HEART BEAT:Nothing describes a medical condition quite like an analogy, writes PAT HARROLD
‘DO YOU know what I’m like?” asked the GP. “I’m like a purveyor of analogies. I peddle them, all day long. I display them to the patients. They might take them on board, they mightn’t.” He stared into the distance, lost in the enormity of his observation.
“They should have taught us this in medical school. There should be courses in it, exams and diplomas. Analogies,” he tails off. “And metaphors.” He smiles. “The whole caboodle.”
Strange as it may seem, I knew just what he meant. When you are confronted by the task of condensing a medical condition and treatment options into a memorable and effective statement, you just can’t beat the analogy. It takes the threat out of the message and gives the patient something to think over before the message is dismissed.
Eczema becomes dry ground with all the top soil removed. An overgrowth of Candida after a course of antibiotics is like an explosion of rabbits if the foxes are all killed. Diabetes and smoking are like two bold puppies. One on its own can create mischief, but put them together and you’re in trouble.
But you have to be careful with the doggy analogies. I once tried to explain the concept of either having a hereditary disease or being a carrier to a man who I knew to be fond of shooting. I was using the example of black and golden Labradors, and explained at great length how one colour can be dominant but the dog can carry the gene for the other colour. I actually spent far too long over it, and it wasn’t important anyway, as he was only asking out of idle curiosity and had come in for an eye test. On and on I went but he just couldn’t get it. At last I found out what was bothering him.
“Where”, he asked bewilderedly, “do the chocolate Labradors come in?”
The area where metaphors are most likely to get mixed and mangled is what is coyly referred to as the “waterworks”. Buckets, hosepipes and pumps are bandied about until you would need a degree in hydraulics, never mind medicine, to understand the conversation yourself.
An elderly patient of mine was told by a consultant that his prostate gland kept growing all his life, like a rat’s teeth. Furthermore, his bladder was like a bucket, and as the years went by there was less room in it. But the good news was that prostate could be re-bored like a shot gun. At this point the old gentleman asked politely could they use the gun to shoot the rat.
Exercise is like the Credit Union. The more you put in, the more you get out. Your ferritin levels denote iron stores, like the deposit account in a bank. Your thyroid is like speed controls on a video; if it is hyper it all goes too fast, hypo and it is too slow. Depression is like a hole in the ground. If you have low blood pressure, you are like a giraffe. If you have high blood pressure you are like a boiler (not to imply that you look like one).
Car analogies have always been useful. The doctor can prattle happily about an abnormal lipid test being like the red light on the dashboard. You can pull in and get it fixed or keep going and wreck the engine. (It helps if you know what state their car is in.) Your hips are like the suspension. If you carry huge weights around, they will get worn down eventually. Mind you, you can go a bit far with this one. If a doctor uses a sporting analogy, it is wise to select the punter carefully. It is no use to compare the immune system to the Munster pack if you are addressing a GAA man, or to talk about Robbie Keane to a Ross O’Carroll Kelly clone. The whole thing will descend into a row and both of you will forget what you were talking about in the first place. Which in some cases may be just as well.
You see, if you are a GP, you are like a train driver, trying to keep the discussion on the tracks. You are like a seanchai, trying to hold attention. You are like a priest delivering a sermon, trying to give a message to take home.
You are like a teacher, an actor, a politician, a confessor and a lawmaker. You are like a careful gardener, a psychologist, a sociologist, a troubadour, a lecturer, a sounding board. You are like a saw doctor, a detective, a companion, a parent, a computer and a scientist.
And if you don’t like any of those, you can just draw diagrams.
Pat Harrold is a GP in Co Galway. Maurice Neligan is on leave