Medical Metaphors: Increasing Clarity but at What Cost?

Document Type : RESEARCH PAPER


1 University of Texas as Austin, Dell Medical School Department of Surgery

2 Department of Population Health, University of Texas at Austin

3 University of Texas, Dell Medical school, Department of Surgery and Perioperative Care

4 Dell Medical School -- The University of Texas at Austin


Purpose: Clinicians often use metaphors to explain complex ideas. Metaphors also have the potential to reinforce unhelpful cognitive bias 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 (cognitive biases).
Object: 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 cognitive bias 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 cognitive biases. The most common purpose of these metaphors was for explaining the mechanism or natural history of the disease.
Conclusions: 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.
Clinical Relevance: Surgeons should be attentive about using proper metaphors to prevent reinforcing misconceptions.


Articles in Press, Accepted Manuscript
Available Online from 15 February 2022
  • Receive Date: 10 September 2021
  • Revise Date: 18 December 2021
  • Accept Date: 26 December 2021
  • First Publish Date: 15 February 2022