Can metaphors enhance togetherness in Family Medicine? A phenomenological-interpretative study in an Italian Family Practice

Introduction. Educating healthcare professionals to communication skills is a crucial issue in order to inform patients about the risks for their health, and to share together a safe decision-making (Hamilton & Wen-Ying, 2014). Family Medicine is the field where clinicians and nurses face with a wide-spectrum of pathologies, and are required to know the story of different patients (West, 2001) to sustain a respectful therapeutic alliance (Wonca-Europe, 2011). Using metaphors, when communicating with patients and other professionals (Hanne, 2015), may improve “togetherness” and cooperation or, conversely, generate disconnection and discontents. Aims. This qualitative case study aimed to understand the representation that a group of family physicians, nurses and administrative staff, working in an Italian family practice, have about metaphors and their use in health communication. The goal of this poster is to investigate whether metaphors enhance or worsen cooperation in the therapeutic relationship, in order to improve undergraduate, postgraduate and continuing healthcare education. Participants. A family practice in Northern Italy was purposively sampled (case study). Fifteen participants (10 physicians, 2 nurses, 3 administrative staff) (10 female, 5 male) worked in the same practice. Methods. We conducted 15 semi-structured interviews exploring participants’ experience of metaphors in clinical communication with patients, and in their previous education. After a month, all the participants were involved in an unstructured interview, to gather further reflections on metaphors, and for member checking. Following the Interpretative Phenomenological Analysis (Smith et al., 2009), we codified and organized data, finding similarities, differences, and relations among them. Five major categories emerged from the interviews. To improve trustiness, researchers discussed all the phases of the analysis, until agreement was achieved. Finally, results were confronted with the literature. Results. Metaphors are used by professionals in their practice, sometimes deliberately. For example, to explain some diagnoses and therapies (“take a hammer to crack a nut”). Patients use metaphors too, especially to describe their symptoms (“I have a cat scratching my throat”). Participants perceive that patients feel closer to them when involved in a clear explanation of therapies and diseases. Metaphors can contribute to make that explanation more understandable, and therefore they can promote closeness. Conversely, according to the participants, metaphors sometimes should be avoided because they may confuse the patient. Additionally, interviewees refer some metaphors may hurt the patient and create discontent (e.g. “the obese”). Discussion. Metaphors have revealed cues that can shape the therapeutic relationship, creating a stronger connection with the patient or, conversely, disconnection and discontent. From the interviews it emerged participants not always are aware of their use of metaphors, when communicating with patients and other professionals. To enhance awareness about this issue, specific curricula could be designed, in order to help students/professionals reflect on metaphoric language as a strategy to promote “togetherness” in the clinical encounter. Further research is needed on the role of metaphors in promoting a sense of belongingness in general practice teams and, therefore, in shaping professional identity (Salling Olesen, 2007).