Neville Goodman’s Metaphor Watch: Three weeks on the front line

neville_goodmanThis blog has so far picked a metaphor, or a theme for metaphors, and searched for them. There are many metaphors that are less overt. For the last blog of 2015, here are the metaphors from three weeks’ worth of editorials in print BMJs.

There was a stronger role for preventive care in the NHS, a role for genetic predisposition, patterns of comorbidity playing a role, and ideas in play to support reform.

This is possibly the commonest metaphor in medical writing: enzymes, cells, and interventions discussed as if they are characters in a play, or strategies on a sports field. Many are not just roles, but important roles: “play an important role” is a common phrase in PubMed®. But, “vitamin-D deficiency seems to play an important role in causing fractures…” (a phrase taken at random from a BMJ search) adds nothing but syllables to “vitamin-D deficiency seems to be important in causing fractures…” It could be worse: “we hypothesize that vitamin-D deficiency seems to play an important role in causing fractures…” is even more unnecessary syllables.

There was a study that offered a benchmark, which is a standard; a study that was a landmark, which (except anatomically) is very much in the eye of the beholder; and an article offering a framework for improving outcome. Looking more widely in PubMed®, framework is commonly used to mean scheme or plan, rather than what it really is: the less definitive outline.

Is describing sites as up and running better than writing that they are operational? Do organisations straddle primary and hospital care or include them? Isn’t tackling a deficit head-on overworn? We just want to reduce it. Are eye-opening parallels to healthcare [although, being The BMJ, eye opening was not hyphenated] not just interesting? A picture catalysing a change in mood is not quite the same as triggering it, which I think was the intended sense. Painting starkly different portraits of types of hospital is a good metaphor, but a head to head study of scoring systems is just a direct comparison, and makes one wonder whose heads were involved.

A barrier to change, spending being dwarfed, and market shares being captured are arguably not metaphors at all.

I am still not quite sure what was meant by “contact with tertiary centres being part of the surgical trajectory“—a phrase more usually applied to a surgical approach planned by three-dimensional imaging. I like the idea that a low recurrence rate is a dealbreaker making randomised trials unfeasible: any word that appears only three times (the other two as deal breaker) in the whole BMJ corpus is original enough not to receive criticism. As is the idea that randomised trials are pilots but observational studies are passengers who, enthusiastic as they may be, are not so good at flying airliners, i.e., guiding clinical practice.

The one other metaphor in those three weeks was between a rock and a hard place, which demands a blog of its own.

Neville Goodman is a retired consultant anaesthetist and a writer, and co-author of a book on medical English.

Competing interests: I have read and understood BMJ policy on declaration of interests and declare that my only competing interest is my co-authorship of a book about medical English.