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Communication and Health: Do Metaphors Matter?

Mariah LaRue

As scholars of health communication we focus on messages about health. Often, the communication we think about relates to messages designed to inform about health, whether it’s in the context of a public health campaign, or an interpersonal context between patients and providers. While these messages are certainly important, we must not overlook smaller, almost subconscious types of health communication. These types of communication are evident in the words and metaphors we use to describe aspects of health and healthcare. For example, illnesses are often described in terms of metaphors. It is common to hear people say things like “she’s battling cancer”. As we learned in Dr. Lambert’s class, the way people talk about illness helps shape their experiences with it. If a person views illness as a battle they may make sense of it in a different way than someone who sees illness as a journey. 

Another area where metaphors can shape health experience is in the way health systems describe patients. Lately, there has been a movement to refer to patients as “clients”, “customers”, or “partners”. These words may seem like synonyms, but the words used to describe the patient can shape how patients and providers make sense of their roles in an interaction. For example, the term “patient” has connotations of passivity. Historically, patients did not take an active role in their care and relied on the doctor to tell them what treatment they needed. Using the term “patient” to describe a role in an interaction can help perpetuate traditional, paternalistic patient-provider interactions. 

Lately, there’s been a push towards shared-decision making and patient centered care. Consider how referring to a patient as a partner might change the dynamic between patients and providers. Framing a patient as a partner creates a context in which the patient has more power. Suddenly, the patient is an equal player in his or her own care. Similarly, referring to a patient as a client or customer could change the dynamic in different ways. In a traditional customer- service provider relationship the customer often holds more power because it is assumed the service provider’s job is to serve and please the client or customer. This framework has interesting implications for healthcare. In some ways, it gives the patient more of a voice, but some argue it takes the focus away from providing quality medical care, and emphasizes unimportant parts of the healthcare experience. As health organizations become focused on patient and customer satisfaction scores, clinicians are forced to play a customer service role rather than focus on what they were trained to do, which is provide good medical care. While some people find the patient as a client metaphor empowering, others find it problematic. 

None of these words are right or wrong. Rather, they illustrate how the language we use to talk about something matters. It is worthwhile to think about how seemingly unimportant metaphors are internalized because they have the potential to influence the larger narratives and perspectives we hold about health at individual, organizational, and societal levels.