Medical Metaphors: Increasing Clarity but at What Cost?

Document Type : RESEARCH PAPER

Authors

1 Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas at Austin, Austin, Texas

2 Department of Population Health, University of Texas at Austin, Austin, Texas

Abstract

Background: Clinicians often use metaphors to explain complex ideas. Metaphors also have the potential to reinforce 
unhelpful thinking regarding symptoms. We surveyed musculoskeletal specialists regarding use of metaphors in their 
daily practice and then assessed the contexts in which they are used, the themes of metaphors, and potential for 
reinforcement of common misconceptions (unhelpful thinking). 
Two primary research questions were posed: 1- What are the common characteristics of the medical metaphors used in 
patient-clinician communication by musculoskeletal specialists? And, 2- What percentage of medical metaphors used 
in patient-clinician communication have potential to induce unhelpful thinking and what are the characteristics of those 
metaphors? 
Methods: Eighty-one orthopedic and trauma specialists provided examples of metaphors they use in daily practice. 
Qualitative analysis of responses was performed through open coding of the data with the use of a constant-comparative 
technique involving several rounds of reading and rereading the data.
Results: The 157 metaphors were categorized into 15 different themes. The most common themes were mechanical, 
objects, and sports and leisure. We also classified metaphors as addressing the natural history of the disease, treatment, 
mechanism, anatomy, or other. Thirty-five metaphors (22%) were identified as having the potential to reinforce unhelpful 
thinking. The most common purpose of these metaphors was for explaining the mechanism or natural history of the 
disease.
Conclusion: Metaphors can either reinforce or reorient potentially unhealthy misconceptions. They can also reinforce 
despair and worry, or they can improve hope and sense of control. Orthopedic surgeons can be strategic and thoughtful 
in their use of metaphors, planning and practicing specific metaphors for optimal mental, social, and physical health. 
Level of evidence: N\A 

Keywords

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The Archives of Bone and Joint Surgery
Volume 10, Issue 8
August 2022
Pages 721-728

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History

  • Receive Date: 10 September 2021
  • Revise Date: 18 December 2021
  • Accept Date: 26 December 2021

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