“There’s something about that world of graphic medicine where you put it out onto paper, and you still sit with those feelings, but when you close the book or when you have something tangible and you can walk away from it, it does let you digest it in a way that talking about it or ignoring it or sublimating it in some way won’t.” -Mike Natter MD

This beautifully honest conversation between Lead Coach Jill Farmer and physician-artist Dr. Mike Natter delves into how intertwining art and medicine has led to vulnerability, and the unexpected positive results. Dr. Natter is in his second year of fellowship in endocrinology and is also a well recognized very talented artist. Jill talks to Dr. Natter about his art and how it impacts his life and practice of medicine. He used his art in medical school as a learning tool and continues to use his art as a way to learn and help others to learn. He also uses his art as an outlet that is relatable to so many other physicians. Tune in to get inspired to tap into your own talents outside of work. 

Michael Natter is an artist, humanist, and doctor. He utilizes his passion for art and storytelling in his medical life in didactic, humorous, and cathartic ways. Diagnosed with Type 1 Diabetes in childhood, he became interested in medicine at a young age. Originally from New York City, he ventured to Philadelphia to attend Sidney Kimmel Medical College, completed his Internal Medicine Residency at NYU/Bellevue and is a current Endocrinology fellow at NYU/Bellevue. His work has been featured in media outlets such as The Philadelphia Inquirer, Annals of Internal Medicine, Buzzfeed, and others. You can follow his journey on instagram @mike.natter, on twitter @mike_natter and via his website www.mikenattermedical.com where there are links to purchase prints of his art and versions of his art in enamel pin form for sale.  

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Please enjoy the full transcript below:

Mike: There’s something about that world of graphic medicine where you put it out onto paper, and you still sit with those feelings. But when you close the book or when you have something tangible, and you can walk away from it, it does let you digest it in a way that talking about it, or ignoring it, or sublimating it in some way won’t.

Jill: Hello, and welcome to DocWorking: The Whole Physician Podcast. I’m Jill Farmer, one of the lead coaches at DocWorking and one of the cohosts of this podcast. I’m really excited today to have joining us for conversation, Dr. Mike Natter, who is an MD, and in his second year of fellowship as an endocrinologist, done with residency now, moving on into life as a practicing physician in this fellowship program. Mike, thank you so much for taking the time to have this conversation. We’re really glad to have you.

Mike: Thank you so much for having me. It’s quite an honor and a pleasure.

Jill: One of the things that makes you maybe a little different than some of the other folks who are listening to us is not only are you a physician, but you are also an artist, a professional artist, who does variety of work, and works in a couple of different mediums. Can you tell us a little bit about your life as an artist, and your desire to be a physician, and how those two things merged, if you will?

Mike: Absolutely. Yeah, I like to describe myself as or I guess, when I was applying to medical school, I’d be described as nontraditional. But I really came into medicine through a very different way, and right now, I feel my art and my medicine are so intertwined that they can’t really be teased apart at this point. I grew up in New York City, and I always gravitated toward the arts, something I was naturally good at, I enjoyed making very easily to me, but the math and the science did not. I was actually pulled, “You’re not really a math and science kid, you’re more of an art kid, stick to what you’re good at,” in no negative ways but play to your strength’s kind of thing. 

No medicine in my family, no doctors or anything like that. I never really thought about medicine until I turned nine, and I was diagnosed with type 1 diabetes. That opened up this world to me of physiology, and this whole really elegant and intricate process that would be going on and handled by the pancreas was now my full-time responsibility as a kid. It actually opened up this world to me, and I was in awe. That medicine bug bit me then, but I was always a little bit shy from the math and sciences.

To make a very, very long story short, I ended up doing an art degree, and then did a postbaccalaureate medical program, and I started to draw my notes out in medical school as a way to recall, remember, and understand these topics, and it was in doing that, that things started to click, and I started to do quite well, and understand things, and then, I was able to not only use it as a didactic tool for myself, but also, now for medical students, and residents, and interns, and also my patients.

Jill: I’ve seen you’ve written and said a couple of different times in places that aren’t makes you a better physician. Why is that?

Mike: I think art is very universal. I think something very unfortunate happens. We’re all born and in preschool, and kindergarten, first grade, we all are drawing. It’s a very natural thing for us to do. Then, what’s unfortunate is that a lot of us stop. I think there’s a whole podcast that we can talk about for the reasons why, but regardless, it is something that’s very, I think, innate to us as human beings to draw and the visual sense. I also think that when you use art as a form of communication, you’re breaking down barriers like literacy, language, age. When you’re talking about complex medical physiology, if you can break it down to that of a child’s understanding in a cartoon or an illustration, anyone can digest that whether you’re a medical scientist or a patient that’s never opened a textbook before. That I think is the sweet spot of being a good physician is that idea of communication, and communication is key to art and to medicine.

Jill: Really cool. One of the things that you’ve talked about as well is the fact that at some point, art was a form of expression and almost a way that you were processing everything. I’m presuming motion, stress, the things that show up in life, and this is a medium for you to express that. Now, you’ve talked about the fact that art has become not just an expression to process your own energy, stress, what have you, but also to become a really meaningful way for you to communicate with patients, with colleagues, and have a voice in the world. Can you talk a little about that?

Mike: Yeah, I think my art falls into a handful of buckets. I think three buckets overall. There’s the didactic bucket, the strictly didactic bucket. When I was studying for step one or when I was preparing for an exam in medical school, I was drawing purely for myself to teach myself the material. That stayed the same, that bucket, but then a new bucket emerged when I started going through my clinical rotations, and then intern year, and then residency, and COVID, and then fellowship. This emotional, stressful, very unique experience of being a physician and a trainee in and of itself. Then during COVID, sometimes there’s no ways to articulate those feelings and to process those feelings, other than having an outlet like art. This other bucket was this narrative medicine, this graphic medicine that came about for me, is I would start drawing these comic style illustration and graphic novel style pieces to recount an experience a moment feeling that I was having given certain emotionally heavy situations.

Jill: Yeah, it’s really cool. I had a chance to really look at some of your work, and I love it. I loved the more illustrative anatomical if you will, quite beautiful, the splatter pieces some of them are called, and then also the more cartoon style that have the message. In that way, I thought it was interesting, because the cartoons really do illustrate and do share a message of humor, satire, [laughs] if you will. There’s sometimes a more serious message underneath. There was one of them, it was funny. It says, “An apple a day will keep the doctor away,” and it shows this patient essentially beating a doctor with apples to keep them running down the hall. That’s funny, and interesting, and a little scary on multiple levels. Can you talk a little bit about the different levels that you communicate with particularly this more cartoon medium that’s emerged for you?

Mike: Yeah, in medicine, my friends and I are, “You either laugh or you cry.” There’s so much going on. Humor is really, like for me, a good tool to harness that is teased into my work. Humor works in a number of ways. When I’m doing something that’s didactic, humor adds an extra layer of stickiness. If something’s cute and funny in addition to it teaching me something, I’ll remember it better. I’ll encode that better, and then remember it better when I tried to retrieve it. But then, humor can also work to soften the blow of a social commentary or criticism. 

Medical training is extremely archaic, and it’s extremely grueling, and I, for one, think most of us don’t think it needs to be that way. I don’t think that our learning in our training needs to be what it was in the late 1800s, and I don’t think that would affect the caliber of physician one would become if it were to be more humane. I often will poke fun at the absurdities that’s required of us at times, like these 28-hour shifts, and basically having no time to take care of yourself. Yet, you’re preaching the exact opposite to your patients for them to become healthy. That irony, to me, is humorous when you make a comic about it, but underneath all of that, it’s actually quite painful.

Jill: Yeah, it’s really maybe a new way for this important message to be heard. It comes through so often in all generations of physicians that we talk to on a variety of different subject’s, light and heavy, just questioning the institution of the ruling nature of the training. I appreciate your perspective on that. It’s one that I know resonates with a lot of our listeners. Speaking of which, we’re up to thousands now, physicians who like to listen to these conversations that we have on. One of the most popular ones we’ve ever had was one where we talked about the importance of having hobbies [laughs] outside medicine. I think the reason so many physicians tuned into that one is, it’s not something that is easy for people to put in practice. I know for you art isn’t a hobby. I think it’s too limiting of a term to describe the role art plays in your life. But talk a little bit, if you will, about your experience of why physicians, even those who aren’t “artists,” or don’t have the same talent, that you have need to make room for whatever that expression is for themselves in their life in practice?

Mike: Yeah, absolutely. That’s a huge point. I’m actually glad you brought that up. Yeah, you can call it as a hobby. I think the problem is when something leads into a career, then you no longer have that same passion for it. I’m happy to call it a hobby. But it’s very much intertwined into who I am today, and how I got through my training, and how I continue to express myself. 

I think what happens is, this funny thing happens, where you are meant to be this all around amazing, shiny human being to get into medical school. They want to see your ballet recitals, and your cello, and all this other stuff in addition to your scores. But then, once you get in the doors there, there’s really no time or you create this sense in your mind that there’s no time to do anything other than study. When you’re not studying, you’re worried that everyone else is studying, and then you’re going to fail out. That’s a very common thread. There is this very prominent imposter syndrome that I think is pervasive in all of medicine. It’s really true in almost every culture and every business culture, but I feel medicine in particular. I think it’s because it’s so hierarchical, and you always look up and see other people, and think that that could never be you, and then somehow, you’re there, but then you still don’t feel like you belong. 

The only way, I think, to retain some sense of identity, because just being a doctor is a very great identity, but it shouldn’t be all you are. I think if that’s all you are, it could become extremely burnout prone and difficult. I like to think about my friends in medical school who did row or sail, and ask them like, “Why don’t you just carve out a period of time to do so?” Because it’s such a shame that part of your life is put to bed. The way I used to describe it to my non-medical friends is that, no[?] normal person can carve up their day with plenty of sections. You wake up, you go to work section, but then there’s also the, you get done with work, you can go to the gym, and then you get a drink with a friend, and then you read a book, and then you watch TV, and then you go to bed or whatever that may be. 

In medicine, you can split that down to one thing. You get out of work, and if you’re someone that needs to exercise, you go to the gym. But that means you’re done. You go to the gym, you go home, that’s it or vice versa, if you’re someone that like myself that really needs to draw, you’ll find the time whether it’s five minutes or an hour to do so, because that is what keeps you sane and anchored. I think once you figure out what that is and it obviously becomes more and more difficult as you get older, because then you’ve got families, and then you have social times, and more responsibilities at work. But if you make that a priority, which I think most people should, it anchors you, and keeps you from getting burnt out so quickly in my opinion.

Jill: Could not agree more. [giggles] Thank you for your perspective on that, because we see, it’s borne out in a lot of different ways. I often say with my physician clients and this comes up in conversations in various ways all the time. Doctors are not afraid of working really, really hard. What burns physicians out is the disconnection from what is meaningful about the work, and a lack of space of what is meaningful in that whole picture of the whole physician, as we call it here on the podcast. I think it’s integral. It’s just not another thing you need to put on your to do list, but it’s an integral fuel to make this meaningful work sustainable. I really love how you put that, and I think that’s an important message for all of our physicians to hear.

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Jill: Couple of other final questions. I think you’re pretty brave sometimes in the message that you share in the art and in the cartoons as you talked about sometimes questioning the machine, [laughs] and how the Institution of medicine is separated sometimes from the human side of what’s happening. We often hear from our physician clients and from physician listeners that culture and the institution of medicine doesn’t always encourage physicians or doesn’t ever really encourage physicians to be vulnerable, even though, we know vulnerability is a really important and meaningful human expression that makes a lot of things better. Is it scary for you to sometimes be vulnerable in your art as you share some of these messages and ideas through that, and can we talk about that experience briefly?

Mike: Yeah, absolutely. It’s another excellent point to bring up. For me, and I think again, this is part and parcel to the way in which I came into medicine, which again is this I guess I “non-traditional route,” I’ve always been unapologetically myself which is usually very vulnerable [chuckles] and a little bit self-flagellating in some degree and poking fun at myself a little bit. I think that in some cases, it was a defense mechanism, but now has become almost a rallying cry, because I see it in all of my colleagues, I would put up these comics poking fun at myself for feeling incompetent, or insufficient, or just not doing as well as I should, I thought I was alone in those feelings. The beauty of things like social media is that, putting that out into an open space, I was shocked at what flooded back at me, which was, “Oh, my God, I feel exactly the same way. You nailed everything that I’m feeling and going through.”

You would never know that. I think people put on this brave face, because this culture of medicine necessitates that or has bred that, because especially, I see my colleagues, these are people that got straight A’s their whole lives, and have always been the best of the best. I wasn’t. I worked hard, but I got very fortunate, and getting into medical school, and then did well afterward but these people were born doing well. I think it’s very hard to always be the best of the best, and then all of a sudden, feel like you’re not, or people around you are doing better, or whatever it may be. 

I think those feelings are never spoken about, and this machine, as you put it, really does drone a lot of the humanity out of you when you’re doing very difficult work, and by difficult, I don’t necessarily mean intellectually difficult, I mean physically and emotionally difficult. People sick, people suffering, people dying, and having to talk to them and their families, and having to try to have these difficult conversations that no education can prepare you for. To not really acknowledge that and acknowledge the privilege that we have to do so, but also the emotional toll that that can take on one another and not have a space to talk about it, or digest it, or deal with it is tough. For me, it was weird that it was easy for me to be vulnerable. But for me, the weird part was the response I didn’t expect that was overwhelmingly everyone saying that they felt exactly the same way.

Jill: Right. Because when we are vulnerable, we are opening the door for meaningful and real human connection. We’re so afraid of it, but it’s such an integral ingredient for meaningful connection, and we know meaningful connection is a huge antidote to burnout. I’m always shouting from the rooftops to my [giggles] physician clients, “You don’t have to be vulnerable with the world but find the people that you trust with that vulnerability, and you’re going to really help serve yourself.” Do you think that some of your willingness to be open and express yourself in a way that is impacting others so well is because of the unique position you come at this role as physician, because you are a patient as well, as a doctor with your previously mentioned type 1 diabetes?

Mike: I don’t know, maybe. It’s hard to say, growing up with diabetes, my makeup is one that I came into medicine, because I was interested in the medicine, but because I just like people. I like to interact with people. I like being able to help people, but I just like those interactions. That was a big reason why I decided not to do a surgical subspecialty, because I wanted more time to spend with my patients. I think it’s just something that I really enjoy. But it’s true, when you deal with a chronic illness yourself, it’s always fascinating to me, like, when I’m sitting in my clinic, and I have a type 1 patient with me, I know what’s going on in their mind. I know what they’re feeling when they get their A1c back, I describe it as when you got your report card from a middle school and your parents are looking at it, you feel, you’re in trouble. I know what that’s like. 

When they find out whether I tell them I’m type 1, or they see my pump or whatever it is, that is such a tangible, palpable change in the room, and it’s like they relax, and they’re like, “Okay, he gets it.” You don’t necessarily need to express the emotional roller coaster that goes into dealing with a chronic disease every day when someone else also lives it. I say that not to say that if you don’t have a chronic disease as a provider that you can’t also have the same level of empathy and understanding. I’m always cautious to say like, “Oh, no, no. My type 1 is not what makes me a more empathetic doctor,” but there is something, an unspeakable bond, that you have when you see someone on the street with their continuous glucose monitor, and you just look at each other like, “Yep, you get it. It’s nice to see,” if you’re just like immediately a family member with them. But regardless, I do think that I have a lot of colleagues that don’t have any medical issues, and they’re way better than I am, than I could ever hope to be as an empathetic and amazing doctor. So, it’s not that you need to have it, but when you do have a chronic condition that you share, it does help, I think.

Jill: Yeah, it’s a different shaped lens that you’re looking at things from not necessarily saying one is better or worse than the other, but it does give you an interesting perspective that can be meaningful. I’m quite sure for the patient’s experience as well. Finally, how did the pandemic affect you as a physician and therefore your art?

Mike: It affected me as a person. It just destroyed me. It was the darkest time of my life without a doubt. It was miserable. Again, it was interesting to me how I didn’t have words to put to what I was experiencing. I was just a shell of a human being. It was really, really hard. I remember there was one particular night or I guess, morning, I had worked a night shift in the COVID ICU, and I came home, and I had just seen horrific things as everyone was in those units in those days, and I couldn’t sleep. I was exhausted, but I couldn’t sleep. I just needed to get that energy out of me. I drew a comic that was loosely based on one of the moments that I experienced that evening. As soon as I finished, I was able to sleep. 

There’s something about that world of graphic medicine, where you put it out onto paper, and you still sit with those feelings. But when you close the book, or when you have something tangible, and you can walk away from it, it does let you digest it in a way that talking about it, or ignoring it, or sublimating it in some way won’t. Again, it was really my art that was helpful. But I also felt this, I don’t know how to describe it this, I was petrified. I was scared out of my mind. But I did feel this pride in being able to have a skill set that could potentially help in the time of need, and that pride was derived from the people around me. When I would walk into the hospital, I absolutely scared out of my mind. I would see my colleagues and they were not scared. They were there to do tasks, and they did that. In seeing them, and their bravery, and their just being incredible humans, I wanted to celebrate them and tell their stories. So, I started to do some portraits at that time in between shifts, when I was home, and all of my friends had the same– well, my friends of medicine said the same, you didn’t really feel scared or unwell until you were at home, when you couldn’t be helping, and you wanted to get back in there, even though you knew that you were exposing yourself and being vulnerable again. But in those moments when I wanted to do something and pay tribute to the people around me, I started to draw them, and I would draw them in their PPE, and I would ask them about their experience, and then put their words behind their portrait to tell their story, because I wanted to lift their voices as well.

Jill: Dr. Mike Natter, MD, second-year endocrinology fellow, and amazing communicator. We have really benefited from your candor, and it’s really inspirational on many, many different levels. Thank you so much for being here. 

Mike: It’s an absolute pleasure. Thank you so much. 

Jill: If you would– I’m not going to say if you would. I’m going to tell you, you need to go to mikenattermedical.com and see the beautiful art that Dr. Natter has created. You can also follow his journey on Instagram @mike.natter. I also, highly encourage you to read his writing great communicator with his blog at BoardVitals. But most of all, I just hope that you also pull some of your own inspiration and think about ways that you can express yourself outside of the silos of just work in order to enrich the important work that you are doing in the world as a whole physician. It’s been great to be with you. I’m Jill Farmer, and we’ll see you next time on DocWorking: The Whole Physician Podcast. 

Thanks all of you for tuning in to listen to this edition of DocWorking: The Whole Physician Podcast. We have something new and exciting to tell you about, so, I want you to hop over to docworking.com. DocWorking THRIVE is getting ready to launch in a very short time, and what that is, is a subscription service for physicians. It includes an excellent self-paced course called STAT, that is all about quick wins for living well. It is group coaching. It is a Facebook group where you have a chance to connect to other physicians and coaches to ask questions about things that are happening in your life. It also includes weekly video tips to come and give you advice on important things in your life. We’re really excited about this. The price is almost too good to be true. It’s so good, and I really think it’s going to be a fabulous support network for physicians. So, we hope you’ll hop on over, check out DocWorking THRIVE, today. Until next time, we’ll see you on DocWorking: The Whole Physician Podcast.

Amanda: Hello, and thank you for listening. This is Amanda Taran. I’m the producer of the DocWorking Podcast. If you enjoyed our podcast, please like and subscribe. We would also love it if you check out our website which is docworking.com. You can also find us on YouTube, Facebook, Twitter and on Instagram. On Instagram, we are @docworking1 and that is with the number one. When you check us out on social, please let us know what you would like to hear on the podcast. Your feedback really means a lot to us. If you’re a physician with a story you’d like to tell, please reach out to me at [email protected] to apply to be on the podcast. Thank you again, and we look forward to talking with you on the next episode of DocWorking: The Whole Physician Podcast.

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