Effective Analogies to Improve Patient Understanding

There are any number of quotes we can use that pokes at the perpetual issue of clinicians using overly complex terminology when communicating with patients about their health.

"One good analogy is worth three hours discussion" - Dudley Field Malone

The better we are able to help a client understand what is happening to their body, what the purposes of our treatments are and how they are related, the more likely they are to take an active role in their health journey.

I'll be sharing some analogies today that will hopefully a) demonstrate today's thoughts in action, and b) help you explain some concepts to your patients

Before we dive into how we can develop, utilise and refine some analogies, I want to explore why it's so relevant for us as clinicians to appreciate their utility.

Regardless of what quote we'd choose to lean on, the overall message remains is clear;
Patient communication is essential for providing quality care and at times, forms the foundation of achieving a positive treatment outcome.

If we are utilising over-complex information, delivering a tsunami of information and/or not tailoring our communication to the person sitting in front of us, for whatever reason (lack of understanding as to how to bridge the communication gap, ego, lack of time, lack of empathy etc), we're short-changing not only our patients, but ourselves.

Patient-Centered Communication

Patient-centered communication (PCC) is a form of communication based on patient-centered care, which is "providing care that is respectful of and responsive to individual patient preferences, needs, and values."

PCC allows for patients and healthcare providers to work together to make decisions.

One element of PCC is ensuring that patients understand information about their health conditions, including achieving a shared understanding of the health issue and treatment.

Clarity of the health information being delivered is an essential component of patient-centered communication.

Provider PCC results in increased patient recall and satisfaction. Hildenbrand & Perrault (2022)

Analogies may align with the concept of PCC because they can be used by providers to explain medical information to patients, with the goals of helping patients better understand medical information and working to generate a positive relationship with patients.

Effective communication extends far beyond the words we say, though they remain an important piece of the puzzle.

A brilliant paper that outlines the importance of clear communication, its various methods of delivery, and its impact on patient understanding quite well is; Lived experience and attitudes of people with plantar heel pain: a qualitative exploration. Cotchett et al (2020).

Below is an infographic I've adapted from the elements of this qualitative paper. The paper aimed to gather patients’ perspective regarding their lived experience, attitudes and educational needs in relation to plantar heel pain, in order to inform clinicians regarding the types of content that may be beneficial, and to guide how the provision of meaningful education may be delivered.

The results of the study identified people with plantar heel pain (PHP) experience uncertainty across multiple areas of their presentations, including; their diagnosis, cause, prognosis and treatment options.

This resulted in participants reporting experiencing frustration and struggling to find an appropriate treatment plan to meet their needs.

Looking at little closer at the result of the study;

"Participants sourced information largely from health professionals but had variable experiences of how useful it was and how well it was provided."

"Participants also expressed the desire to have their pain eliminated and education delivered that was clearly communicated and individually tailored to their condition and needs."

What can we take away from this?

Given a large volume of information provided to patients regarding PHP (and other pathologies) comes from health professionals, we have a responsibility to ensure the quality of our communication & the quality of the information conveyed is not only evidence-based, but also communicated in a way that is easy-to-understand, relatable and meaningful to the client receiving the information.

This is where analogies may play a role...

Analogies

"A comparison between one thing and another, typically for the purpose of explanation or clarification." - Oxford Dictionaries

An analogy is a comparison between two things, typically for the purpose of explanation or clarification.

In healthcare, analogies can be used to enhance comprehension of medical concepts by comparing them to familiar or more easily understandable concepts.

In short, we as providers may use analogies to clarify medical concepts and assist our patients in comprehending health-related information.

Analogies can be particularly useful when patients are dealing with complex or difficult-to-understand health issues, as they can help patients better understand medical information and they may also serve to improve the provider-patient relationship.

Analogies may serve as a form of patient-centered communication, as they may contribute to the desired goal of shared understanding, as well as increasing the clarity of the health information we are providing, which we now know, are both essential components of patient-centered care.

Grace M. Hildenbrand & Evan K. Perrault (2022)
The influence of physician use of analogies on patient understanding, Communication Quarterly, 70:5, 495-518

"Because PCC involves gearing treatment toward the desires of patients, and since so many participants indicated they find it helpful when providers use analogies, providers may want to consider incorporating analogies into their consultations." (Hildenbrand & Perrault, 2022).

Analogies as Memorable Messages

Analogies help patients remember by making complex or unfamiliar information more accessible and understandable. Analogies may also help patients recall information, by creating a mental image or association that can be easily retrieved from memory.

"Memorable messages are verbal messages that are recalled for along time, and are perceived as influential. These messages are often brief, given by some-one of higher status, are personally relevant, and delivered when the receiver needs help." (Hildenbrand, 2021)

In addition, analogies can help patients relate new information to something they already know, making it easier to remember and apply in the future.

Example Analogies

I want to share some analogies that demonstrate this concept in practice (as well as potentially helping you explain a few things to your clients).

Example 1: Central Pain Processing (learn more)

Analogy: When we experience pain, it's like receiving a notification on our phone.

For a notification (pain) to occur, some new information has been generated within the phone or app (nociceptive input).

Our phone then lets us know about the new information via a notification (pain).

Normally, the notification is accurate and goes away once we've addressed it.
However, if the phone's settings are altered, it might start giving too many notifications for small things, or it might keep showing old notifications even after they've been dealt with.

In altered central pain processing, the brain's "notifications" about pain can become exaggerated or persistent, even when there's no longer a need for them.

Example 2: Functional Ankle Instability (learn more & more)

Analogy: Have you ever sprained your ankle and felt like it was wobbly or unstable afterward? That's what we call functional ankle instability (FAI), part of what can contribute to this are changes in our nervous system (somatosensory system), nerve conduction velocity & reaction time (H-reflex).

How our body controls muscles and movements (ie: stopping us from rolling our ankles), we have sensors in and around the ankle that tell our brain where our ankle is relative to the environment around us, like the evenness of the surface we're walking on or if there are any rocks, and they also tell us how our ankle is moving relative to all of this.

So, these sensors send information to the brain, then the brain sends information back that controls muscles and keeps us stable.

If we've rolled our ankle before, what can happen is the speed in which the signals get from the ankle to the brain and back again can slow down as well as the information that is being sent just isn't as clear, like having bad mobile phone reception.

So, what this means is that normally (ie: we don't have FAI) if our foot was moving into a position where we might roll our ankle, the ankle can talk to the brain quickly, and then the brain can understand the information and then reply to the ankle fast enough so that our muscles can react and stop us from rolling our ankle. But in FAI this often doesn't happen fast enough and the information that is sent can be a bit jumbled.

** Remember that these are just examples and depending on the client more or less information may be required, as well as other information relating to their condition, clinical presentation &/or treatment **

Clinical Application / Take-Aways

Analogies can be utilised in face-to-face and written formats, though some evidence suggests that written format may be slightly more beneficial to enhance objective understanding.

Therefore, we can consider providing written synopses of the information we've presented with our analogies to patients at the end of our consultation, or steer them towards other resources that may enhance their understanding (eg: Explain Pain 2nd Ed - Butler & Moseley).

It may serve us to consider developing & using analogies (and well as some resources), that we can lean on in particular situations, such as when patients a health issue is new to them (eg: new diagnosis), complex (eg: explaining pathophysiology etc) or difficult to understand (ie: physiology, pathophysiology & treatment effects in general...).

By using analogies in a conscientious manner, we may be able to have an increased positive impact on our patient interactions, their understanding, and ultimately, their treatment outcomes.

As always, I'd love to hear your thoughts on this.

Do you use analogies often in your clinical practice?

Have you found this article helpful? If yes, the best thing you can do to support this content is sharing it with your networks - I'm always appreciative when you do!

References

Cotchett, M., Rathleff, M.S., Dilnot, M. et al. Lived experience and attitudes of people with plantar heel pain: a qualitative exploration. J Foot Ankle Res 13, 12 (2020).

Grace M. Hildenbrand (2021) Healthcare Provider Analogies as Memorable Messages. Journal of Health Communication, 26: 764–772.

Grace M. Hildenbrand & Evan K. Perrault (2022) The influence of physician use of analogies on patient understanding, Communication Quarterly, 70:5, 495-518