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Metaphorically transmitted diseases. How do patients embody medical explanations?
1Institute of General Practice, University of Aarhus, Denmark.
Background:
The examination was guided by recent theories on metaphors, holding that our conception of the physical world in many ways derives from personal bodily experiences. Such experiences are fundamental to the elaboration of abstract structures of meaning, which, through metaphorical projections, provide a constitutive role in our overall comprehension of the world. It is thus to be assumed that patients will bring their own cluster of metaphors into the consultation room to structure the doctor's explanations. Our study was an attempt to identify some manifestations of this work of structuring and to learn about its consequences for interpersonal communication between patient and doctor.
Objective:
The aim of this study was to examine how, and to what extent patients in a general practice understand pathoanatomical and pathophysiological disturbances as explanations of their illness.
Method:
The empirical basis of the study comprised interviews with a group of patients from a general practice, who were asked to narrate their understanding of medical disturbances. Based on these interviews we identified and classified a number of metaphors they used to describe bodily problems and relations. A deviating mechanical understanding of the body, which we characterize as ethnomechanics, was manifest in all the interviews. This understanding is expanded upon and its significance discussed. Although patients do not feel qualified to understand scientific explanations of their health problems, they do relate to a scientific disease mode of understanding. They do not, however, relate to the fine details and professional implications of this mode. Instead they will associate medical explanations with their pre-established, illness-based system of understanding through imaginative projections.
Conclusions:
Doctors need to be aware that patients possess such imaginative and experiential resources to make sense of medical explanations. Attempts to draw patients radically away from these resources may cause confusion and undesired breakdowns in the communication between them and their physician.
Insights
Patients use personal metaphors and an "ethnomechanics" understanding to interpret medical explanations, rather than detailed scientific concepts. Recognizing these imaginative resources is key for effective doctor-patient communication.
Area of Science:
- Medical Sociology
- Cognitive Linguistics
- Patient Communication
Background:
- Patient understanding of illness is shaped by embodied experiences and metaphorical thinking.
- Patients utilize personal metaphors to structure and comprehend medical explanations.
- This study explores how patients' metaphors influence their interpretation of doctor's explanations.
Purpose of the Study:
- To investigate patient comprehension of pathoanatomical and pathophysiological explanations in general practice.
- To identify the extent to which patients understand scientific illness explanations.
Main Methods:
- Qualitative study involving interviews with general practice patients.
- Analysis of patient narratives to identify and classify metaphors for bodily problems.
- Characterization of a prevalent mechanical body understanding as 'ethnomechanics'.
Main Results:
- All interviewed patients exhibited an 'ethnomechanical' understanding of the body.
- Patients relate to scientific disease models but not intricate details.
- Patients integrate medical information with pre-existing, metaphor-driven understanding.
Conclusions:
- Doctors should acknowledge patients' imaginative and experiential frameworks for understanding illness.
- Radically diverging from patient metaphors can lead to communication breakdown.
- Respecting patients' sense-making resources is crucial for effective medical communication.