Doctors being up there and we being down here: a metaphorical analysis of talk about student/doctor-patient relationships

This paper describes the metaphorical conceptualisations of student/doctor-patient relationships, as articulated by multiple stakeholders in healthcare. Eight focus group discussions with 19 patients, 13 medical students and 15 medical educators (comprising doctors, other healthcare professionals and non-clinical academics) were conducted in England and we subjected our transcribed and audiotaped data to a secondary level of data analysis i.e. systematic metaphor analysis. The analysis revealed six over-arching metaphors associated with the target domain of student/doctor-patient relationships i.e. STUDENT/DOCTOR-PATIENT RELATIONSHIPS AS WAR, HIERARCHY, DOCTOR-CENTREDNESS, MARKET, MACHINE and THEATRE. All of the metaphors (except theatre) emphasised the oppositional quality of student/doctor-patient relationships. Three of the source domains emerging from our empirical data (i.e. hierarchy, doctor-centredness, and market) relate to metaphors already employed in the non-empirical literature to discuss doctor-patient relationships (e.g. paternalism, patient-centredness, and consumerism). The three remaining source domains (i.e. war, machine and theatre) were novel in their conceptualisation of student/doctor-patient relationships, albeit that they have been reported in previous empirical literature to describe other target domains. In this paper, we discuss each of these metaphors and their associated entailments, including those found in our data and those absent from our data. We also differentiate between the unconscious use of metaphorical linguistic expressions by our participants and those serving a rhetorical function. Although analysing metaphoric talk is not without its difficulties, the construction of metaphoric models can help social researchers better understand how individuals conceptualise and construct student/doctor-patient relationships.