Chandler Calvin, Azarpey Ali, Brinkman Niels, Ring David, Reichel Lee, Ramtin Sina
Author Affiliation: Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin.
Qual Manag Health Care. 2024;33(4):246-252. doi: 10.1097/QMH.0000000000000447. Epub 2024 Sep 30.
This study measured patient reactions to medical metaphors used in musculoskeletal specialty offices and asked: (1) Are there any factors associated with patient thoughts and emotions in response to common metaphors? (2) Is there a difference between patient ratings of metaphors rated as potentially reinforcing misconceptions and those that are more neutral?
In a cross-sectional study, 228 patients presenting to multiple musculoskeletal specialty offices rated reactions to 4 metaphors presented randomly from a set of 14. Two were categorized as potentially reinforcing common misconceptions and 2 as relatively neutral. Bivariate tests and multivariable regression identified factors associated with patient ratings of levels of emotion (using the standard assessment manikins) and aspects of experience (communication effectiveness, trust, and feeling comfortable rated on 11-point ordinal scales) in response to each metaphor.
Levels of patient unhelpful thinking or distress regarding symptoms were not associated with patient ratings of patient emotion and experience in response to metaphors. Metaphors that reinforce misconceptions were associated with higher ratings of communication effectiveness, trust, and comfort ( P < .05).
The observation that metaphors that validate a person's understanding of his or her illness may elicit trust even if those metaphors have the potential to reinforce misconceptions may account for the common usage of such metaphors. Clinicians can work to incorporate methods for building trust without reinforcing misconceptions.
本研究测量了患者对肌肉骨骼专科诊所中使用的医学隐喻的反应，并提出以下问题：（1）患者对常见隐喻的想法和情绪反应是否存在相关因素？（2）被认为可能强化误解的隐喻与较为中立的隐喻在患者评分上是否存在差异？
在一项横断面研究中，228名前往多家肌肉骨骼专科诊所就诊的患者对从14个隐喻中随机呈现的4个隐喻的反应进行了评分。其中两个被归类为可能强化常见误解的隐喻，另外两个则相对中立。双变量检验和多变量回归确定了与患者对每个隐喻的情绪水平评分（使用标准评估人体模型）以及体验方面（沟通效果、信任和舒适感，在11点序数量表上进行评分）相关的因素。
患者对症状的无益思维或痛苦程度与患者对隐喻的情绪和体验评分无关。强化误解的隐喻与更高的沟通效果、信任和舒适度评分相关（P < .05）。
验证一个人对其疾病理解的隐喻即使有可能强化误解也可能引发信任，这一观察结果或许可以解释此类隐喻的普遍使用情况。临床医生可以努力采用既能建立信任又不会强化误解的方法。
