The right metaphor can increase patient understanding

Ohio State University just released a study showing that the language doctors use with their patients can help determine whether these patients agree to participate in clinical trials testing new cancer treatments.

The same thing holds true with chiropractic and other wellness professions — using good metaphors can help explain everything from subluxations to chi energy and determine whether people decide to receive (or continue receiving) care.

The nervous system as water hose metaphor has been used for years.

In the study, doctors explained the concept of “randomization” to a group of 64 low-income, rural women over age 50 living in Appalachia. All of them watched a short video produced by the National Cancer Institute describing clinical trials. They then watched an additional video further explaining randomization, featuring a local doctor.

A third of the participants saw a video which explained randomization using simple language: “Randomization is a method used to ensure the research study is fair. It means that patients are assigned by chance to different treatment groups.”

For a second group, the video explained that randomization was like “a flip of the coin” determining whether they would be in the treatment or standard-care group. “The chance of getting heads is the same as getting tails,” the doctor said.

The third group saw a different video with a local doctor who explained randomization with a metaphor that it was “like determining the sex of a baby. The possibility of a boy is the same as the possibility of a girl.”

Some people didn’t need the “metaphor” video at all. They paid attention to the first video and understood the concept. But for others, the metaphors helped – in different ways.  The “flip of the coin” concept was a turnoff to most (the ‘winner-loser’ notion isn’t real smart when you’re talking about cancer treatment!) while for most of the women, the baby metaphor worked.

Using metaphors to explain concepts like subluxations, neurological functioning and symptoms (such as the well-used light bulb, train system or fire alarm) are all helpful, but we have to consider our “audience” when we choose which metaphor to use. While it may sound sexist to make assumptions about such things, using mechanical or sports metaphors are likely to have more impact on male patients and clients. Metaphors involving relationships and recipes are generally going to elicit more response among women.

As non-medical providers, wellness professionals also need to be careful about using metaphors that portray the body in an overly mechanistic manner. Neurolinguistic psychotherapists Penny Tompkins and James Lawley point out in an article titled The Mind, Metaphor and Health, that “Doctors [i.e., medical doctors] tended to use metaphors which assume the body is a machine (the urinary tract was the ‘waterworks’, bodies could be ‘repaired’, joints suffer ‘wear and tear’); illness is a puzzle (symptoms are ‘clues’ to ‘problems’ that have to be ‘solved’); and a doctor is a controller (they ‘administer’ medication to ‘manage’ symptoms and ‘control’ disease).”

Wellness professionals need to develop and use a new set of metaphors that stress the vitalistic nature of the body without pushing too far into the realm of religious rhetoric. It’s an interesting challenge but the right metaphors ultimately will help redefine health and educate patients.

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