Can metaphors enhance "togetherness" in Family Medicine? : A Phenomenological-Interpretative study in an Italian family practice

Introduction. Educating healthcare professionals to communication skills is a crucial issue in order to inform patients about the risks for their health, and to share together a safe decision-making (Hamilton & Wen-Ying, 2014). Family Medicine (FM) is the field where clinicians and nurses face with a wide-spectrum of pathologies, and are required to know the story of different patients (West, 2001) to sustain a respectful therapeutic alliance (Wonca-Europe, 2011). Using metaphors, when communicating with patients and other professionals (Gibbs, 2008), may improve “toghetherness” and cooperation or, conversely, generate disconnection and discontents. Aims. This qualitative case study aimed to understand the representation that a group of family physicians, nurses and administrative staff, working in an Italian family practice, have about metaphors and their use in healthcare professional communication. The goal of this poster is to investigate whether metaphors enhance or worsen cooperation in the therapeutic relationship, in order to improve undergraduate, postgraduate and continuing healthcare education. Participants. A family practice in Northern Italy was purposively sampled (case study). Fifteen participants (10 physicians, 2 nurses, 3 administrative staff) (10 female, 5 male) worked in the selected center, in the same family practice. Methods. We conducted 15 semi-structured interviews exploring participants’ experience of metaphors in clinical practice/ communication with patients and in their previous education. After a month, all the participants were involved in an unstructured interview, to gather further reflections on metaphors, and for member checking. Following the Interpretative Phenomenological Analysis (Smith et al., 2009), we codified and organized data, finding similarities, differences, and relations among them. Six major categories emerged from the interviews. To improve trustiness, researchers discussed all the phases of the analysis, until agreement was achieved. Finally, results were confronted with the literature. Results. Metaphors are used by participants in their practice, sometimes deliberately. For example, metaphors are used to explain some diagnoses and therapies. Patients use metaphors too, especially when they describe their symptoms. Participants perceive that patients feel closer to them when involved in a clear explanation of therapies and diseases. Metaphors can contribute to make that explanation more understandable, and therefore they can promote closeness. Conversely, according to the participants, metaphors sometimes should be avoided because they may confuse the patient. Additionally, interviewees refer some metaphors may hurt the patient and create discontent (e.g. “the obese”). Discussion. Metaphors have revealed cues that can shape the therapeutic relationship, creating a stronger connection with the patient or, conversely, disconnection and discontent. From the interviews it emerged that participants not always are aware of their use of metaphors, when communicating with patients and other professionals. To enhance awareness about this issue, specific curricula could be designed, in order to help students/professionals reflect on metaphoric language as a strategy to promote “togetherness” in the clinical encounter. Further research is needed on the role of metaphors in promoting a sense of belongingness in general practice teams and, therefore, in shaping professional identity (Salling Olesen, 2007). References Wonca-Europe (2011). The European definition of General Practice/Family Medicine. Retrieved from: http://www.woncaeurope.org/sites/default/files/documents/Definition 3rd ed 2011 with revised wonca tree.pdf Lakoff G. & Johnson M. (1980). Metaphors we live by. Chicago: University of Chicago Press. Hamilton H, & Wen-Ying S. (2014). The Routledge Handbook of Language and Health Communication. London-New York: Routledge. Salling Olesen H. (2007). “Professional Identities, Subjectivity, and Learning. Be(com)ing a General Practitioner”. In West L., Alheit P., Anderson A. & Merrill B. (Eds.). Using biographical and life history approaches in the study of adult and lifelong learning: perspectives from across Europe. Frankfurt-Am-Main: Peter Lang Verlag. Smith J., Flowers P. & Larkin M. (2009). Interpretative Phenomenological Analysis. London: SAGE. West, L. (2001). Doctors on the edge. London: Free Association Book.