Can a picture really paint a thousand words?

Plastic surgeons require a three-dimensional appreciation of form and function in order to meet reconstructive challenges. The popular perception that plastic surgeons must be artistic was tested in an observational study of sketch illustrations in plastic surgery case notes. Only in the trunk and breast category of illustrations could career plastic surgeons demonstrate superior artistic skill to non-career plastic surgeons and there was little correlation between the artistic merit of a diagram and the likelihood of its meaning being understood by an independent observer. Simple but accurate outline sketches are as capable of leading an observer to the correct diagnosis as complex works of art, while illustrations with low diagnostic scores are not only misleading but may also have medico-legal implications.