UF doctors examine cancer metaphors

Doctors warn that war comparisons turn some patients off.

Published: Wednesday, January 12, 2005 at 6:01 a.m.
Last Modified: Wednesday, January 12, 2005 at 12:59 a.m.
Cancer is the enemy, and in the war against it, the weapons can be chemical, biological or nuclear.
But Dr. Gary M. Reisfield, a University of Florida physician, warns that doctors who depend on warlike metaphors for doctor-patient communication may lose more than the battle. It could cost them their patients.
"War talk is easily adaptable to cancer," said Reisfield, an assistant professor of community health and family medicine at the UF Health Science Center in Jacksonville.
"The enemy is cancer, the commander is the physician, the combatant is the patient and the allies in the battle are the health-care team," he explained.
Unfortunately, thinking of cancer in those terms suggests that defeating the disease is just a matter of fighting hard enough, even if opting out of the battle might be a better choice for a patient who will see little benefit from further treatment.
Although metaphors can help a patient understand their disease, battlefield analogies can strike some as overly masculine, power-based, paternalistic and violent, said Reisfield and his co-researcher, Dr. George R. Wilson, associate chairman of community health and family medicine at UF Jacksonville.
The pair have published their findings in the current issue of the Journal of Clinical Oncology.
Reisfield points to the case of six-time Tour de France winner Lance Armstrong. Armstrong was diagnosed with testicular cancer and switched oncologists after the first specialist he saw told him he would hit him so hard with chemotherapy that he would virtually kill him.
It wasn't a message the world-class cyclist wanted to hear. Instead, Armstrong adopted his own metaphor - that he was in the most important bicycle race in the world. It's a race he apparently has won.
For their study, Reisfield and Wilson analyzed dozens of narratives of illness, looking at how the patients involved used or felt about metaphors.
The human brain is wired to operate in metaphors, the researchers said, but oncologists need to be sensitive to the language they and their patients use.
"We all think in metaphors," said Reisfield, adding that such comparisons are useful in today's medicine, where a doctor's visit may last only five minutes. "Metaphors are part of a physician's bag of tricks. Some are enabling for our patients, and others are disabling."
Reisfield suggests that a journey metaphor may be much more relevant to a cancer patient than a battlefield comparison, as an increasing number of cancer patients may live with their disease for years.
"The life-is-a-journey comparison is a quieter metaphor and has the depth, richness and seriousness to apply to the cancer experience," he said. "The road may not be as long as one hoped, and important destinations may be bypassed, but there's no winning, losing or failing."
The UF study doesn't tag a metaphor as good or bad, but suggests that a metaphor's usefulness depends on each individual's value system. Patients devise their own metaphors based on what they know and value. A physician's role is to listen.
About 90 million American adults have difficulty understanding basic medical information, according to an Institute of Medicine study published last year. Choosing the appropriate metaphor can help patients understand, communicate and thus symbolically control their illness.
Language that works for one patient may not work for another, Wilson said, "but metaphorical skill, imagination and sensitivity can help create rapport and communicate the nature of unshared experience."
Diane Chun can be reached at (352) 374-5041 or chund@gvillesun.com.

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