8 (2): 122. doi:10.4103/0974-2069.157025. [13] The Children’s Hospital of Philadelphia. 2014. “Transposition of the Great Arteries.” https://www.chop.edu/conditions-diseases/transposition-great-arteries (Figures: “Transposition of the Great Arteries (TGA) With Intact Ventricular Septum”, “Transposition of the Great Arteries (TGA) Arterial Switch Operation – Step 1”, “Transposition of the Great Arteries (TGA) Arterial Switch Operation – Step 2”, “Transposition of the Great Arteries (TGA) Arterial Switch Operation – Step 3”)

 © Shirley Long 2019