Article from the Boston Globe’s On Call Magazine, January 2003

By Helen Osborne, MEd, OTR/L,
President of Health Literacy Consulting

Sometimes for patients, making the effort to understand healthcare information can seem like putting together a jigsaw puzzle without a picture to guide you or corner pieces to start you. It’s very hard to do. Giving them a place to start can help.

Analogies are comparisons that give people a framework they can use to understand new information. They work by comparing one thing to another in order to emphasize some shared quality. If one of the two items is unfamiliar, that shared quality can help make it understandable. Or it can cause someone to consider something familiar in some new way. Terry S. Ruhl, MD, is associate director of the Altoona Family Physicians Program in Pennsylvania. He says that in addition to being useful, analogies can also be fun — for both patients and providers.

Ruhl often uses analogies in his work as a family physician to explain concepts patients need to understand. For instance, he may tell a patient “a heart is like a pump” or “a kidney is like a filter.” There have been few studies looking specifically at the effectiveness of using analogies in healthcare settings. But research in mathematics, business, computer programming, and education all show that analogies help people recall and understand new information. “Analogies allow patients to hang difficult concepts onto information they already know rather than having to learn from scratch,” Ruhl says. “Many times,” he adds, “when patients come back several weeks later they may not remember the disease, illness, or process, but they will remember the analogy.”

You can use analogies to help your patients use the framework of what they already know to understand new words and concepts. Here are some tips for creating and using analogies when communicating important information.

Creating analogies

A good analogy is familiar, short, clear, visual, and illustrative. It is used to enhance understanding — not for the sake of being clever, even though cleverness can be an asset if it helps the audience remember. In an analogy, the unfamiliar word or phrase you are trying to explain is known as “the target.” The familiar concept you want to use for the comparison is known as “the analog.” The analog explains or gives a visual image of the target. The target and analog are often connected by the words “like” or “as.” In the analogy “the heart is like a pump,” the word “heart” is the target, “pump” the analog, and “like” the connector.

Some medical analogies are easier to create than others. Ruhl has found that providers can easily come up with analogs for cholesterol, such as “high cholesterol is like hair that clogs up your drain.” Other concepts, such as menopause, seem to be more difficult. When providers have trouble finding an analogy, Ruhl suggests that they simply focus on one part of the concept. For example, you might explain the occurrence of menopause by comparing it to the way trees change colors in autumn – although you know it’s going to happen, it happens at the different times for different trees.

Ruhl encourages healthcare educators and providers to be creative and spontaneous when creating analogies. It isn’t necessary that the analogies be the same as those their colleagues use. He says that patients generally do not get confused when they hear several analogies for the same concept. Most people enjoy analogies and Ruhl has never experienced a patient being offended by one. He does recommend, however, that the analogies you use fit with the way patients speak. You should create analogies that match the style of language and the common references that patients use.

Using Analogies

Here are five important things to remember when you use analogies.

1. Determine whether an analogy is necessary. Some healthcare concepts are straight forward and a simple explanation is sufficient. Save analogies for those times when you are teaching something that is unfamiliar or hard to understand. For example, Ruhl would not use an analogy to talk about lacerations (cuts) because most people know what they are. But when talking with a patient who looks quizzical or seems to have trouble understanding new information, Ruhl might use an analogy and introduce it by saying, “Let me see if I can explain it this way….”

2. Check for the patient’s understanding of the analogy. When choosing an analog, make sure that the example you use is familiar to the person you are speaking with. For example, saying that “getting a vaccination is like installing anti-virus software” may have meaning to someone familiar with computers. But if the person prefers camping to computing, you might say instead that “getting a vaccine is like putting on bug spray before going out in the woods.” After you use an analogy, confirm that the other person gets the point you intend. Ruhl does this by saying, “I just want to make sure I explained this well. Tell me how you understood it when I said …” That way, you not only can confirm that the person understood you, but, by asking the patient to put the idea into his own words, can reinforce the information you’ve just given.

3. Explain the analogy. Analogies by themselves are seldom sufficient. After you use an analogy, follow up with a fuller explanation. When Ruhl says that “the heart is like a pump,” he clarifies how these two terms are alike by saying, “The heart pushes blood from one part of the body to another.” He may also show a picture or model so the patient can visualize how the pumping action of the heart works. The analogy gives the patient the framework or reference to be able to understand the more exact explanation.

4. Help your patient know the limitations of the analogy. Analogies are not perfect and sometimes then can be misleading or overly simplistic. Talk not only about how the analog is similar to the target but also explain how it is different. For example, when Ruhl says that the heart is like a pump, he acknowledges that the heart is really much more complex than a pump. By pointing out its limitations, Ruhl uses the analogy to open the door to a more substantial discussion about the heart’s physiology.

5. Wean the patient from the analogy. Just like corner pieces of a jigsaw puzzle, analogies provide a starting place for understanding. But neither corner pieces nor analogies alone are sufficient. After you confirm that the patient understands the analogy and recognizes how the target and analog are similar and different, make sure to help the patient move beyond the analogy. An analogy is simply a starting place for introducing patients to the important medical words and healthcare concepts they need to know. But it isn’t all they need to know.

Here are some examples from the “Special Analogies” list found on www.altoonafp.org/analogies. These analogies answer the question, “Why don’t we use antibiotics for colds, acute bronchitis, and other viral illnesses?”

• You don’t use bug spray to kills weeds in your lawn.
• Using antibiotics for viruses is like using a large net to catch minnows. They just go through the holes.
• Using antibiotics for viruses is like putting gas in your gas tank if your battery is dead.
• Treating a cold with antibiotics is like using an umbrella to stay warm in winter. It just doesn’t work and when it starts to rain, your umbrella might be worn out.

To Learn More

Terry S. Ruhl, MD is the associate director at the Altoona Family Physicians Residency Program in Altoona, Pennsylvania. He invites readers of On Call to add to the Altoona List of Medical Analogies that can be found on the Altoona Family Physicians Web site at www.altoonafp.org/analogies.