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Comment & Response
August 1, 2017

Risks of Medical Metaphors

Author Affiliations
  • 1University of North Carolina School of Medicine, Chapel Hill
  • 2University of South Carolina School of Medicine, Columbia
JAMA. 2017;318(5):482. doi:10.1001/jama.2017.8197

To the Editor In the A Piece of My Mind article, Ms Trogen1 identified potential problems associated with the use of metaphor in the education of patients. Although we agree with her call for more effective communication with patients, we have reservations about the implications of extending the evidence-based paradigm to the use of metaphor.

There is a conceptual error inherent in evidence-based practice when practitioners seek to apply population-level empirical data to make definitive claims about particular patients.2 We suspect this shortcoming could be amplified in the application of population-level, “evidence-based” metaphors to individual patients. The use of effective and fitting metaphor in medicine requires attention to the particularities of patients’ own stories, beliefs, experiences, and vernacular. As such, medical metaphors, as an extension of language, are inherently participatory and require a level of nuanced specification that other evidence-based practices do not. We have concerns that the application of evidence-based metaphors could therefore constrain the very adaptability that allows such speech to be both accessible and rhetorically compelling for patients.