Thursday, March 11, 2010

Using Similes and Metaphors to Help Patients Learn

Similes and metaphors can act as cool, brisk breezes on a sweltering summer day. They can soothe a patient's frayed emotions, clarify a confusing concept, or build support for difficult lifestyle changes.

The trick is to use them wisely, not toss them about willy-nilly.

First, though, definitions.

A simile is a comparison of two unlike things, typically marked by use of "like" or "as." Here are a few examples:

  • The skin on his shin was as smooth as polished marble.

  • He has a face like an open book.

  • The dressing absorbed the fluid like a sponge picks up water.

A metaphor is an indirect comparison between two or more seemingly unrelated subjects, often taking a " blank is a (or an) blank " form. Examples:

  • Think of the urinary tract as a set of waterworks.

  • Your illness is a real puzzle.

  • The skull caved in.

Similes and metaphors can convey a great deal of information in just a few words. They can also help make complex information more meaningful to the patient, thus enhancing learning and, one hopes, improving health outcomes.

Although these literary constructs generally shouldn't be used in clinical documentation, they can be invaluable in talking with patients, explaining procedures, discussing at-home care, and in similar situations.

Imagine a healthcare professional, while discussing how new capillaries form in the heart when a vessel becomes partly blocked, says to the patient, "The capillaries grow around the blockage like ivy around a fence post."

You can just feel the patient learning and see the light bulb flashing over his head.

A few more examples:

  • It's the kind of itching that feels like ants running around your leg.

  • Please squeeze this ball gently, like it's a squeeze bottle of ketchup.

  • It sounds like the "ping" in a ping-pong match.

Just be careful and make sure the imagery is positive, not negative. Consider these examples as the kind you should avoid:

  • Cancer therapy as a "war"—This is a rather masculine, power-based, and even violent metaphor and may be misconstrued by the patient as if the war can be won if only she fights hard enough.

  • Comparing an arthritic knee to an old car—Don't try this one, especially if the person is, um, significantly life-experienced. (Read: Older.)

  • Disease as a "pit bull" or some such—Yikes! We may think that way as healthcare providers, but that doesn't mean the patient should.

Planning ahead

Most people can't think of really good similes and metaphors in healthcare right off the top of their head. So do this.

If you find yourself describing certain procedures or treatments frequently, sit down and think of three solid, clear metaphors or similes that won't scare a patient. Memorize them, and then use them the next time you're performing the procedure.

Then you'll be as ready as Custer was at Bull Run. Wait, what? That's not right, is it? Hmm, I'd better keep thinking of a good simile.


I'm indebted to two key sources for this post, and I thank them profusely.