Translating the Metaphors: Improving Communication Between Patients

No matter what style of the medicine you practice, you’re bound to have to explain things. There’s no question that using words like Qi seem too ethereal for most patients, and if we’re to mention Liver-Qi Stagnation the only word our patient hears is ‘liver,’ they grab their right flank, and worry about their physical organ.

The language of the medicine is important. In fact, I try to teach students and recent graduates: “Master the language, and you master the medicine.” If we don’t use the language of the medicine, we can’t diagnose and treat our patient because the diagnosis is the treatment. That being said, I also believe the language of the medicine is for us, and us alone - to help us diagnose and communicate with each other, but not for our patients.

I share many of my patients with Naturopathic Doctors and Osteopaths. Patients frequently tell me they have adrenal fatigue, or that their gallbladder had fallen out of its place but it got put back. This type of language is useless for the patient without the right explanation. I’m going to share how I use metaphors inspired by Chinese medicine to answer my patients’ questions.

How Does Acupuncture Work?

This is likely the most common question - and a difficult one because patients want the answer put to them in plain biomedical language. As I’m placing needles, and get probed with the question as to how acupuncture works, I use it as a way to start teaching patients how I will be communicating with them for the remainder of our relationship: in metaphors. I tell them I practice metaphorical medicine - everything I do for a living doesn’t exist. (They laugh at this.) The key to the metaphors is that they point to something else: a collection of symptoms or a way of living. Chinese medicine relies on systems diagnosis. Collection of data is key.

“It’s the can of worms question,” I say. “So prepare yourself!” (More laughter. Laugher is the best medicine…) Have you heard of the word Qi? Qi often gets translated as air, breath or energy. I like to translate it as healing potential. It’s like the steam coming off of rice, it’s not quite air and it’s not quite rice. It has the potential to be air or steam. By stimulating the Qi in the acupuncture channels, I’m influencing the body’s healing potential - the ability for the body to heal itself. This is just like homeostasis. Sometimes we bump our elbow and it gets better. When it doesn’t get better, that’s where bodyworkers come in - we remind the body that is has the potential to heal. All patients understand that.

Then I hit ‘em with what they want to hear: the biomedical technical jargon. I finish with this because it’s likely what they are going to remember and this is the answer they want. I tell them that studies show an internal massage by way of needle: 1. changes tissue morphology, 2. is anti-inflammatory, 3. and is analgesic. I’ve never had anyone ask me this question twice after explaining it in a two-tiered way.

What Does My Tongue and Pulse Tell You?

I look for colour, coating, cracking and shape when diagnosing a tongue. I tell patients this. I tell them I can primarily see how their digestion is doing and that it reflects their core (I then motion to my chest and abdomen). The tongue is like the soil of a potted plant. We can know a lot about the environment a plant is growing in by just looking at the soil. Is it too wet? Too dry? Something growing on it? Also, the tongue takes a long time to change. It’s the past.

The pulse is the now. Again, it reflects the core, and I’m looking for rate and rhythm, but it can change in an instant. I could ask a patient about their dog that passed away recently and the pulse will change. The tongue is the past and the pulse is the present.

Liver-Qi Stagnation

Another common question is, “So. What did you find? What’s wrong with me?” I really try to avoid naming any condition for my patient in regards to their Zang-Fu organ. It causes nothing but problems. Do you remember when you had a hard time learning the difference between your heart and your Heart? It’s only after years of practicing Chinese medicine that I can reference the right amount of overlap between a Western and Eastern organ system. (The concept of blood/Blood in the liver/Liver is a pretty good one that overlaps, but the concept of small intestine/Small Intestine does not.)

Let’s look at Liver-Qi Stagnation as an example, as this way of communicating can be used for any other Zang-Fu diagnosis.

“What’s wrong with me?” the patient asks. So I tell them what they already know, and, likely, what they already told me during the initial interview. This might seem silly, but it isn’t. It builds rapport, and it teaches them how Chinese medicine works. “You’re not a human. You’re a tree!” (More laughter.) A patient has branches and my job is to see which ones have a common root. Then, the treatment is to geared to target both the branch and root at the same time. The patient has been going through a very stressful time lately, they are experiencing pain in the stomach area, pain before menstruation, and temporal headaches (oh - and the pulse felt like an over-tightened guitar string) - symptoms that all point to the same diagnosis. I tell them all of this. They can really relate to feeling like an over-tightening guitar! More metaphors are a good thing. Patients learn that they aren’t apart from nature, they are a part of it.

And you don’t have to name that diagnosis - I promise. Just by telling a patient that they are all related is enough. They understand what they already know.

More Words Count Less

Chapter Five of the Tao Te Ching ends with

More words count less.

Hold fast to the center.

(translation by Gia-fu Feng and Jane English)

Patients don’t have the education we have. They don’t use the language we use. So we have to come up with metaphors to teach them about nature, themselves and the role that nature, emotions, diet, etc. affect them. This takes practice. However, if I’ve learned anything in my years of practice is that more words count less. 40-80% of medical information provided by healthcare practitioners is forgotten immediately.* So don’t confuse them with too many terms or information.

When you read the Tao Te Ching or the Ling Shu, what kind of feeling do you get? It’s the same feeling a sunset or a poem gives you. That’s the same feeling we’re trying to lead our patients to, and we do this through creating metaphors. Steal what I say. Say it a bunch of times to your patients. Then modify it and make your own words informed by your own ideas and life experiences.