Metaphors in medicine

Nov 06, 2014

The Twitter post on Wednesday from Mike Stewart (@knowpainmike) followed on from our Tweet chat on philosophy and physiotherapy on Monday night, and quite a lot of work from people like Jack Chew (http://chewshealth.co.uk) to explore the role of metaphors in health care.

It reminded me of a meeting I had some years ago with Alan Bleakley, Professor of Medical Education and Medical Humanities at the Plymouth University Peninsula School of Medicine in England (click here to read his profile on the International Health & Humanities Network website).

We met in Reykjavik at my first In Sickness and In Health Conference and his presentation blew me away. Alan was talking about the power of metaphors in medicine. He has a passion for medical humanities (another subject vastly under-explored in physiotherapy), and talked about some of the changes that they were implementing in the medical school curriculum as a result of their research.

He presented a study where he had put visual artists in the same room as pathologists. Pathologists spend their lives looking at tissue samples under microscopes, but they learn to 'read' the images in quite biomedical ways. They look for the presentation of abnormality based on their extensive knowledge of human pathology, but it's well known that their accuracy is very variable - partly because their ability to think in literal terms is essentially an abstract and unnatural way to view the world.

So Alan got visual artists to look at the same slides that the pathologists were looking at and realised that they looked at them very differently. They had none of the pathological schooling of the scientists, but had the trained eye of a visual artist. They saw negative space, visual fields, and, most importantly, visual representations of common objects and everyday things. One photographer looked at a slide of cirrhotic liver cells and thought it looked like a strawberry. Which, you'd have to admit, would be pretty memorable!

This got them thinking...if the pathologists could be trained to see the way the visual artists did, would it help them to be better pathologists? So they worked together looking at different slide samples, and the artists offered the pathologists their metaphors and methods of learning and, sure enough, the pathologists retained much more and dramatically reduce the error rate. Now every time one of the pathologists sees 'strawberries', they instantaneously know what they're seeing.

Metaphors are not only the province of visual artists though. Most of our patients tell stories in metaphors as ways of getting across the complexities of their life stories in the limited time we give them to explain why they need us. Like the pathologists, we're often not that great at seeing what they're saying because we've focused so much on our objective measurement skills. Hopefully, Mike, Jack and the other physios now looking at metaphors in pain, neuroscience and elsewhere will provide some good advice on how to make more of metaphors in the future.

The Critical Physiotherapy Network Herald

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