The use of metaphors in General Practice. A Phenomenological Interpretative Analysis in an Italian setting

Background. The metaphor is defined as «an expression which describes a person or an object, by referring to something that is supposed to have similar characteristics» (Cambridge Academic Content Dictionary, 2017). Since the 90s, metaphors were studied in General Practice (GP) as communication phenomena with positive and negative effects on patients. Literature showed a dualistic representation of metaphors as useful or dangerous tools, while no research is available on clinicians’ deliberate use of these expressions. Summary of work. The research question “what is the representation of metaphor provided by professionals who work in a GP group, and eventually its perceived utility?” arose from a gap in the literature, the design was qualitative. The Interpretative Phenomenological Analysis (IPA) (Smith, Flowers & Larkin, 2009) was selected as methodology. The research aimed to understand the representations of physicians, nurses, and administrative assistants in a GP group. Fifteen participants (10 physicians, 3 administrative assistants, 2 nurses) (10 females, 5 males) was recruited with a purposeful sampling. Fifteen semi-structured interviews were conducted about the use of metaphors by participants and their patients. After a month, in-depth interviews were conducted to saturate data. Summary of results. Five categories emerged from the analysis: 1) representing metaphors differently when referring to professionals or patients (e.g. professionals’ metaphors are patient-tailored explanations, patients’ metaphors are symptomatic characteristics); 2) recognizing the clinical value of metaphors; 3) highlighting the strengths of metaphors; 4) underlining the limitations of metaphors; 5) explaining unintentionally issues through metaphors (e.g. the effects of clinical language). Discussion & Conclusions. Metaphors help to educate patients especially in difficult conversations. To overcome the dualism in the literature, this study suggests that a metaphor is an epistemological phenomenon (its use depends from what the participant believes a metaphor is), relational (its use varies according to the professional relationship), and ontological (its use shows personal beliefs and values). Specific curricular activities could be designed for students and professionals’ in CME as well, to recognize and beware of the potential that metaphors have when communicating and educating patients in clinical encounters. Take-home Message: Metaphors can hurt or empower the patient. Awareness is essential.