The Monkey King's dilemma: Metaphorical constructions of physicians' identity and doctor-patient communication in...

In the context of tense doctor-patient relationships, physicians' understandings of their own roles and relationships may be relevant to clinical communication. This study examines how Chinese physicians construct their understanding of doctors, patients, and doctor-patient relationships through metaphors, and analyses cross domain shifts in metaphorical paradigms.

This study used Elicited Metaphor Analysis (EMA) and surveyed 222 frontline physicians in China. The respondents completed three metaphorical prompts about doctors, patients, and doctor-patient relationships, generating a total of 666 statements. The responses were coded into three macro paradigms: Humanistic/Cooperative, Service/Burnout, and Mechanistic. Chi-square tests examined differences by career stage and hospital tier, while Sankey flow mapping visualized within participant transitions across the three elicitation domains (M1-M3).

Humanistic/cooperative metaphors dominated, accounting for 61.1% (407/666); Service/burnout metaphors accounted for 23.3% (155/666); mechanistic metaphors accounted for 15.6% (104/666). Sun Wukong (the Monkey King, a powerful yet constrained Chinese mythic hero) and beasts of burden metaphors embody the tension between expected clinical omnipotence and limited physician autonomy. There were differences in baseline self-metaphors among different career stages, with service/burnout metaphors being more prominent among mid-career doctors; there was no significant difference across hospital tiers. Flow analysis showed that 95 doctors (42.8%) maintained the same paradigm across the three nodes; among 148 doctors who used humanistic/cooperative self-metaphors, 44 (29.7%) shifted to the service/burnout paradigm when describing doctor-patient relationships.

Chinese physicians' elicited metaphors were predominantly Humanistic/Cooperative, while some showed a shift toward Service/Burnout framing in the relationship domain, highlighting cross domain variation in physicians' metaphorical conceptualizations.

Doctor patient communication support could combine empathy and communication skills training with organizational support, particularly for mid-career physicians; reflective support approaches such as Balint groups and clearer medical dispute resolution and occupational safety support may also be considered.