Mabeck C E, Olesen F
Institute of General Practice, University of Aarhus, Denmark.
Fam Pract. 1997 Aug;14(4):271-8. doi: 10.1093/fampra/14.4.271.
The examination was guided by recent theories on metaphors, holding that our conception of the physical world in many ways derives from personal bodily experiences. Such experiences are fundamental to the elaboration of abstract structures of meaning, which, through metaphorical projections, provide a constitutive role in our overall comprehension of the world. It is thus to be assumed that patients will bring their own cluster of metaphors into the consultation room to structure the doctor's explanations. Our study was an attempt to identify some manifestations of this work of structuring and to learn about its consequences for interpersonal communication between patient and doctor.
The aim of this study was to examine how, and to what extent patients in a general practice understand pathoanatomical and pathophysiological disturbances as explanations of their illness.
The empirical basis of the study comprised interviews with a group of patients from a general practice, who were asked to narrate their understanding of medical disturbances. Based on these interviews we identified and classified a number of metaphors they used to describe bodily problems and relations. A deviating mechanical understanding of the body, which we characterize as ethnomechanics, was manifest in all the interviews. This understanding is expanded upon and its significance discussed. Although patients do not feel qualified to understand scientific explanations of their health problems, they do relate to a scientific disease mode of understanding. They do not, however, relate to the fine details and professional implications of this mode. Instead they will associate medical explanations with their pre-established, illness-based system of understanding through imaginative projections.
Doctors need to be aware that patients possess such imaginative and experiential resources to make sense of medical explanations. Attempts to draw patients radically away from these resources may cause confusion and undesired breakdowns in the communication between them and their physician.
本研究以近期关于隐喻的理论为指导，该理论认为我们对物理世界的概念在很多方面源于个人的身体体验。这些体验对于阐述抽象的意义结构至关重要，而这些结构通过隐喻投射，在我们对世界的整体理解中发挥着构成性作用。因此，可以假定患者会将自己的隐喻集群带入诊疗室，以构建医生的解释。我们的研究旨在识别这种构建工作的一些表现形式，并了解其对医患人际沟通的影响。
本研究的目的是考察全科医疗中的患者如何以及在多大程度上理解病理解剖和病理生理紊乱对其疾病的解释。
本研究的实证基础包括对一组来自全科医疗的患者进行访谈，要求他们叙述对医疗紊乱的理解。基于这些访谈，我们识别并分类了他们用来描述身体问题及关系的一些隐喻。一种偏离常规的对身体的机械理解，我们将其定义为民族机械论，在所有访谈中都有体现。我们对这种理解进行了扩展并讨论了其意义。尽管患者觉得自己没有资格理解对其健康问题的科学解释，但他们确实与一种科学的疾病理解模式相关。然而，他们并不涉及这种模式的细微细节和专业含义。相反，他们会通过想象投射将医学解释与他们预先建立的、基于疾病的理解系统联系起来。
医生需要意识到患者拥有这种富有想象力和体验性的资源来理解医学解释。试图让患者彻底远离这些资源可能会导致他们与医生之间的沟通出现混乱和意外的中断。
