Background: The examination was guided by recent theories on metaphors, holding that our conception of the physical world in many ways derives from personal bodily experiences. Such experiences are fundamental to the elaboration of abstract structures of meaning, which, through metaphorical projections, provide a constitutive role in our overall comprehension of the world. It is thus to be assumed that patients will bring their own cluster of metaphors into the consultation room to structure the doctor's explanations. Our study was an attempt to identify some manifestations of this work of structuring and to learn about its consequences for interpersonal communication between patient and doctor.
Objective: The aim of this study was to examine how, and to what extent patients in a general practice understand pathoanatomical and pathophysiological disturbances as explanations of their illness.
Method: The empirical basis of the study comprised interviews with a group of patients from a general practice, who were asked to narrate their understanding of medical disturbances. Based on these interviews we identified and classified a number of metaphors they used to describe bodily problems and relations. A deviating mechanical understanding of the body, which we characterize as ethnomechanics, was manifest in all the interviews. This understanding is expanded upon and its significance discussed. Although patients do not feel qualified to understand scientific explanations of their health problems, they do relate to a scientific disease mode of understanding. They do not, however, relate to the fine details and professional implications of this mode. Instead they will associate medical explanations with their pre-established, illness-based system of understanding through imaginative projections.
Conclusions: Doctors need to be aware that patients possess such imaginative and experiential resources to make sense of medical explanations. Attempts to draw patients radically away from these resources may cause confusion and undesired breakdowns in the communication between them and their physician.